51 research outputs found
Stroke rehabilitation summer school Upper limb therapy dose during (sub)acute rehabilitation of people with a cervical spinal cord injury
No full textPurpose
This study aims to inventory the current therapy dose dimensions (TDD) in upper limb motor training.
Methods
In this longitudinal observational study in three rehabilitation centers, active upper limb training during usual care for patients with a cervical spinal cord injury (4-8 post-injury weeks at inclusion) was observed three days of the week during three separate weeks and recorded on video. Sessions with 25% of the time upper limb training were included. TDD were retrieved from observations, and subjective difficulty and intensity perceived by the patient were assessed using a Visual Analogue Scale. Patient characteristics and TDD were reported using means (M), standard deviations (SD), and percentages.
Results
In the ongoing study, 84 sessions were examined, involving eight patients (AIS B-D, lesion C1-C5, mean age 56.1 years (SD: 12.1) and mean post-injury weeks 7.5 (SD: 1.6) at inclusion). The sessions had a mean planned time of 54’06’’ (SD: 29’15’’), with a mean session length of 40’56’’ (SD: 25’25’’), and a mean session length spent on the upper limb of 33’00’’ (SD: 23’25’’). The sessions had a mean active time of 20’31’’ (SD: 13’56’’). Patients indicated a subjective difficulty of, on average, 3.9 (SD: 2.4) and a subjective intensity of, on average, 3.9 (SD: 2.2).
Conclusions
These preliminary results showed session lengths of only 75.6% of the planned time and 62.2% active time during upper limb training. Patients indicated a relatively low subjective difficulty and intensity. Future research is needed to optimize and implement TDD into upper limb motor training
Upper limb training: strategies and therapy dose dimensions across the rehabilitation of people in the (sub)acute phase after a cervical spinal cord injury
No full textIntroduction
Different motor training strategies and therapy doses may lead to diverse upper limb treatment outcomes. However, it is unknown how they are used in therapy. This study aims to inventory the current motor training strategies and therapy doses used in upper limb motor training.
Methods
A longitudinal observational study was executed in three rehabilitation centers (in Belgium and the Netherlands). Active upper limb training during usual care for patients with a cervical spinal cord injury (i.e.lesions ranging from C1 to Th1 and AIS A-D) between 4-8 post-injury weeks at inclusion were observed per patient on three days of the week during three separate weeks, interspaced by eight weeks, and recorded on video. Sessions with 25% of the time upper limb training were included. Motor training strategies (training modalities and task-oriented training components) and therapy dose dimensions were retrieved from observations by trained observers using standard forms. The therapy dose dimensions, subjective difficulty, and intensity perceived by the patient were assessed using a Visual Analogue Scale. Patient characteristics, motor training strategies, and therapy dose dimensions were reported in terms of means (M), standard deviations (SD), and percentages.
Results
In the ongoing study, 84 upper limb sessions were examined, involving eight patients (AIS B-D, lesion C1-C5, mean age 56.1 years (SD: 12.1) and mean post-injury weeks 7.5 (SD: 1.6) at inclusion). The sessions had a mean planned time of 54’06’’ (SD: 29’15’’), with a mean session length of 40’56’’ (SD: 25’25’’). 80.6% (M: 33’00’’; SD: 23’25’’) of the session length was spent on upper limb training. The sessions had a mean active time of 20’31’’ (SD: 13’56’’) and a session density of 62.2% active and 37.8% inactive time. Patients indicated a subjective difficulty of, on average, 3.9 (SD: 2.4) and a subjective intensity of, on average, 3.9 (SD: 2.2). The frequencies of used training modalities were: skill training: 36.9%, analytical training: 34.6%, strength training: 24.6%, and endurance training: 3.8%. The mean active time and the amount of movements per training modality were, respectively: skill training: 14’38’’ (SD: 14’19’’); 349.5 (SD: 403.3), analytical training 15’28’’ (SD: 11’04’’); 225.9 (SD: 161.8), strength training 8’26’’ (SD: 6’04’’); 213.9 (SD: 180), endurance training 8’51’’ (SD: 10’35’’); 142 (SD: 118.2). The sessions frequently included the task-oriented training components: different movement planes: 67.5%, patient-customized training load: 66.3% and functional movements: 63.9%. In 21.7% of the sessions, real-life objects were used, and 12% were performed in a context-specific environment.
Conclusions
These preliminary results showed session lengths of only 75.6% of the planned time, and within the session only 62.2% was active upper limb training. Patients indicated a relatively low subjective difficulty and intensity, while a patient-customized training load was observed in 66.3%. Analytical training is frequently used; however, the literature shows no evidence of its effect on upper limb outcomes. Task-oriented training components recommended to improve training outcomes were not frequently used; context-specific environments and real-life objects. Future research is needed to optimize and implement training strategies and therapy doses into upper limb motor training
Upper limb training: strategies and therapy dose dimensions across the rehabilitation of people in the (sub)acute phase after a cervical spinal cord injury
No full textIntroduction
Different motor training strategies and therapy doses may lead to diverse upper limb treatment outcomes. However, it is unknown how they are used in therapy. This study aims to inventory the current motor training strategies and therapy doses used in upper limb motor training.
Methods
A longitudinal observational study was executed in three rehabilitation centers (in Belgium and the Netherlands). Active upper limb training during usual care for patients with a cervical spinal cord injury (i.e.lesions ranging from C1 to Th1 and AIS A-D) between 4-8 post-injury weeks at inclusion were observed per patient on three days of the week during three separate weeks, interspaced by eight weeks, and recorded on video. Sessions with 25% of the time upper limb training were included. Motor training strategies (training modalities and task-oriented training components) and therapy dose dimensions were retrieved from observations by trained observers using standard forms. The therapy dose dimensions, subjective difficulty, and intensity perceived by the patient were assessed using a Visual Analogue Scale. Patient characteristics, motor training strategies, and therapy dose dimensions were reported in terms of means (M), standard deviations (SD), and percentages.
Results
In the ongoing study, 84 upper limb sessions were examined, involving eight patients (AIS B-D, lesion C1-C5, mean age 56.1 years (SD: 12.1) and mean post-injury weeks 7.5 (SD: 1.6) at inclusion). The sessions had a mean planned time of 54’06’’ (SD: 29’15’’), with a mean session length of 40’56’’ (SD: 25’25’’). 80.6% (M: 33’00’’; SD: 23’25’’) of the session length was spent on upper limb training. The sessions had a mean active time of 20’31’’ (SD: 13’56’’) and a session density of 62.2% active and 37.8% inactive time. Patients indicated a subjective difficulty of, on average, 3.9 (SD: 2.4) and a subjective intensity of, on average, 3.9 (SD: 2.2). The frequencies of used training modalities were: skill training: 36.9%, analytical training: 34.6%, strength training: 24.6%, and endurance training: 3.8%. The mean active time and the amount of movements per training modality were, respectively: skill training: 14’38’’ (SD: 14’19’’); 349.5 (SD: 403.3), analytical training 15’28’’ (SD: 11’04’’); 225.9 (SD: 161.8), strength training 8’26’’ (SD: 6’04’’); 213.9 (SD: 180), endurance training 8’51’’ (SD: 10’35’’); 142 (SD: 118.2). The sessions frequently included the task-oriented training components: different movement planes: 67.5%, patient-customized training load: 66.3% and functional movements: 63.9%. In 21.7% of the sessions, real-life objects were used, and 12% were performed in a context-specific environment.
Conclusions
These preliminary results showed session lengths of only 75.6% of the planned time, and within the session only 62.2% was active upper limb training. Patients indicated a relatively low subjective difficulty and intensity, while a patient-customized training load was observed in 66.3%. Analytical training is frequently used; however, the literature shows no evidence of its effect on upper limb outcomes. Task-oriented training components recommended to improve training outcomes were not frequently used; context-specific environments and real-life objects. Future research is needed to optimize and implement training strategies and therapy doses into upper limb motor training
Stroke rehabilitation summer school Upper limb therapy dose during (sub)acute rehabilitation of people with a cervical spinal cord injury
No full textPurpose
This study aims to inventory the current therapy dose dimensions (TDD) in upper limb motor training.
Methods
In this longitudinal observational study in three rehabilitation centers, active upper limb training during usual care for patients with a cervical spinal cord injury (4-8 post-injury weeks at inclusion) was observed three days of the week during three separate weeks and recorded on video. Sessions with 25% of the time upper limb training were included. TDD were retrieved from observations, and subjective difficulty and intensity perceived by the patient were assessed using a Visual Analogue Scale. Patient characteristics and TDD were reported using means (M), standard deviations (SD), and percentages.
Results
In the ongoing study, 84 sessions were examined, involving eight patients (AIS B-D, lesion C1-C5, mean age 56.1 years (SD: 12.1) and mean post-injury weeks 7.5 (SD: 1.6) at inclusion). The sessions had a mean planned time of 54’06’’ (SD: 29’15’’), with a mean session length of 40’56’’ (SD: 25’25’’), and a mean session length spent on the upper limb of 33’00’’ (SD: 23’25’’). The sessions had a mean active time of 20’31’’ (SD: 13’56’’). Patients indicated a subjective difficulty of, on average, 3.9 (SD: 2.4) and a subjective intensity of, on average, 3.9 (SD: 2.2).
Conclusions
These preliminary results showed session lengths of only 75.6% of the planned time and 62.2% active time during upper limb training. Patients indicated a relatively low subjective difficulty and intensity. Future research is needed to optimize and implement TDD into upper limb motor training
Assessment of Neuroplastic Changes in the Peripheral Nervous System Following Cervical Spinal Cord Injury Using Nerve Excitability Testing and MScanFit Motor Unit Number Estimation
No full textSpinal Cord Injuries primarily affect the central motor system, but research suggests that the peripheral nervous system is also altered and marked by delayed deterioration. Interest is growing, but knowledge about the extent of damage and implications for rehabilitation remains limited. This research presents the pilot findings of neurophysiological assessments of the peripheral nerve of the abductor pollicis brevis. It highlights the potential of our proposed methods to establish the evaluation of peripheral neuroplasticity for spinal cord research
Therapists' perspectives on an interdisciplinary approach of arm-hand rehabilitation in cervical spinal cord injury: a qualitative study
Full text linkPurposeTo explore therapists' experiences on what elements arm-hand rehabilitation should contain, their importance, and the information needed to apply them in clinical practice.Materials and methodsThis qualitative study, with an exploratory approach, used focus group discussions with purposive sampling. Based on Braun and Clarke's methodology, inductive thematic analysis was employed to develop themes, subthemes, and categories. The study included seven physiotherapists and seven occupational (>= 2 year experience) therapists from three spinal cord rehabilitation wards in Belgium and the Netherlands.ResultsThe data analysis revealed five major themes, i.e., gathering knowledge, the process of thinking and acting, practice beyond therapy, and motivation. The first theme involves collecting information about the person and their client system. The second focuses on the goal-setting process for a patient-tailored therapy plan, described in the third theme as goal task-oriented with an individualized therapy dose. The fourth theme highlights meaningful activities to enhance performance beyond therapy, while the fifth emphasizes maintaining motivation through rehabilitation.ConclusionTherapists highlight centralizing the person and their social environment in arm-hand rehabilitation, leading to a personalized goal-setting process and a patient-tailored therapy plan incorporating meaningful tasks. This approach can increase therapy dose and improve patients' motivation.This work was supported by Bijzonder Onderzoeksfonds (BOF) UHasselt [21OWB23]
Circulating immune profile changes reflect memory immune responses in spinal cord injury patients
No full textFollowing a spinal cord injury (SCI), an inflammatory immune reaction is triggered which results in advanced secondary tissue damage. This study aimed to extensively analyse the circulating immune cell composition in traumatic SCI patients. High-dimensional flow cytometry was performed on peripheral blood mononuclear cells of traumatic SCI patients and healthy controls (n=18 each). SCI blood samples were collected at multiple time points in the (sub)acute ((s)aSCI, 0-4 days and 3 weeks post-SCI) and chronic (cSCI, 6, 12, 18 and >18 weeks post-SCI) disease phase up to a total of 46 SCI samples. Total and CD4 + T cell frequencies were increased in cSCI patients. CD4 + T cells and B cells were shifted towards memory phenotypes in (s)aSCI and cSCI patients, respectively. Most profound changes were observed in the B cell compartment. Decreased immunoglobulin (Ig)G + and increased IgM + B cell frequencies reflected disease severity, as these correlated with American Spinal Injury Association (ASIA) impairment scale (AIS) scores. Post-SCI B cell responses consisted of an increased frequency of B cells and B cell subsets expressing the survival receptor CD74. Expression of CD74 was also elevated on B cell subsets of cSCI but not (s)aSCI patients. In conclusion, post-SCI inflammation is driven by memory immune cell subsets. The elevated CD74 expression on B cells of SCI patients suggests the potential involvement of CD74-related pathways in post-SCI B cell responses. Monitoring of circulating IgM + and IgG + B cell levels could aid in the clinical evaluation and prognosis of SCI patients
Circulating immune profile changes reflect memory immune responses in spinal cord injury patients
No full textFollowing a spinal cord injury (SCI), an inflammatory immune reaction is triggered which results in advanced secondary tissue damage. This study aimed to extensively analyse the circulating immune cell composition in traumatic SCI patients. High-dimensional flow cytometry was performed on peripheral blood mononuclear cells of traumatic SCI patients and healthy controls (n=18 each). SCI blood samples were collected at multiple time points in the (sub)acute ((s)aSCI, 0-4 days and 3 weeks post-SCI) and chronic (cSCI, 6, 12, 18 and >18 weeks post-SCI) disease phase up to a total of 46 SCI samples. Total and CD4 + T cell frequencies were increased in cSCI patients. CD4 + T cells and B cells were shifted towards memory phenotypes in (s)aSCI and cSCI patients, respectively. Most profound changes were observed in the B cell compartment. Decreased immunoglobulin (Ig)G + and increased IgM + B cell frequencies reflected disease severity, as these correlated with American Spinal Injury Association (ASIA) impairment scale (AIS) scores. Post-SCI B cell responses consisted of an increased frequency of B cells and B cell subsets expressing the survival receptor CD74. Expression of CD74 was also elevated on B cell subsets of cSCI but not (s)aSCI patients. In conclusion, post-SCI inflammation is driven by memory immune cell subsets. The elevated CD74 expression on B cells of SCI patients suggests the potential involvement of CD74-related pathways in post-SCI B cell responses. Monitoring of circulating IgM + and IgG + B cell levels could aid in the clinical evaluation and prognosis of SCI patients
Altered Circulating Immune Cell Distribution in Traumatic Spinal Cord Injury Patients in Relation to Clinical Parameters
No full textFollowing a spinal cord injury (SCI), an inflammatory immune reaction is triggered which results in advanced secondary tissue damage. The systemic post-SCI immune response is poorly understood. This study aimed to extensively analyse the circulating immune cell composition in traumatic SCI patients in relation to clinical parameters. High-dimensional flow cytometry was performed on peripheral blood mononuclear cells of 18 traumatic SCI patients and 18 healthy controls to determine immune cell subsets. SCI blood samples were collected at multiple time points in the (sub)acute (0 days to 3 weeks post-SCI, (s)aSCI) and chronic (6 to >18 weeks post-SCI, cSCI) disease phase. Total and CD4+ T cell frequencies were increased in cSCI patients. Both CD4+ T cells and B cells were shifted towards memory phenotypes in (s)aSCI patients and cSCI patients, respectively. Most profound changes were observed in the B cell compartment. Decreased immunoglobulin (Ig)G+ and increased IgM+ B cell frequencies reflected disease severity, as these correlated with American Spinal Injury Association (ASIA) impairment scale (AIS) scores. Post-SCI B cell responses consisted of an increased frequency of CD74+ cells and CD74 expression level within total B cells and B cell subsets. Findings from this study suggest that post-SCI inflammation is driven by memory immune cell subsets. The increased CD74 expression on post-SCI B cells could suggest the involvement of CD74-related pathways in neuroinflammation following SCI. In addition, the clinical and prognostic value of monitoring circulating IgM+ and IgG+ B cell levels in SCI patients should be further evaluated.</p
Longitudinal Plasma Biomarker Profiles Predict Neurological Outcome in Traumatic Spinal Cord Injury
Full text linkObjectiveTraumatic spinal cord injury (SCI) is diagnosed by imaging and clinical scoring using the American Spinal Injury Association Impairment Scale (AIS). These methods have limited value for prognosis. Here, the prognostic value of plasma neurofilament-light (NfL), glial fibrillary acidic protein (GFAP), and contactin-1 (CNTN-1) was analyzed. MethodsBiomarker levels were determined in the plasma of traumatic SCI patients (n = 37) and healthy controls (n = 22). SCI samples (n = 112) were collected at different time points from 0 to 4 days to 18 weeks post-injury. NfL and GFAP were measured by single molecule array (Simoa) technology, CNTN-1 by Luminex. Baseline and outcome AIS and motor scores were collected as a measure of injury severity. ResultsNfL, GFAP, and CNTN-1 showed different kinetics in SCI patients over time. Baseline biomarker levels could identify AIS-A SCI patients (NfL + GFAP) and discriminate between patients with a motor score change = 5 (NfL + GFAP+CNTN-1). Longitudinally, NfL could identify AIS-A patients up to 12 weeks post-SCI and discriminate between patients with a motor score change = 5 up to 18 weeks post-SCI. Further, baseline biomarker levels positively (NfL + GFAP) or negatively (CNTN-1) correlated with outcome injury severity and together could accurately predict AIS conversion (AUC 0.863) and motor score change (AUC 0.857). This predictive ability was maintained in subacute/chronic SCI stages. InterpretationIn conclusion, plasma NfL, GFAP, and CNTN-1 are potential prognostic biomarkers in SCI. This is important for patient stratification in clinical trials, prediction of neurological outcome and informed decision-making in SCI treatment and rehabilitation. ANN NEUROL 2025The authors thank Kim Ulenaers (Hasselt University, Biomedical Research Institute, Belgium) for help with the sample and data collection, Prof. Tomas Menovsky (Antwerp University Hospital, Belgium) for patient inclusion, and
dr. Liesbeth Bruckers and dr. Anna Ivanova (BioStat, Data Science Institute, Hasselt University, Belgium) for help with data analysis. This work was supported by Hasselt University and a grant from the Wings for Life Spinal Cord
Research Foundation (WFL-BE-20/20)
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