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Objective: To investigate oral health changes and its associated factors during hospitalization in individuals with acquired brain injury (ABI).Material and Methods: Sixty-one individuals were recruited to evaluate the acute changes in oral health by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at week 1 and week 5. Individuals’ brushing habits, eating difficulties, onset of pneumonia etc. were retrieved from e-journal. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.Results: Dental plaque (P=0.01) and total BOE score (PConclusions: Nursing care has been fundamental in improving oral health but non-significant improvement in calculus, BOP and brushing frequency indicates a need for development in existing oral care program through academic-clinical partnership keeping eating difficulties and patients’ vegetative and cognitive state in consideration.

PurposeFree of charge physiotherapy (FCP) is free physiotherapy provided by the Danish government for patients with a range of chronic diseases. To date, the population has not been described in depth making evaluation and decision making difficult. The purpose of this study was to (1) describe the development and the content of a novel clinical physiotherapy database for FCP (PhysDB-FCP) and (2) present the cohort profile based on the data collected.ParticipantsNinety-nine clinics (17 460 FCP patients) were invited to participate in the development process from 2018 to 2019. Eleven clinics consented (2780 FCP patients) and 534 patients performed the physiotherapy assessment using the PhysDB-FCP tool, with 393/534 completing the patient survey.Findings to dateThe content of the PhysDB-FCP was developed through an iterative process involving consensus between clinical and research workgroups. Prior to using the tool all consenting sites received training to use/administer the tool. All data were collected/stored using the PhysDB-FCP. Items finally chosen for the PhysDB-FCP included demographic information, questions about health status and daily functioning, functional tests, treatment plan and validated questionnaires. The initial patient cohort composed of 63.4% women with main diagnoses of multiple sclerosis (22.7%) and Parkinson’s disease (17.0%). The ability to perform personal/instrumental activities of daily living and functional ability varied widely. Other non-physiotherapy related issues were identified in numerous patients (ie, 34.9% of patients were at risk of depression) and multidisciplinary interventional approaches could be considered.Future plansThe current study has provided a comprehensive description of patients receiving FCP, using data collected from the novel PhysDB-FCP. Collected information can be used to facilitate microlevel to macrolevel programme evaluation and decisions. Although the PhysDB-FCP is promising, the tool requires optimisation before it is implemented regionally and/or nationally.

Background Affective and cognitive sequelae are frequently reported in cardiac arrest survivors; however, little is known about the risk factors. We assessed the hypothesis that self-reported affective and cognitive sequelae six months after OHCA may be associated with demography, acute care and cerebral outcome. Methods This is a sub-study of the multicentre “Target Temperature Management for 48 vs. 24 h and Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomised Clinical Trial” (the TTH48 trial) investigating the effect of prolonged TTM at 33 ± 1 °C. We invited patients with good outcome on the Cerebral Performances Categories (CPC score ≤ 2) to answer questionnaires on anxiety, depression, emotional distress, perceived stress and cognitive failures six months post OHCA. Results In total 79 of 111 eligible patients were included in the analysis. There were no significant differences in baseline characteristics between the included group and the group lost to follow-up. Younger age was a negative predictor across all self-reported outcomes, even when controlling for gender, ROSC time, treatment allocation, cognitive impairment and global outcome (CPC 1 or 2). Female gender was a predictor of anxiety, though this should be interpreted cautiously as only eight women participated. A CPC score of 2 score was a negative predictor of self-reported affective outcomes, albeit not for self-reported cognitive failures. Conclusion Younger age was associated with higher levels of self-reported affective and cognitive sequelae six months post OHCA. Female gender may be associated with self-reported anxiety. A higher CPC score may be a proxy for self-reported affective sequelae.

To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or individual factors impact outcome. A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway (n = 208) and Central Denmark (n = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure. The Norwegian participants were older than the Danish (Mage= 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores. Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services.IMPLICATIONS FOR REHABILITATIONThe stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services.The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services.For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning. The stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services. The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services. For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning.

Introduction: In Denmark specialized neurorehabilitation(SN) in patients with severe acquired brain injury(SABI) is centralised in two centres. In west neurorehabilitation is managed by Hammel Neurocentre(HNC). The NeuroIntensive Stepdown Unit(NISU) at Silkeborg Regional Hospital offers intensive care in addition to SN in patients en route to HNC. Knowledge on patients’ characteristics and course in the setting of NISU is sparse. Objective: To characterise NISU patients and change in function and to identify variables associated with referral from NISU to HNC. Methods: Data on functional scores and relevant covariates was extracted from hospital records on 251 patients admitted from 01.11.2011–31.07.2016. Statistical methods included logistic regression and paired tests. Results: Mean(SD) time from injury to NISU admission was 30(22) days, medians(IQR) of Functional Independence Measure(FIM) and Early Functional Abilities(EFA) increased from 18(18,19) to 24(18,44) and 37(30,46) to 52(43,70) respectively from admission to discharge, both significant (p

The aim of this study was to describe the physical activity profiles, in patients with stroke, Parkinson’s disease, multiple sclerosis and rheumatoid arthritis and to investigate the association between physical activity and functional performance. Physical activity profiles were conducted using tri-axial accelerometers and functional performance was examined by the “Six-Spot Step Test” and the “Timed Up and Go”. Patients daily performed 5896 ± 3176 steps with an average cadence of 88.3 ± 11.1, 368 ± 418 inclined walking steps and 50 ± 16 sit-stand transfers. Daily activity was modestly explained by functional performance. The activity profiles showed a large variance in activity parameters and results suggest that activity parameters and the two functional performance tests are different constructs.

To investigate the construct validity of the Functional Oral Intake Scale (FOIS) as a proxy measure for dysphagia, through associations with swallowing prerequisites, orofacial functions, age, and diagnosis; and to investigate content validity through distributions of FOIS ratings. Methods: A cohort of 1,876 patients with severe acquired brain injury. Early Functional Abilities items were applied as measures of swallowing prerequisites and orofacial functions. Clustered logistic regression model with 6,052 cross-sectional observations. Results: Disturbance in swallowing 10.55 OR 9 (95%CI:7.90;14.09), oro-facial stimulation 3.04 OR (95%CI:2.41;3.83), and head control 2.86 OR (95%CI:2.25;3.62) were robustly associated with tube feeding (FOIS 1-3). Disturbance in trunk control, wakefulness, tongue movement/chewing, older age, and a non-stroke diagnosis were also associated with tube feeding. BMI did not attenuate associations in sensitivity analyses. FOIS ratings had greatest density in FOIS evel 1 and level 7, with 25% and 40% of registrations, respectively. Level 4 was rated in only 1% of 6,052 registrations. Conclusions: The FOIS was robustly associated with indicators of dysphagia. However, associations with postural control, wakefulness, age and diagnosis highlights that tube feeding may be attributed to other issues than dysphagia. It should be further investigated whether FOIS level 4 is meaningful in neurorehabilitation.

Patients High or excessive parafunctional jaw muscle activity is a frequent complication of acquired brain injury (ABI) and may have some similarities to bruxism. Bruxism has been associated with increased tooth wear, masseter hypertrophy and headaches. The aim of this observational study was to identify the levels of jaw muscle activity from fourteen ABI patients having different functional and cognitive levels in their early phase of neurological rehabilitation (according to their Ranchos Los Amigos Scale (RLAS) score). Nine patients were severely cognitive impairement (RLAS score 1–3): with no or little response to any external stimuli due to low arousal and five patients were with RLAS score 4–8: depending on responses to stimuli and confusion level i.e. defining that patients had enough arousal to respond and react and therefore were able to follow the instructions. A single-channel electromyographic (EMG) device was used to assess the jaw muscle EMG activity in ABI patients for two hours continuously at two different days. Discussion The mean (± SD) jaw muscle activity observed in patients with ABI was 46.9 ± 6.5 EMG events/h with a wide range between 1–163 EMG events/h but with no significant difference between days (P = 0.230). Conclusion Irrespective of functional and cognitive ability scores patients with ABI had a wide range of EMG activity. The use of ambulatory single-channel EMG devices might open a path for further studies to determine levels of jaw muscle activity associated with potential side effects in ABI patients.

Background A major goal of upper limb (UL) rehabilitation after stroke is to facilitate the use of the paretic arm in daily life activities. Purpose To examine if UL impairment two weeks after stroke can predict real-life UL use at three months. Furthermore, to identify additional factors which contribute to future UL use, and characteristics of patients who do not achieve normal UL use. Methods This study included patients with stroke ≥ 18 years. UL impairment was assessed by Fugl-Meyer upper extremity motor assessment (FM). Use ratio between affected and unaffected UL was assessed with accelerometers at three months after stroke. The association between FM score and UL use ratio was investigated with linear regression models and adjusted for secondary variables. Non-normal use was examined by a logistic regression. Results Eighty-seven patients were included. FM score two weeks after stroke predicted 38% of the variance in UL use ratio three months after stroke. A multivariate regression model predicted 55%, and the significant predictors were FM, motor-evoked potential (MEP) status, and neglect. Non-normal use could be predicted with a high accuracy based on MEP and/or neglect. In a logistic regression sensitivity for prediction of non-normal use was 0.93 and specificity was 0.75. Conclusion Better baseline capacity of the paretic UL predicted increased use of the arm and hand in daily life. Non-normal UL use could be predicted reliably based on the absence of MEPs and/or presence of neglect.

PRIMARY OBJECTIVES: We hypothesized that the microstructure of the corpus callosum, thalamus and hippocampus, as measured with diffusion and Mean of the Kurtosis Tensor (MKT) MRI, differs between healthy subjects and patients with extensive and minimal post-concussion symptoms (PCS) and that MKT measures correlate with PCS severity and self-reported cognitive symptoms.RESEARCH DESIGN: A cross-sectional study comparing patients with extensive PCS and patients with minimal PCS 2-5 months after mild traumatic brain injury (mTBI) with each other and with an external healthy control group.METHODS AND PROCEDURES: Diffusion MRI was obtained in 25 patients with extensive PCS and in 25 patients with minimal PCS as measured by the Rivermead Post-concussion Symptoms Questionnaire. The patients were matched on age, sex and time since accident. Data from an external healthy control group (n = 27) was included.MAIN OUTCOME AND RESULTS: There was no difference in MKT between the two groups with mTBI and no correlation between MKT and PCS. There was no difference between the three groups in other diffusion measures.CONCLUSIONS: Our results did not point to microstructural changes in the corpus callosum, thalamus and hippocampus in relation to PCS after mTBI.

Background It is important to monitor progress during rehabilitation of stroke patients. To that end, clinical function tests may be supported by three-dimensional kinematic measures. The aim of this study was to evaluate the inter- and intra-rater reliability of three-dimensional kinematic measures of shoulder movements in stroke patients with reduced shoulder function. Methods Seventeen patients were tested in three sessions by two trained raters. Three-dimensional motion capture was performed of the more affected upper extremity and the trunk. Measures of movements of the scapula and humerus related to the trunk, the trunk related to the laboratory, the forearm related to the humerus, and temporospatial measures were obtained during two reach tasks from the Wolf Motor Function Test, ReachLow and ReachHigh. Inter- and intra-rater reliability was quantified with intraclass correlation coefficients (ICC). Findings In general, range of movements of scapula, shoulder, trunk and elbow and movement time and reach length showed high inter-rater reliability ( ICC ∞ 0.84–0.98) and intra-rater reliability ( ICC ∞ 0.75–1.00), A minimum of five trials per task were required to achieve reliable ICC estimates. Interpretation Selected three-dimensional kinematic measures can be used reliably to evaluate specific movements of the shoulder in stroke patients with reduced shoulder function.

Blood flow restriction training (BFRT) has been proposed for elderly and clinical populations with weakness. Before being used in these populations it is important to understand the neurological effects of, and subject perceptions to, BFRT. Seventeen healthy subjects were recruited and performed 2 experimental sessions, BFRT and training without blood flow restriction (TR-only), on separate days. Four sets of concentric/eccentric dorsiflexion contractions against theraband resistance were performed. Surface electromyography of the tibialis anterior was recorded during exercise and for the electrophysiological measures. At baseline, immediately-post, 10-min-post and 20-min-post exercise, motor evoked potentials (MEPs) from single pulse transcranial magnetic stimulation (TMS), paired-pulse TMS with interstimulus intervals of 2-ms (SICI) and 15-ms (ICF), and the M-max amplitude were recorded in the resting TA. Following training, subjects provided a numerical rating of the levels of pain, discomfort, fatigue, focus and difficulty during training. Muscle activation was higher in the last 20 contractions during BFRT compared to TR. There was no difference (time × condition interaction) between BFRT and TR for single-pulse MEP, SICI, ICF or M-max amplitude. There was a significant main effect of timepoint for single-pulse MEP and M-max amplitudes with both significantly reduced for 20-min-post exercise. No reductions were observed for SICI and ICF amplitudes. Taken together, BFRT and TR-only were only different during exercise and both regimes induced similar significant reductions in M-Max and MEP-amplitude post-training. Due to the lack of changes in SICI and ICF, it is unlikely that changes occurred in cortical sites related to these pathways. The increased surface electromyography activity in the last 20 contractions, indicate that the training regimes are different and that BFRT possibly induces more fatigue than TR. As such, BFRT could be used as an adjunct to conventional training. However, as subjects perceived BFRT as more painful, difficult and uncomfortable than TR-only, people should be selected carefully to undertake BFRT.

Background Denmark is a welfare state with a publically funded healthcare system that includes the right to free of charge physiotherapy (FCP) for patients with chronic or progressive disease who fulfill strict criteria. The aim of this study was to investigate the incidence of referral to FCP in patients with a hospital diagnosis of stroke, multiple sclerosis (MS), Parkinson’s disease (PD) and rheumatoid arthritis (RA) between 2007 and 2016. Methods The study was register-based and included data from The Danish National Patient Registry and The National Health Service Registry. The study population included the four largest disease groups receiving FCP in Denmark. The incidence of receiving FCP was reported as the cumulated incidence proportion (CIP). Results The study showed that FCP was mainly initiated within the first 2 years after diagnosis. The 2-year CIP was 8% for stroke patients, 53% for PD patients, 49% for MS patients, and 16% for RA patients. The proportion of patients referred to FCP generally increased over the period of the study due to more patients being referred from medical specialists in primary care. Conclusion This study found substantial differences in the incidence of referral to FCP in a Danish population of stroke, PD, MS and RA patients.

Objective: To test if prognostic performance is affected by prolonged targeted temperature management (TTM) in comatose out-of-hospital cardiac arrest patients using two recently proposed EEG pattern classification models. Methods: In this sub-study of the “Target Temperature Management for 48 vs. 24 hand Neurologic Outcome after Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial” EEGs of 20–30 min duration were collected 24 h and 48 h after reaching the target temperature of 33 ± 1 °C. We classified EEGs according to two EEG classification models by Westhall et al. (“highly malignant” “malignant” and “benign”) and Hofmeijer et al. (“unfavorable” “intermediate” and “favorable”). We tested prognostic ability against 6 months functional outcome using the Cerebral Performance Category score. Results: We recorded EEGs in 120 patients at 24 h and in 44 patients at 48 h. We found no difference in specificities or sensitivities of the two models between the two TTM groups (all p-values >0.19) or in prognostication at 24 h compared to 48 h (all p-values >0.13), except for the presence of EEG reactivity favoring prognostication at 24 h (p < 0.001). Being classified in the “benign” or “favorable” category was strongly associated with good outcome with specificities of 100% (90–100) and 97% (85–100) for the Westhall and Hofmeijer models respectively. Conclusions: We found no difference in the prognostic performance of the two studied EEG classification models during prolonged TTM for 48 h compared to standard duration, nor between EEG classification performed at 24 h versus 48 h after reaching target temperature. The two models performed best in good outcome prediction.

The aim of this prospective, descriptive cohort study is to describe the prevalence of lower bowel dysfunction, possible relationship to diagnosis and severity, use of laxatives, and defecation patterns in patients with acquired brain injury during inpatient rehabilitation. Enrollment consisted of all patients admitted to an inpatient rehabilitation hospital (n = 98) within a 3-month period and assessments of fecal incontinence and fecal constipation at admission were performed. Documentation of used laxatives, number of defecations, and the macroscopic form during 4 weeks was conducted. Analysis of variance and Kruskal-Wallis analyses were conducted using the statistical software package STATA v 12/IC. At admission 75% of the patients suffered from lower bowel dysfunction, which was related to the severity of injury and age but not major diagnosis or gender. Of these, 68% suffered from fecal incontinence and 32% from fecal constipation. Ninety percent of the patients received laxatives during the initial 28 days. After 28 days, 20% continued to receive laxative treatment. There was no difference between weekly defecations in patients who had functional constipation and patients who had no bowel dysfunction. There was a strong relationship between bowel dysfunction status and prescribed laxative treatment. These findings indicate that lower gastrointestinal dysfunction is a long-lasting, profound complication following an acquired brain injury.

Introduction Brain injury increases metabolic and catabolic responses initiated by injured tissue, perfusion deficits, infection and release of hormones. Body Mass Index (BMI) and biochemistry insufficiently describes nutritional status after brain injury. Bioelectrical impedance analysis (BIA) is an additional tool to estimate body composition but so far unused in patients with brain injury. Aim: To describe the nutritional status in patients admitted for subacute neurorehabilitation after acquired moderate to severe brain injury. Method: This prospective, descriptive cohort study included patients consecutively admitted to a neurorehabilitation hospital (n=92). Measures of malnutrition were fat-free mass index (FFMI), weight loss, BMI, fat mass index (FMI), muscle strength and Biochemical markers according to recommended standards. Malnutrition was compared between admission and after 4 weeks using McNemars test. Findings From admission to after 4 weeks of rehabilitation, low FFMI FFMI (< 14.6 kg/m2 in women and < 16.7 kg/m2 in men) decreased from 17 to 11%, weight loss >5% compared to habitual weight decreased significantly from 56 to 40%, whereas low BMI (

BACKGROUND: Cognitive sequelae, most frequently memory, attention, and executive dysfunctions, occur commonly in out-of-hospital cardiac arrest (OHCA) survivors. Targeted temperature management (TTM) following OHCA is associated with improved cognitive function. However, the relationship between the duration of TTM and cognitive outcome remains unclear. We hypothesised that OHCA survivors that were subjected to prolonged TTM of 48 h (TTM48) would exhibit better cognitive functions compared to those subjected to standard TTM of 24 h (TTM24) six months post-OHCA.METHODS: A predefined, cognitive post-hoc sub-study was conducted on the multicentre clinical trial: "Target Temperature Management for 48 vs. 24 h and Neurologic Outcome after out-of-hospital cardiac arrest: A Randomised Clinical Trial" (the TTH48 trial). OHCA survivors with perceived good cognitive outcome (CPC score ≤ 2) were invited to a neuropsychological assessment of memory, attention, and executive functions six months post-OHCA.RESULTS: In total, 79 patients were included in the study. Multivariate regression analysis revealed that TTM48 was associated with a significant better performance on three of 13 cognitive tests specific to memory retrieval after adjusting for age at follow-up and time to return of spontaneous circulation. Overall, patients in the TTM24 group were almost three times more likely (RR = 2.9 (95% CI 1.1-7.4)), p = 0.02) to be cognitively impaired.CONCLUSIONS: This study reports an association between the duration of TTM and cognitive outcome. In OHCA survivors with perceived good cognitive outcome (CPC ≤ 2), TTM48 was associated with reduced memory retrieval deficits and lower relative risk of cognitive impairment six months after OHCA compared to standard TTM24. ClinicalTrials.gov (identifier: NCT01689077).

Objective: The aim of this study was to determine if external subglottic air flow (ESAF) influences swallowing frequency in severely dysphagic tracheotomized patients with brain injury. Methods: Ten patients were recruited at the neurological intensive care unit. The ESAF intervention was provided through the standard cuffed suction aid tracheotomy tube, which primarily is used to suction residual secretion volume from the subglottic area. Sessions were 150 minutes, and ESAF was provided at 60-65, 90-95, and 120-125 minutes at 3 L/min. Outcome measures included swallowing frequency (swallows/5 min) at 0-5 minutes (pre-baseline), 25-30 and 55-60 minutes (baseline/control), and 85-90, 115-120, and 145-150 minutes (postintervention). The residual secretion volume (ml) from the subglottic area was collected using a syringe at 0 minutes (pre-baseline), 30 and 60 minutes (baseline/ control), and at 90, 120, and 150 minutes (postintervention). Results: The mean (±SEM) swallowing frequency (swallows/5 min) increased from 0.60 ± 0.30 to 2.10 ± 0.70 during the ESAF intervention ( P < .001). The mean (±SEM) residual secretion volume reduced from 3.10 ± 0.31 ml to 0.50 ± 0.30 ml after the ESAF intervention ( P < .001). Conclusion: The increase in swallowing frequency and reduction in residual secretion volume may indicate that ESAF influences swallowing parameters in patients with tracheotomy tubes.

PURPOSE: To test if the Rehabilitation Complexity Scale Extended (RCS-E) can be used as decision support for patient referral to primary rehabilitation as either complex specialized services (CSS) or district specialist services (DSS).METHOD: Two independent expert teams analyzed medical records on 299 consecutive patients admitted for CSS or DSS rehabilitation. One team provided a golden standard for the patient referrals, and the other team provided RCS-E scores. Models for predicting referrals from RCS-E scores were developed on data for 149 patients and tested on the remaining 150 patients.RESULTS: The optimal RCS-E sum score threshold for referral prediction was 11, predicting the golden standard for patient referral with sensitivity 88%, specificity 78% and correct classification rate 81%. Improved referral prediction performance was achieved by using RCS-E item-wise score thresholds (sensitivity 81%, specificity 89%, correct classification rate 87%). The RCS-E sum score range for patients referred CSS and DSS by the item-wise model was, respectively, 0-12 and 2-22 suggesting strong non-linear interaction of the RCS-E items.CONCLUSIONS: We found excellent referral decision support in the RCS-E and the item specific threshold model, when patients with acquired brain injury are to be referred to CSS or DSS as their primary rehabilitation. Implications for Rehabilitation Efficient rehabilitation after acquired brain injury requires rehabilitation settings that meet patient needs. Validated tools for referral decision support make the process more transparent. Patient rehabilitation complexity can be stratified by the RCS-E with high sensitivity, specificity and predictive value of positive test. RCS-E is an excellent tool for referral decision support.

PRIMARY OBJECTIVE: To perform a detailed clinical oral health assessment and oral-health-related social and behavioural aspect assessment in individuals with acquired brain injury (ABI).RESEARCH DESIGN: Prospective observational study.METHODS AND PROCEDURES: Thirteen individuals with ABI were recruited. Individual's social and behavioural history, bed-side oral examination score (BOE), tooth condition and periodontal status (bleeding, plaque and clinical attachment loss) were thoroughly examined. The entire examination took up to 60 minutes, using proper dental armamentarium.MAIN OUTCOMES AND RESULTS: All evaluated individuals were diagnosed with chronic generalized periodontitis. A relationship between active periodontal disease and severe BOE score was observed (p = 0.01). Significant interaction between severe BOE scores (≥ 15 or ≥ 14) and periodontal disease severity of ≥ 2 mm (p = 0.01) was observed. The same interaction was seen between severe BOE scores and the combination of 75% extent and 2 mm severity (p = 0.01). Severity and activity of periodontitis showed dependence on individual brushing frequency (p = 0.03 and p = 0.05, respectively).CONCLUSIONS: Individuals with ABI had a poor status across a range of oral-, dental- and periodontal-related parameters. Further structured studies are required to define evidence-based assessment approaches for such clinical reality.

Primary objective: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury.Methodology: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion.Results: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time.Conclusions and implications: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress. PRIMARY OBJECTIVE: Rehabilitation scales following neurological injury can be useful for monitoring patient progress. However, too often, rehabilitation scales are administered unnecessarily placing an extra burden on clinicians and patients. The primary objective was to reduce redundant testing by providing guidelines for the concurrent use of the Functional Independence Measure (FIM) and Early Functional Abilities (EFA) scales during rehabilitation in patients with brain injury.METHODOLOGY: In total, 3289 concurrent FIM and EFA scores from 929 patients were examined. We proposed, using clinically sound and operational criterion, that the FIM should be used throughout rehabilitation, EFA should be used as a supplement when the FIM is ≤36 and FIM should be administered before the EFA on each testing occasion.RESULTS: Around 24% of patients should be measured with the FIM and EFA throughout rehabilitation, 35% of patients should be measured with the EFA and FIM initially but not require EFA measurements when there is an increase in function and 39% of patients should only be measured with the FIM. According to these guidelines, the EFA was administered unnecessarily 53% of the time.CONCLUSIONS AND IMPLICATIONS: These guidelines ensure that the EFA is used when it is sensitive. This will optimize clinician time and minimize redundant testing, without compromising the measurement of clinical progress.

Background Constipation is suspected to occur frequently after acquired brain injury (ABI). In patients with ABI, heart rate variability (HRV) is reduced suggesting autonomic dysfunction. Autonomic dysfunction may be associated with prolonged gastrointestinal transit time (GITT). The primary aim of this study was to investigate if GITT is prolonged in patients with ABI. Secondarily, HRV and its correlation with GITT was investigated. Methods We included 25 patients with ABI (18 men, median age: 61.3 years, range [30.7–74.5]). GITT was assessed using radio-opaque markers and HRV was calculated from 24-hour electrocardiograms. Medical records were reviewed for important covariates, including primary diagnosis, time since injury, functional independence measure, and use of medication. The GITT assessed in patients was compared to a control group of 25 healthy subjects (18 men, median age: 61.5 years, range [34.0–70.9]). Results In ABI patients, the mean GITT was significantly longer than in healthy controls (2.68 days, 95% CI [2.16–3.19] versus (1.92 days, 95% CI [1.62–2.22], p = 0.011)). No correlation was found between HRV and GITT. Conclusion Patients with mild to moderate ABI have prolonged GITT unrelated to the HRV.

Background: Aerobic exercise is an effective treatment to improve aerobic capacity following stroke and might also improve cognitive impairments in sub-acute stroke survivors. The aim of the study was to assess the effect of high-intensity aerobic exercise on cognitive impairments in sub-acute stroke survivors. Methods: A pilot, randomised controlled trial on the effects of aerobic exercise on cognitive impairments of stroke patients in the sub-acute (1-3 months) phase was conducted. Thirty patients with moderate cognitive impairments (maximum score of 5 on at least two items on the cognitive subscales of the Functional Independence Measure [FIM]) were included in the study and randomly assigned to either the intervention group – performing high-intensity aerobic exercise (above 70% of maximum heart rate), or the control group – performing low-intensity aerobic exercise (below 60%). Patients in both groups exercised for 50 min twice a week for 4 weeks. Primary neuropsychological outcome: Trail Making Test B. Results: Thirty stroke patients completed the interventions. The results showed that the high-intensity group, compared with the low-intensity group, achieved significant improvements on Trail Making Test B, which assesses processing speed and divided attention ( P = .04 after training and P = .01 at follow-up). However, the significant improvements on Trail Making Test B might relate to a ceiling effect in the control group. Conclusions: This study does not provide evidence to support that aerobic exercise can improve cognition in stroke survivors, even though significant improvement was revealed on the primary outcome in sub-acute stroke survivors following high-intensity aerobic exercise compared with low-intensity general exercise.

Background Several predictors have been associated with upper extremity (UE) recovery after stroke, but characteristics that predict shoulder function after constraint-induced movement therapy (CIMT) have not yet been identified. Objectives To identify predictors associated with satisfactory shoulder function in patients with reduced shoulder function at admission to CIMT. Methods One hundred and seventy five patients were treated using CIMT while in a specialized inpatient hospital. Satisfactory shoulder function was defined according to the functional ability scale of the Wolf Motor Function test. Predictors of satisfactory shoulder function after CIMT were identified using multivariable logistic regression. Results Better distal arm function and good proximal shoulder function on admission to CIMT were strong predictors of satisfactory shoulder function, while age and time of admission to CIMT since stroke were not. Seventeen percent of all CIMT-participants with reduced shoulder function pre-CIMT reached a level of satisfactory shoulder function after CIMT. Discussion A substantial part of patients with reduced shoulder function reached a level of satisfactory shoulder function after CIMT. Intensive CIMT training, comprising tasks that require both distal and proximal UE function, may increase shoulder function in patients with a potential functional reserve.

Not least tuberculosis caused the growth of many spas. In Denmark, the Society for Physical Therapy and Dietetic was formed in 1902, and in 1921 it changed its name to the Danish Physiatrists Society, later the Danish Society for Physiatrists and Rehabilitation. In the early 1980's the National Board of Health decided, that all specialties should rehabilitate patients within their own area, and the specialty for rehabilitation was abolished. Therefore, all doctors need to have knowledge of the biopsychosocial model and the involvement of other professional groups and sectors.

Not least tuberculosis caused the growth of many spas. In Denmark, the Society for Physical Therapy and Dietetic was formed in 1902, and in 1921 it changed its name to the Danish Physiatrists Society, later the Danish Society for Physiatrists and Rehabilitation. In the early 1980’s the National Board of Health decided, that all specialties should rehabilitate patients within their own area, and the specialty for rehabilitation was abolished. Therefore, all doctors need to have knowledge of the biopsychosocial model and the involvement of other professional groups and sectors.

Background We aimed to investigate the impact of prolonged targeted temperature management (TTM) in cardiac arrest patients on release of serum levels of NSE and S-100b and their prognostic performances. Methods This is a substudy of the Targeted Temperature Management for 24 vs 48 h trial. NSE and S-100b levels were analysed retrospectively in serum samples collected upon admission, at 24, 48, and 72 h after reaching the target temperature of 33 ± 1 °C. The primary outcome was biomarker serum concentrations and secondary outcome was the cerebral performance category score after 6 months. Results 115 patients from two centres were analysed. NSE and S-100b levels did not differ between TTM groups at any single time-point. Poor outcome patients had higher biomarker levels at 24, 48, and 72 h: NSE: 9.73 (7.2; 10.9) versus 20.40 (12.7; 27.2), 8.86 (6.6; 9.6) versus 17.47 (11.1; 37.3) and 6.23 (5.3; 8.5) versus 31.05 (12.8; 52.5) respectively and S-100b: 0.09 (0.07; 0.11) versus 0.23 (0.19; 0.39), 0.08 (0.07; 0.09) versus 0.18 (0.15; 0.33) and 0.07 (0.06; 0.08) versus 0.13 (0.09; 0.23). The daily changes in NSE from admission to Day 2 after the cardiac arrest (CA) were also related to the outcome (p = 0.003 and p = 0.02). The best prediction of outcome was found at 72 h for NSE and at 24 h as well as 48 h for S100b. Conclusions No clinically relevant differences were found in the levels of NSE or S-100b between standard and prolonged TTM. Prognostic reliability of NSE and S-100b was unaltered by prolonged TTM.

Automatic analysis of body movement to identify physical activity of patients who are at bed rest is crucial for treatment or rehabilitation purposes. Existing methods of physical activity analysis mostly focused on the detection of primitive motion/non-motion states in unimodal video data captured by either RGB or depth or thermal sensor. In this paper, we propose a multimodal vision-based approach to classify body motion of a person lying on a bed. We mimicked a real scenario of ‘patient on bed’ by recording multimodal video data from healthy volunteers in a hospital room in a neurorehabilitation center. We first defined a taxonomy of possible physical activities based on observations of patients with acquired brain injuries. We then investigated different motion analysis and machine learning approaches to classify physical activities automatically. A multimodal database including RGB, depth and thermal videos was collected and annotated with eight predefined physical activities. Experimental results show that we can achieve moderately high accuracy (77.68%) to classify physical activities by tracking the body motion using an optical flow-based approach. To the best of our knowledge this is the first multimodal RGBDT video analysis for such application.

Background: Constraint-induced aphasia therapy (CIAT) is an intensive, short-term speech and language therapy. Previous research indicates that CIAT can lead to lasting improvements in chronic aphasia. CIAT in the subacute phase of recovery has only been sparsely investigated and only in modified versions compared to the original protocol.Aims: The aim of the current pilot study was to investigate unmodified CIAT in stroke patients in the subacute phase of recovery in the frame of an inpatient multidisciplinary neurorehabilitation program.Methods & Procedures: Eleven stroke patients with subacute aphasia completed 30 hr of CIAT in 10 weekdays. Language functions as well as the amount and quality of communication were assessed four times, before the control period, pre- and post-CIAT, and at follow-up. The primary outcome measure was Western Aphasia Battery. Secondary measures were the Danish adaptions of Communication Effectiveness Index and of Communication Effectiveness Profile. Issues of applicability ...

BACKGROUND There is a paucity of studies, which have described malnutrition in patients with acquired brain injury (ABI) across etiology. This study describes weight change, malnutrition, and potential associations in patients with ABI at a subacute inpatient rehabilitation hospital. METHOD This is a descriptive cohort study. Ninety-eight patients were admitted in a 3-month period, of whom n = 76 met inclusion criteria. The Malnutrition Universal Screening Tool was used for categorizing patients according to risk of malnutrition. RESULTS Patients had experienced weight loss of 5.59% ± 5.89% (p < .001) at admission at the rehabilitation hospital, and patients with traumatic brain injury had experienced a greater weight loss than patients with stroke (p < .01). Thirty percent of patients were at high risk for malnutrition, and 52% of these patients received enteral or parenteral nutrition at admission at the rehabilitation hospital. No association was found between risk of malnutrition and severity of injury, complications, functional outcome, or length of stay. CONCLUSION RESULTS underline the importance that nurses, especially in acute care, adhere to clinical guidelines to minimize weight loss. Special attention should be on patients with traumatic brain injury. Weight gain in the following course of rehabilitation may facilitate positive rehabilitation outcomes.

OBJECTIVE Patients with non-traumatic rupture of an aneurysm located at the anterior communicating artery (ACoA) often experience cognitive disabilities. It is unknown whether location of aneurysm also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim was to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at discharge from rehabilitation. Additionally, age and FIM at admission were explored. METHOD Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data were analyzed using multivariable logistic regression. RESULTS Patients with ACoA were admitted with poorer cognitive FIM (median 6 (IQR 5-14) compared to patients with aneurysms located elsewhere (median 12 (IQR 6-23) (p = 0.0129); no difference at discharge. No association between aneurysm location and functional independence was observed. Higher age was associated with poorer outcome in bowel management OR 0.54 (95% CI 0.31-0.92), bladder management OR 0.59 (95% CI 0.35-0.98), comprehension OR 0.53 (95% CI 0.30-0.94), and memory OR 0.48 (95% CI 0.25-0.93). Overall, FIM at admission was associated with functional independence at discharge with the exception of stair walking and bladder management which did not reach statistical significance. CONCLUSION ACoA was not associated with poorer level of functional independence compared to patients with a-SAH located elsewhere. Higher age was associated with poorer outcome in continence, comprehension, and memory, whereas higher FIM was associated with better functional independence across items at discharge.

Background:There is a paucity of stroke-specific instruments to assess health-related quality of life in the Norwegian language. The objective was to examine the validity and reliability of a Norwegian version of the 12-domain Stroke-Specific Quality of Life scale.Methods:A total of 125 stroke survivors were prospectively recruited. Questionnaires were administered at 3 months; 36 test–retests were performed at 12 months post stroke. The translation was conducted according to guidelines. The internal consistency was assessed with Cronbach’s alpha; convergent validity, with item-to-subscale correlations; and test–retest, with Spearman’s correlations. Scaling validity was explored by calculating both floor and ceiling effects. A priori hypotheses regarding the associations between the Stroke-Specific Quality of Life domain scores and scores of established measures were tested. Standard error of measurement was assessed.Results:The Norwegian version revealed no major changes in back translations. The internal consistency values of the domains were Cronbach’s alpha = 0.79–0.93. Rates of missing items were small, and the item-to-subscale correlation coefficients supported convergent validity (0.48–0.87). The observed floor effects were generally small, whereas the ceiling effects had moderate or high values (16%–63%). Test–retest reliability indicated stability in most domains, with Spearman’s rho = 0.67–0.94 (all p Conclusions:The Norwegian version of the Stroke-Specific Quality of Life scale is a reliable and valid instrument with good psychometric properties. It is suited for use in health research as well as in individual assessments of persons with stroke.

© 2017 Informa UK Limited, trading as Taylor & Francis Group. The aim of the study was to assess the reliability and variability of stretch reflex magnitude (SRmag) in sub-acute stroke patients. For testing, rapid dorsiflexion stretches were induced 24 h apart in 22 patients and 34 controls. SRmag between sessions in patients and controls was not different and the SRmag on the more-affected side was significantly larger than the less-affected, dominant, and non-dominant sides. The SRmag was consistent between sessions. Therefore, patients were not as variable between sessions as we had hypothesized.

ObjectiveTo compare the changes in functional independence measured by the FIM after specialized neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage (SAH) and patients with intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS).DesignHistorical cohort study comparing changes in functional independence between patients with nontraumatic SAH and those with ICH/AIS, using FIM scores from a local database and clinical information from the Danish National Patient Registry.SettingPostacute specialized inpatient neurorehabilitation.ParticipantsParticipants (N=660) comprised patients with a first-time nontraumatic SAH (n=212) and age-matched patients with a first-time ICH/AIS (n=448).InterventionsNot applicable.Main Outcome MeasuresCrude and adjusted comparisons of FIM (total and item by item) measured at baseline and at discharge.ResultsPatients with nontraumatic SAH were admitted with a lower functional level compared with patients with ICH/AIS (median total FIM score, 25 [interquartile range (IQR), 18–81] vs 78.5 [IQR, 47–107]), and discharged with a lower functional level (median total FIM score, 98 [IQR, 40–116] vs 110 [IQR, 82.5–119]), although they made more progress during neurorehabilitation (median change in total FIM score, 27 [IQR, 4–60] vs 17 [IQR, 7–35]). Statistically, patients with nontraumatic SAH had significantly better odds for obtaining functional independence than did patients with ICH/AIS in 6 of the 18 FIM items: eating (odds ratio [OR]=3.2; 95% confidence interval [CI], 1.7–5.8); dressing–upper body (OR=2.0; 95% CI, 1.1–3.5); transfer tub/shower (OR=2.0; 95% CI, 1.1–3.6); stair walking (OR=2.2; 95% CI, 1.3–3.7); comprehension (OR=2.3; 95% CI, 1.3–3.9); and expression (OR=3.6; 95% CI, 2.0–6.5).ConclusionsPatients with nontraumatic SAH made significantly more progress during neurorehabilitation, although they were discharged with a lower level of functional independence compared with patients with ICH/AIS. However, both patients with nontraumatic SAH and those with ICH/AIS improved their functional outcome significantly. Also, patients with nontraumatic SAH admitted with severe functional outcome were shown to be capable of recovering to a moderate level of functional independence.

OBJECTIVE: To evaluate recreational and medical cannabis use in individuals with traumatic spinal cord injury, including reasons and predictors for use, perceived benefits and negative consequences.DESIGN: Cross-sectional survey in Denmark.METHODS: A 35-item questionnaire was sent to 1,101 patients with spinal cord injury who had been in contact with a rehabilitation centre between 1990 and 2012.RESULTS: A total of 537 participants completed the questionnaire. Of these, 36% had tried cannabis at least once and 9% were current users. Of current users, 79% had started to use cannabis before their spinal cord injury. The main reason for use was pleasure, but 65% used cannabis partly for spinal cord injury-related consequences and 59% reported at least good effect on pain and spasticity. Negative consequences of use were primarily inertia and feeling quiet/subdued. Lower age, living in rural areas/larger cities, tobacco-smoking, high alcohol intake and higher muscle stiffness were significantly associated with cannabis use. Those who had never tried cannabis reported that they would mainly use cannabis to alleviate pain and spasticity if it were legalized.CONCLUSION: Cannabis use is more frequent among individuals with spinal cord injury in Denmark than among the general population. High muscle stiffness and various demographic characteristics (lower age, living in rural areas/larger cities, tobacco-smoking and high alcohol intake) were associated with cannabis use. Most participants had started using cannabis before their spinal cord injury. There was considerable overlap between recreational and disability-related use.

Background and Purpose— Transcranial direct current stimulation may enhance effect of rehabilitation in patients with chronic stroke. The objective was to evaluate the efficacy of anodal transcranial direct current stimulation combined with constraint-induced movement therapy of the paretic upper limb. Methods— A total of 44 patients with stroke were randomly allocated to receive 2 weeks of constraint-induced movement therapy with either anodal or sham transcranial direct current stimulation. The primary outcome measure, Wolf Motor Function Test, was assessed at baseline and after the intervention by blinded investigators. Results— Both groups improved significantly on all Wolf Motor Function Test scores. Group comparison showed improvement on Wolf Motor Function Test in the anodal group compared with the sham group. Conclusions— Anodal transcranial direct current stimulation combined with constraint-induced movement therapy resulted in improvement of functional ability of the paretic upper limb compared with constraint-induced movement therapy alone. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01983319.

Importance: International resuscitation guidelines recommend targeted temperature management (TTM) at 33°C to 36°C in unconscious patients with out-of-hospital cardiac arrest for at least 24 hours, but the optimal duration of TTM is uncertain.Objective: To determine whether TTM at 33°C for 48 hours results in better neurologic outcomes compared with currently recommended, standard, 24-hour TTM.Design, Setting, and Participants: This was an international, investigator-initiated, blinded-outcome-assessor, parallel, pragmatic, multicenter, randomized clinical superiority trial in 10 intensive care units (ICUs) at 10 university hospitals in 6 European countries. Three hundred fifty-five adult, unconscious patients with out-of-hospital cardiac arrest were enrolled from February 16, 2013, to June 1, 2016, with final follow-up on December 27, 2016.Interventions: Patients were randomized to TTM (33 ± 1°C) for 48 hours (n = 176) or 24 hours (n = 179), followed by gradual rewarming of 0.5°C per hour until reaching 37°C.Main Outcomes and Measures: The primary outcome was 6-month neurologic outcome, with a Cerebral Performance Categories (CPC) score of 1 or 2 used to define favorable outcome. Secondary outcomes included 6-month mortality, including time to death, the occurrence of adverse events, and intensive care unit resource use.Results: In 355 patients who were randomized (mean age, 60 years; 295 [83%] men), 351 (99%) completed the trial. Of these patients, 69% (120/175) in the 48-hour group had a favorable outcome at 6 months compared with 64% (112/176) in the 24-hour group (difference, 4.9%; 95% CI, -5% to 14.8%; relative risk [RR], 1.08; 95% CI, 0.93-1.25; P = .33). Six-month mortality was 27% (48/175) in the 48-hour group and 34% (60/177) in the 24-hour group (difference, -6.5%; 95% CI, -16.1% to 3.1%; RR, 0.81; 95% CI, 0.59-1.11; P = .19). There was no significant difference in the time to mortality between the 48-hour group and the 24-hour group (hazard ratio, 0.79; 95% CI, 0.54-1.15; P = .22). Adverse events were more common in the 48-hour group (97%) than in the 24-hour group (91%) (difference, 5.6%; 95% CI, 0.6%-10.6%; RR, 1.06; 95% CI, 1.01-1.12; P = .04). The median length of intensive care unit stay (151 vs 117 hours; P Conclusions and Relevance: In unconscious survivors from out-of-hospital cardiac arrest admitted to the ICU, targeted temperature management at 33°C for 48 hours did not significantly improve 6-month neurologic outcome compared with targeted temperature management at 33°C for 24 hours. However, the study may have had limited power to detect clinically important differences, and further research may be warranted.Trial Registration: clinicaltrials.gov Identifier: NCT01689077.

OBJECTIVE: To explore if the definition of labour market attachment (LMA) changes LMA proportions after severe traumatic brain injury (TBI).DESIGN: Cohort study with 5-year follow-up.PARTICIPANTS: Patients aged 18-64 years with severe TBI from 2004 to 2012 (n = 637) and matched controls (n = 2497).METHODS: LMA was defined in three ways. All definitions included patients working with no government benefits. Definition 2 included patients receiving unemployment benefits (LMA-unemployment benefits). Definition 3 included patients receiving supplemental benefits/services such as patients involved in work-activation schemes (LMA supplementary benefits). First week of return to work (RTW), stable LMA first year after RTW and weekly LMA prevalence were calculated. Patients and controls were compared using multivariable conditional logistic regression.RESULTS: LMA unemployment benefits had similar proportions to LMA with no benefits. These estimates were lower than LMA supplemental benefits where 52% attempted to RTW and 31% achieved stable LMA within 2 years. The maximal LMA prevalence (LMA supplementary benefits) decreased from 33 to 30% from years 2 to 5. Adjusted odds ratios were 0.05 and 0.06 for years 1 and 2, and 0.07 for stable LMA in patients compared to controls.CONCLUSION: LMA proportions differed depending on the definition. Regardless of definition, LMA proportions following severe TBI were low in Denmark.

Objective: To investigate the influence of tongue-disability, age and gender on motor performance for a tongue training paradigm involving playing a computer game using the Tongue Drive System (TDS). Design: Two controlled observational studies.Setting: A neurorehabilitation center and a dental school.Participants: In Study 1, eleven tongue-disabled patients with symptoms of dysphagia and dysarthria and 11 age-and sex-matched controls participated in tongue training. In Study 2, 16 healthy elderly and 16 healthy young participants volunteered. Intervention: In study 1 and study 2, the tongue training lasted 30 min and 40 min respectively. The participants were instructed to play a computer game with the tongue using TDS. Main Outcome Measures: Motor performance was compared between groups in both studies. Correlation analyses were performed between age and relative improvement in performance. Subject-based reports of motivation, fun, pain and fatigue evaluated on 0-10 numerical rating scales (NRS) were compared between groups. Results: In study 1, tongue-disabled patients performed poorer than healthy controls (P=0.005) and with a trend of a gender difference (P=0.046). In study 2, healthy young participants performed better than healthy elderly (P0.094). Conclusions: The present study provided evidence that tongue-disability and age can influence behavioral measures of tongue motor performance. TDS may be a new adjunctive neurorehabilitation regime in treating tongue-disabled patients.

Background Constraint-Induced Movement Therapy (CIMT) is an evidence-based rehabilitation intervention for stroke. Several factors influence the motor gain from CIMT, including age and level of impairment. However, it is currently unknown to what extent cognitive status affects motor gain during CIMT. Objective The aim of this study was to investigate whether cognitive and emotional status affects motor improvement during two weeks of CIMT and retention of the gain at three months follow-up. Methods Twenty stroke patients (3-12 months post stroke) completed two weeks of CIMT. Motor performance was measured using the Wolf Motor Function Test (WMFT). Cognitive and emotional status was measured with a comprehensive neuropsychological test battery and a questionnaire on emotional status. All measures were performed at baseline, after two weeks of training, and at three months follow-up. Results We found no significant correlation between cognitive or emotional measures at baseline and improvement in motor performance post training. Also, cognitive and emotional status did not correlate with motor retention at three months follow-up. Conclusions We found no evidence to support that cognitive performance in stroke patients can predict motor gain from CIMT.

Background: Evidence for effective interventions to prevent long-term sequelae after concussion is sparse. This study aimed to test the efficacy of Get going After concussIoN (GAIN), an interdisciplinary, individually-tailored intervention of 8 weeks duration based on gradual return to activities and principles from cognitive behavioural therapy. Methods: We conducted an open-label, parallel-group randomised trial in a hospital setting in Central Denmark Region. Participants were 15–30-year-old patients with high levels of post-concussion symptoms (PCS) 2–6 months post-concussion (i.e., a score ≥20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)). They were randomly assigned (1:1) to either enhanced usual care (EUC) or GAIN+EUC. Masking of participants and therapists was not possible. The primary outcome was change in RPQ-score from baseline to 3-month FU. All analyses were done on an intention-to-treat basis using linear mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT02337101. Findings: Between March 1, 2015, and September 1, 2017, we included 112 patients. Patients allocated to GAIN+EUC (n=57) reported a significantly larger reduction of PCS than patients allocated to EUC (n=55) with a mean adjusted difference in improvement of 7·6 points (95% confidence interval (CI) 2·0–13·1, p=0·008), Cohen's d=0·5 (95% CI 0·1–0·9). Number needed to treat for prevention of one additional patient with RPQ ≥20 at 3-month FU was 3·6 (95% CI 2·2–11·3). No adverse events were observed. Interpretation: Compared with EUC, GAIN+EUC was associated with a larger reduction of post-concussion symptoms at 3-month FU. Funding: Central Denmark Region and the foundation “Public Health in Central Denmark Region - a collaboration between municipalities and the region”. Keywords: Brain concussion, Cognitive behavioural therapy, Graded exercise therapy, Illness perceptions, Intervention, Mild traumatic brain injury, Post-concussion syndrome, Rivermead Post-Concussion Symptoms Questionnaire

Purpose: To investigate the correlation between left/right judgement and the effect of mirror therapy (MT). A partial aim was to describe adverse effects of MT. Methods: This prospective follow-up study included 36 stroke patients, mean time since stroke was 33 d, SD 23. Left/right judgement is the ability to judge a pictured hand as belonging to one side of the body or the other. In this study, left/right judgement was established before the onset of MT by asking the patient to recognise left and right hands in photographs. Patients were tested before and after the intervention with the motor assessment scale (MAS) and two-point discrimination (2PD). The correlation between left/right judgement and the change of effect measured on the MAS and 2PD were tested by Spearman's rank correlation. Results: The ability to perform left/right judgement before the onset of MT had no significant correlation with change of effect measured on the MAS and 2PD (rho -0.169, p = 0.363 and rho = -0.227, p = 0.219). Thirty-one patients completed the intervention without adverse effects. Conclusion: Left/right judgement does not influence the effect of MT. There seems to be no reason to test the ability to perform left/right judgement before the onset of MT. MT is an intervention without major adverse effects. Implications for Rehabilitation Mirror therapy (MT) is a method for treating sensory and motor disturbances post-stroke. It is important to clarify whether the ability to perform left/right judgement influences the effect of MT. In this study, left/right judgement does not influence the effect of MT. Based on the results of this study, testing and training left/right judgement before commencing MT cannot be recommended.

The primary aim of this study was to investigate the effect of different training types and secondary to test gender differences on the training-related cortical plasticity induced by three different tongue-training paradigms: (1) therapeutic tongue exercises (TTE), (2) playing computer games with the tongue using the Tongue Drive System (TDS) and (3) tongue-protrusion task (TPT). Forty-eight participants were randomized into three groups with 1h of TTE, TDS, or TPT. Stimulus-response curves of motor evoked potentials (MEPs) and motor cortex mapping for tongue muscles and first dorsal interosseous (FDI) (control) were established using transcranial magnetic stimulation at three time-points: (1) before tongue-training, (2) immediately after training, (3) 1h after training. Subject-based reports of motivation, fun, pain and fatigue were evaluated on 0-10 numerical rating scales after training. The resting motor thresholds of tongue MEPs were lowered by training with TDS and TPT (P0.011) but not by TTE (P=0.167). Tongue MEP amplitudes increased after training with TDS and TPT (P0.030) but not with TTE (P=0.302). Men had higher MEPs than women in the TDS group (P0.045) at all time-points. No significant effect of tongue-training on FDI MEPs was observed (P0.335). The tongue cortical motor map areas were not significantly increased by training (P0.142). Training with TDS was most motivating and fun (P0.001) and TTE was rated the most painful (P0.001). Fatigue level was not different between groups (P0.071). These findings suggest a differential effect of tongue-training paradigms on training-induced cortical plasticity and subject-based scores of fun, motivation and pain in healthy participants.

To allow a routinely use of brain-computer interfaces (BCI), there is a need to reduce or completely eliminate the time-consuming part of the individualized training of the user. In this study, we investigate the possibility of avoiding the individual training phase in the detection of movement intention in asynchronous BCIs based on movement-related cortical potential (MRCP). EEG signals were recorded during ballistic ankle dorsiflexions executed (ME) or imagined (MI) by 20 healthy subjects, and attempted by five stroke subjects. These recordings were used to identify a template (as average over all subjects) for the initial negative phase of the MRCPs, after the application of an optimized spatial filtering used for pre-processing. Using this template, the detection accuracy (mean ± SD) calculated as true positive rate (estimated with leave-one-out procedure) for ME was 69 ± 21 and 58 ± 11 % on single trial basis for healthy and stroke subjects, respectively. This performance was similar to that obtained using an individual template for each subject, which led to accuracies of 71 ± 6 and 55 ± 12 % for healthy and stroke subjects, respectively. The detection accuracy for the MI data was 65 ± 22 % with the average template and 60 ± 13 % with the individual template. These results indicate the possibility of detecting movement intention without an individual training phase and without a significant loss in performance.

The aim of this study was to determine if external subglottic air flow (ESAF) influences swallowing frequency in severely dysphagic tracheotomized patients with brain injury.Ten patients were recruited at the neurological intensive care unit. The ESAF intervention was provided through the standard cuffed suction aid tracheotomy tube, which primarily is used to suction residual secretion volume from the subglottic area. Sessions were 150 minutes, and ESAF was provided at 60-65, 90-95, and 120-125 minutes at 3 L/min. Outcome measures included swallowing frequency (swallows/5 min) at 0-5 minutes (pre-baseline), 25-30 and 55-60 minutes (baseline/control), and 85-90, 115-120, and 145-150 minutes (postintervention). The residual secretion volume (ml) from the subglottic area was collected using a syringe at 0 minutes (pre-baseline), 30 and 60 minutes (baseline/ control), and at 90, 120, and 150 minutes (postintervention).The mean (±SEM) swallowing frequency (swallows/5 min) increased from 0.60 ± 0.30 to 2.10 ± 0.70 during the ESAF intervention ( P.001). The mean (±SEM) residual secretion volume reduced from 3.10 ± 0.31 ml to 0.50 ± 0.30 ml after the ESAF intervention ( P.001).The increase in swallowing frequency and reduction in residual secretion volume may indicate that ESAF influences swallowing parameters in patients with tracheotomy tubes.

Background: The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) after six months in comatose out-of-hospital cardiac arrest (OHCA) patients. Methods: TTH48 is an investigator-initiated, multicentre, assessor-blinded, randomised, controlled superiority trial of 24 and 48 hours of TTM at 33 (±1) ° C performed in 355 comatose OHCA patients aged 18 to 80 years who were admitted to ten intensive care units (ICUs) in six Northern European countries. The primary outcome of the study is the Cerebral Performance Category (CPC) score observed at six months after cardiac arrest. CPC scores of 1 and 2 are defined as good neurological outcomes, and CPC scores of 3, 4 and 5 are defined as poor neurological outcomes. The secondary outcomes are as follows: mortality within six months after cardiac arrest, CPC at hospital discharge, Glasgow Coma Scale (GCS) score on day 4, length of stay in ICU and at hospital and the presence of any adverse events such as cerebral, circulatory, respiratory, gastrointestinal, renal, metabolic measures, infection or bleeding. With the planned sample size, we have 80% power to detect a 15% improvement in good neurological outcomes at a two-sided statistical significance level of 5%. Discussion: We present a detailed statistical analysis protocol (SAP) that specifies how primary and secondary outcomes should be evaluated. We also predetermine covariates for adjusted analyses and pre-specify sub-groups for sensitivity analyses. This pre-planned SAP will reduce analysis bias and add validity to the findings of this trial on the effect of length of TTM on important clinical outcomes after cardiac arrest. Trial registration: ClinicalTrials.gov: NCT01689077, 17 September 2012, SCOPUS: ar.j, info:eu-repo/semantics/published

Background Assessing primary rehabilitation needs in patients with acquired brain injury is a challenge due to case complexity and the heterogeneity of symptoms after brain injury. The Rehabilitation Complexity Scale-Extended (RCS-E) is an instrument used in assessment of rehabilitation complexity in patients with severe brain injury. The aim of the present study was to translate and test the face validity of the RCS-E as a referral tool for primary rehabilitation. Face validity was tested in a sample of patients with acquired brain injury. Methods Ten clinicians and records from 299 patients with acquired brain injury were used in the translation, cross-cultural adaptation and face validation study of the RCS-E. RCS-E was translated into Danish by a standardized forward-backward translation by experts in the field. Face validity was assessed by a multi-professional team assessing 299 patients. The team was asked their opinion on whether the RCS-E presents a sufficient description of the patients. Results The RCS-E was translated according to international guidelines and tested by health professionals; some adaptations were required due to linguistic problems and differences in the national health system structures. The patients in the study had a mean age of 63.9 years (SD 14.7); 61 % were male. We found an excellent face validity with a mean score of 8.2 (SD 0.34) assessed on a 0–10 scale. Conclusions The RCS-E demonstrated to be a valid assessment of primary rehabilitation needs in patients with acquired brain injury. Excellent face validity indicates that the RCS-E is feasible for assessing primary rehabilitation needs and the present study suggests its applicability to the Danish health care system. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0728-7) contains supplementary material, which is available to authorized users.