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Item does not contain fulltext AIM: To investigate the association between subjective spasticity ratings and objective spasticity measurement using a new tool for spasticity assessment, that is long-term surface electromyography (sEMG) recordings during daily activities. For monitoring, processing and analysis of this long-term sEMG data, a muscle activity detection algorithm was developed. METHOD: sEMG of the rectus femoris, vastus lateralis, adductor group and semitendinosus of 14 complete spinal-cord-injured patients, in whom voluntary muscle contraction was absent, was recorded continuously during daily activities. Synchronously, subjects stored their activities in a diary and scored their experienced level of spasticity on the Visual Analogue Scale (VAS) for that particular activity. sEMG data were analysed using a high-quality burst-detection algorithm that was developed and validated within this study. Derived sEMG parameters were clustered using principal-component analysis (PCA) and used in a linear mixed model analysis to study their association with VAS. RESULTS: VAS scores appeared significantly associated with the PCA components representing the number and the duration of bursts, but not burst amplitude. Furthermore, VAS scores were associated with the activity performed. The percentage explained variance was, however, low, that is 27-35%. CONCLUSIONS: Patient ratings of the level of spasticity appear poorly associated with spasticity in terms of involuntary muscle activity assessed with long-term sEMG recordings. It is likely that other factors such as pain and cognitions are also incorporated in these patient ratings. Clinicians are therefore strongly advised to perform complementary objective assessments using long-term sEMG recordings.

Background Elderly people frequently experience a decline in hand function, due to ageing or diseases. This leads to decreased independence in activities of daily living (ADL). Assistive technology may enhance independence. Objectives The objective of this paper was to explore user acceptance of an affordable wearable soft-robotic glove (ironHand (iH) system), that supports grip and hand opening in ADL. In addition, functional performance with the iH system was explored. Methods For this study 28 elderly people used the iH system across two sessions. During these sessions, participants performed six functional tasks with and without the iH system. Outcome measures were System Usability Scale (SUS), Intrinsic Motivation Inventory (IMI) and performance time of the functional tasks. Results User acceptance scored highly, with a mean SUS score of at least 63.4 (SD = 19.0) and a mean IMI score of 5.1 points (SD = 0.97 points). Functional task performance improved across repetitions both with and without the glove ( p ≤ 0.017), but all functional tasks were performed faster without the glove ( p ≤ 0.032). Conclusion Participants perceived the iH system as useful, pleasant and meaningful. The learning curve in functional performance time (improvements across repetitions) is promising, since it suggests there is room for improved performance when a longer acquaintance period is applied.

The first aim of this study was to assess prospectively the incidence of phantom breast sensations (PB sensations) and phantom breast pain (PB pain) in a sample of patients treated for breast cancer (n = 204) by means of a modified radical mastectomy (n = 82). Patients were assessed 6 weeks, 6, 12 and 24 months after mastectomy, by means of a questionnaire. After 24 months, assessments of 74 (90%) patients were available.Two years after mastectomy, PB sensations were present in 19% (n = 14) of the patients and PB pain was present in 1% (n = 1) of the patients. Over time the percentage of patients with PB sensations remained relatively stable (around 20%) but for PB pain the percentage reduced from 7% to 1%. The amount of suffering as a result of P13 sensations or PB pain was very limited. PB sensations and P13 pain are of little clinical relevance in the 24 months following mastectomy.The second aim of this paper was to analyse the influence of research methodology on the prevalences of PB sensations and PB pain previously reported. Research design, assessment method and publication date were recorded. Data were weighted according to the number of women investigated. Linear regression analysis was performed to analyse the influences of methodology on the prevalences of P13 sensations and P13 pain.Of the 29 studies identified, 23 were cross-sectional and 6 were prospective. In 17 studies patients were interviewed and in 12 studies a questionnaire was used.A prospective design resulted in prevalences of P13 sensations and PB pain averagely 8% lower respectively 9% higher than in cross-sectional studies. The use of an interview resulted in prevalences of PB sensations and PB pain averagely 13% lower respectively 5% lower than questionnaire use. Prevalences of PB sensations and PB pain reduce averagely with 0.08% respectively 0.13% per year since 1950.It is concluded that research design and assessment method have a significant influence on reported prevalence of PB sensations and PB pain. (C) 2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.

Background: In a prospective study, upper limb morbidity and perceived disability/activities of daily life (ADLs) were assessed before and 1 year after sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND).Methods: A total of 204 patients with stage I/II breast cancer (mean age, 55.6 years; SD, 11.6 years) entered the study, and 189 patients (93%) could be evaluated after I year. Fifty-eight patients (31%) underwent only SLNB, and 131 (69%) underwent ALND. Assessments performed before surgery (t(0)) and 1 year after surgery (t(1)), included pain, shoulder range of motion, muscle strength, upper arm/forearm circumference, and perceived shoulder disability/ADL.Results: Considerable treatment-related upper limb morbidity was observed. Significant (P Conclusions: One year after treatment of breast cancer, there is significantly less upper limb morbidity after SLNB compared with ALND. ALND is a predictor for upper limb morbidity.

Objectives: To evaluate long term change in impairment, disability, and health related functional status in patients with severe spasticity who received intrathecal baclofen. Methods: A long term (more than five years) observational longitudinal follow up study assessing 21 patients who received intrathecal baclofen given by programmable pump. Patients had chronic disabling spasticity which did not respond to oral antispasmolytic agents. Clinical efficacy was assessed by the Ashworth scale and spasm score; disability by the expanded disability status scale (EDSS), ambulation index (AI), and incapacity status scale (ISS); and health related quality of life by the sickness impact profile (SIP) and the Hopkins symptom checklist (HSCL). Results: Compared with pretreatment values, there was a significant improvement in clinical efficacy (Ashworth scale and spasm score, p

Purpose : The aim of this study was to assess impairments, disabilities and health related Quality of Life (QOL) after treatment of breast cancer and to analyse the relationship between treatment modalities, impairments, disabilities and health related QOL.Method : Fifty-five patients who underwent a modified radical mastectomy or a segmental mastectomy with axillary lymph node dissection were retrospectively assessed with a mean follow up of 2.7 years after treatment. Impairments were assessed by means of measuring active shoulder range of motion, grip strength, arm volume and pain. Disabilities were assessed by means of the Shoulder Disability Questionnaire (SDQ) and health related QOL was assessed by means of the RAND 36-item Health Survey (RAND-36).Setting : University Hospital Groningen (The Netherlands).Results : Pain (60%) and reduction of grip-strength (40%) were the most frequent impairments found. The prevalence of impaired range of motion and oedema was 9 - 16% respectively 15%. Mean group score of the SDQ was 33.7 (sd: 32.1) and mean scores of the RAND-36 differed significantly for physical functioning, vitality and health perception to that of a female norm group. Radiotherapy and chemotherapy were significant factors in the prediction of impaired range of motion. Pain and restricted range of motion explained 61% respectively 12% of the variance in disability (SDQ). In the prediction of health related QOL, pain, grip strength and arm volume were significant factors respectively in six, three and two domains.Conclusions : Pain is the most frequent assessed impairment after breast cancer treatment with strong relationship to perceived disability and health related QOL. Disability is mild and health related QOL (RAND-36) differed in three of the nine domains with a female norm group.

Aims: Breast cancer treatment may result in long-term upper limb morbidity: reduced range of motion of the shoulder, muscle weakness of the arm and hand, lymph edema, pain and numbness. Relationship of this late morbidity with activities of daily life (ADL) and quality of life (QOL) is infrequently described and the strength of this relationship is not clear.Methods: A systematic review was performed to evaluate the results of studies, analyzing late morbidity of breast cancer treatment in relationship with ADL and/or QOL. A literature search over the last 20 years (1980-2000) was performed in the databases MEDLINE, EMBASE, PSYCHLIT and CANCERLIT. Methodological quality of selected articles was assessed and additional, aspects of treatment related late morbidity and the relationship to ADL and/or QOL were summarized.Results: From the 1642 yielded articles 15 fulfilled our primary selection criteria. Only six articles could be selected due to the inappropriate methodological quality. There was high variation in prevalence of pain (12-51%), impairments in range of motion (2-51%), edema (6-43%) and decreased muscle strength (17-33%). Four articles reported significant relationships between late morbidity of the upper limb and perceived disabilities in ADL/QOL. The strength of these relationships was rather low.Conclusions: Few studies investigated the relationship between late morbidity of the upper limb after treatment of early breast cancer and ADL/QOL. Significant relationship between late morbidity and restrictions of daily activities and poorer QOL was reported, however, the strength of this relationship was rather low. (C) 2002 Elsevier Science Ltd. All rights reserved.

A review was performed of the literature of the last eleven years (1990-2000) with the topic: "clinical use of instrumented gait analysis in patients wearing a prosthesis of the lower limb". To this end a literature search was performed in Embase, Medline and Recal. Forty-five (45) articles were identified for study from which 34 were reviewed. The reviews were divided into five subtopics: 1) adaptive strategies in gait (12 studies); 2) the influence of different parts of the prosthesis on gait (12 studies); 3) pressure measurements in the socket in gait studies (4 studies); 4) the influence of the mass of the prostheses on gait (5 studies); 5) energy considerations in gait (2 studies). A considerable part of the studies concerned the adaptive strategies of the amputee in walking and running and the evaluation of different prosthetic feet. All aspects and outcomes were reviewed concerning the clinical relevance.

Reeds in de oudheid zijn er ontwikkelingen in de amputatiechirurgie te bespeuren. Amputaties worden eerst uitgevoerd in het al afgestorven weefsel, door een gewricht en alleen met het mes. Later vinden afzettingen plaats op de grens van gezond en dood weefsel of zelfs in het gezonde weefsel door het onderbeen met behulp van mes en zaag.

The first aim of this study was to assess prospectively the incidence of phantom breast sensations (PB sensations) and phantom breast pain (PB pain) in a sample of patients treated for breast cancer (n = 204) by means of a modified radical mastectomy (n = 82). Patients were assessed 6 weeks, 6, 12 and 24 months after mastectomy, by means of a questionnaire. After 24 months, assessments of 74 (90%) patients were available. Two years after mastectomy, PB sensations were present in 19% (n = 14) of the patients and PB pain was present in 1% (n = 1) of the patients. Over time the percentage of patients with PB sensations remained relatively stable (around 20%) but for PB pain the percentage reduced from 7% to 1%. The amount of suffering as a result of PB sensations or PB pain was very limited. PB sensations and PB pain are of little clinical relevance in the 24 months following mastectomy. The second aim of this paper was to analyse the influence of research methodology on the prevalences of PB sensations and PB pain previously reported. Research design, assessment method and publication date were recorded. Data were weighted according to the number of women investigated. Linear regression analysis was performed to analyse the influences of methodology on the prevalences of PB sensations and PB pain. Of the 29 studies identified, 23 were cross-sectional and 6 were prospective. In 17 studies patients were interviewed and in 12 studies a questionnaire was used. A prospective design resulted in prevalences of PB sensations and PB pain averagely 8% lower respectively 9% higher than in cross-sectional studies. The use of an interview resulted in prevalences of PB sensations and PB pain averagely 13% lower respectively 5% lower than questionnaire use. Prevalences of PB sensations and PB pain reduce averagely with 0.08% respectively 0.13% per year since 1950. It is concluded that research design and assessment method have a significant influence on reported prevalence of PB sensations and PB pain.

Gait initiation in transfemoral amputees (TFA) is different from non-amputees.This is mainly caused by the lack of stability and push-off from the prosthetic leg. Adding control and artificial push-off to the prosthesis may therefore be beneficial to TFA.In this study the feasibility of real-time intention detection of gait initiation was determined by mimicking the TFA situation in non-amputees. EMG and inertial sensor data was measured in 10 non-amputees. Only data available in TFA was used to determine if gait initiation can be predicted in time to control a transfemoral prosthesis to generate push-off and stability. Toe-off and heel-strike of the leading limb are important parameters to be detected, to control a prosthesis and to time push-off.The results show that toe-off and heel-strike of the leading limb can be detected using EMG and kinematic data in non-amputees 130–260ms in advance. This leaves enough time to control a prosthesis. Based on these results we hypothesize that similar results can be found in TFA, allowing for adequate control of a prosthesis during gait initiation.

Lower limb prosthetic technology has greatly advanced in the last decade, but there are still many challenges that need to be tackled to allow amputees to walk efficiently and safely on many different terrain conditions. Neuro-mechanical modelling and online simulations combined with somatosensory feedback, has the potential to address this challenge. By virtually reconstructing the missing limb together with the associated somatosensory feedback, this approach could enable amputees to potentially perceive the bionic legs as extensions of their bodies. A prosthesis equipped with such biologically inspired closed-loop control could duplicate the mechanics of walking far more accurately than conventional solutions. The project SimBionics aims to explore these opportunities and advance the state-of-the-art in lower limb prosthesis control.

Background The majority of stroke survivors have to cope with deficits in arm function, which is often measured with subjective clinical scales. The objective of this study is to examine whether circle drawing metrics are suitable objective outcome measures for measuring upper extremity function of stroke survivors. Methods Stroke survivors (n = 16) and healthy subjects (n = 20) drew circles, as big and as round as possible, above a table top. Joint angles and positions were measured. Circle area and roundness were calculated, and synergistic movement patterns were identified based on simultaneous changes of the elevation angle and elbow angle. Results Stroke survivors had statistically significant lower values for circle area, roundness and joint excursions, compared to healthy subjects. Stroke survivors moved significantly more within synergistic movement patterns, compared to healthy subjects. Strong correlations between the proximal upper extremity part of the Fugl-Meyer scale and circle area, roundness, joint excursions and the use of synergistic movement patterns were found. Conclusions The present study showed statistically significant differences in circle area, roundness and the use of synergistic movement patterns between healthy subjects and stroke survivors. These circle metrics are strongly correlated to stroke severity, as indicated by the proximal upper extremity part of the FM score. In clinical practice, circle area and roundness can give useful objective information regarding arm function of stroke survivors. In a research setting, outcome measures addressing the occurrence of synergistic movement patterns can help to increase understanding of mechanisms involved in restoration of post stroke upper extremity function.