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Alice Nieuwboer

Publications and source records attributed to Alice Nieuwboer.

10 recordsLinked to original sources
PubMed2006

Trunk performance after stroke: an eye catching predictor of functional outcome.

BACKGROUND AND AIMS: Trunk performance is an important predictor of functional outcome after stroke. However, the percentage of explained variance varies considerably between studies. This may be explained by the stroke population examined, the different scales used to assess trunk performance and the time points used to measure outcome. The aim of this multicentre study was to examine the predictive validity of the Trunk Impairment Scale (TIS) and its subscales when predicting the Barthel Index score at 6 months after stroke. METHODS: A total of 102 subjects were recruited in three European rehabilitation centres. Participants were assessed on admission (median time since stroke onset 20 days) and 6 months after stroke. Correlation analysis and forward stepwise multiple regression analysis were used to model outcome. RESULTS: The best predictors of the Barthel Index scores at 6 months after stroke were total TIS score (partial R2 = 0.52, p<.0001) and static sitting balance subscale score (partial R2 = 0.50, p<.0001) on admission. The TIS score on admission and its static sitting balance subscale were stronger predictors of the Barthel Index score at 6 months than the Barthel Index score itself on admission. CONCLUSIONS: This study emphasises the importance of trunk performance, especially static sitting balance, when predicting functional outcome after stroke. The TIS is recommended as a prediction instrument in the rehabilitation setting when considering the prognosis of stroke patients. Future studies should address the evolution of trunk performance over time and the evaluation of treatment interventions to improve trunk performance.

Adult↗
PubMed2006

Gait and gait-related activities and fatigue in Parkinson's disease: what is the relationship?

PURPOSE: To explore the relationship between gait and gait-related activities and fatigue in Parkinson's disease (PD). METHOD: Twenty people with idiopathic PD (12 male, 8 female; mean age 64.6 +/- 7.96) and 10 age, sex and education matched controls (6 male, 4 female; mean age 63.5 +/- 7.03) wore an activity monitor for approximately 24 h, from which the percentage time walking and standing, the number of periods of walking greater than 10 sec were derived. Prior to monitoring, levels of fatigue (Multi-dimensional Fatigue Index, MFI) were evaluated. RESULTS: Activity data related to gait were compared for the waking hours of the day, reflected by the period between 6 am and 10 pm. Overall, PD subjects demonstrated reduced activity compared to controls, however there was no significant difference between PD and controls for the percentage time spent walking (p = 0.149), standing (p = 1.0) or engaged in periods of walking that were greater than 10 sec (p = 0.059). Significantly greater levels of fatigue were experienced by PD subjects in all MFI domains compared to controls (physical p = 0.001; activity p = 0.001; general p = 0.001; mental p = 0.028; motivation p = 0.024). There was no clear association between activity and fatigue in PD subjects. CONCLUSIONS: Evidence of increased fatigue is not supported by evidence of significantly decreased levels of activity in PD subjects. The relationship between activity and fatigue therefore remains unclear, highlighting the complex nature of the relationship between these factors. Further work is required to increase our understanding of the impact of fatigue on gait and gait-related activity so that improved management can be explored.

Fatigue↗
PubMed2006

Reliability and validity of trunk assessment for people with multiple sclerosis.

BACKGROUND AND PURPOSE: Standardized scales are a prerequisite for rehabilitation and research. This study was designed to determine the reliability and validity of scores on items of the trunk assessment of the Melsbroek Disability Scoring Test (MDST) and Trunk Impairment Scale (TIS) in people with multiple sclerosis (MS). SUBJECTS: Thirty people with MS participated in the study. METHODS: Interrater and test-retest reliability and construct validity were assessed. RESULTS: Kappa and weighted kappa values for the items of the trunk assessment of the MDST ranged from .74 to .95, and the kappa and weighted kappa values for the TIS items ranged from .46 to 1.00. Intraclass correlation coefficients for interrater and test-retest agreement were .93 and .92, respectively, for the trunk assessment of the MDST and .97 and .95, respectively, for the TIS. Bland-Altman analysis showed consistency of scores without observer bias. Construct validity was established. DISCUSSION AND CONCLUSION: The MDST and TIS provide reliable assessments of the trunk and are valid scales for measuring trunk performance in people with MS.

Abdomen↗
PubMed2006

Trunk performance after stroke and the relationship with balance, gait and functional ability.

OBJECTIVE: To evaluate trunk performance in non-acute and chronic stroke patients by means of the Trunk Control Test and Trunk Impairment Scale and to compare the Trunk Control Test with the Trunk Impairment Scale and its subscales in relation to balance, gait and functional ability after stroke. SUBJECTS: Fifty-one stroke patients, attending a rehabilitation programme, participated in the study. MAIN MEASURES: SUBJECTS were evaluated with the Trunk Control Test, Trunk Impairment Scale, Tnetti balance and gait subscales, Functional Ambulation Category, 10-m walk test, Timed Up and Go Test and motor part of the Functional Independence Measure. RESULTS: Participants obtained a median score of 61 out of 100 on the Trunk Control Test and 11 out of 23 for the Trunk Impairment Scale. Twelve participants (24%) obtained the maximum score on the Trunk Control Test; no subject reached the maximum score on the Trunk Impairment Scale. Measures of trunk performance were significantly related with values of balance, gait and functional ability. Multivariate linear regression analysis showed an additional, significant contribution of the dynamic sitting balance subscale of the Trunk Impairment Scale in addition to the Trunk Control Test total score for measures of gait and functional ability (model R2 = 0.55-0.62). CONCLUSIONS: This study clearly indicates that trunk performance is still impaired in non-acute and chronic stroke patients. When planning future follow-up studies, use of the Trunk Impairment Scale has the advantage that it has no ceiling effect.

Abdomen↗
PubMed2005

Quantitative gait analysis in Parkinson's disease: comparison with a healthy control group.

OBJECTIVE: To compare gait parameters in Parkinson's disease (PD) during the on-phase of medication cycle with those of healthy elderly control subjects. DESIGN: A group-comparison study. SETTING: Gait analysis laboratory of a university hospital. PARTICIPANTS: Fifteen patients with PD and 9 healthy elderly controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and kinetic gait parameters. RESULTS: The PD spatiotemporal results showed a significant reduction in step length and walking velocity compared with controls. In the kinematics, the major feature of the PD group was a markedly reduced ankle plantarflexion excursion (at 50%-60% of the gait cycle). Most important, the kinetics showed reduced ankle push-off power and hip pull-off power. Unlike the control subjects, the patients with PD did not show any correlation between ankle generation (push-off) power and stride length ( r =.19) or with gait speed ( r =.29). Correction for walking velocity did not result in significant changes in the kinetics between the groups. CONCLUSIONS: Reduced ankle (push-off) power generation and reduced hip flexion (pull-off) power persisted in PD gait despite being tested in the on-phase of the medication cycle. Lack of a correlation between ankle and hip power generation and walking velocity suggests that peripheral and central factors contribute to lack of forward progression. Patients with PD may benefit from intervention strategies that correct the kinematic and the kinetic gait components.

Aged↗
PubMed2005

The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson's disease.

OBJECTIVES: To evaluate (1) the influence of rhythmic cues on gait interference during a functional activity and (2) the relationship of clinical symptoms to gait interference. DESIGN: Repeated-measures study. SETTING: Participants' homes. PARTICIPANTS: Twenty subjects with idiopathic Parkinson's disease (PD) and a control group of 10 age-, sex-, and education-matched subjects. INTERVENTIONS: Subjects performed a simple functional task that included a walking component and a dual-motor task. The functional task was performed with and without external rhythmic (auditory and visual) cues. MAIN OUTCOME MEASURES: Walking speed, mean step length, and step frequency were compared during trials of the tasks. In addition, tests of cognitive executive function (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression Scale), and fatigue (Multidimensional Fatigue Inventory) were undertaken. RESULTS: The use of auditory cues during a dual task involving gait reduced the interference effect on the task; significant increases in step length were observed in PD subjects ( P =.018), representing an increase of 19%. CONCLUSIONS: External auditory cues may be useful in reducing interference and maintaining gait performance during more complicated functional activities. Clinical symptoms, such as depression and fatigue, could influence the ability to focus attention and may increase gait interference during the performance of complex tasks, with subsequent implications for functional walking and safety.

Aged↗
PubMed2004

Electromyographic profiles of gait prior to onset of freezing episodes in patients with Parkinson's disease.

Freezing in Parkinson's disease is a severe and disabling problem of unknown aetiology. The aim of this study was to analyse the temporal pattern and the magnitude of the electromyographic activity of the lower limb muscles just before freezing and to compare this with a voluntary stop and ongoing gait. We recruited 11 patients with a mean age of 64.8 years (SD 5.1) and a mean Unified Parkinson Disease Rating Scale (part III--off) score of 29 (SD 7.9). Within a standard 3D gait laboratory setting, surface electromyographic (EMG) data of the tibialis anterior (TA) and gastrocnemius (GS) muscles were collected using a portable EMG module. Patients in the off-phase of the medication cycle performed several trials of normal walking and voluntary stops or were exposed to freezing-provoking circumstances. Filtered EMG signals were rectified, smoothed and expressed as a percentage of the gait cycle. EMG onset was determined using a preset threshold, corrected after visual inspection. The magnitude of EMG was calculated by integrating EMG signals (iEMG) over (real) time. To control for the altered timing of activity, iEMG was also normalized for time (iEMGnormt). Analysis of variance of repeated measures analysis showed that significantly abnormal timing occurred in the TA and GS muscles with overall preserved reciprocity. Before freezing, TA swing activity already started prematurely during the pre-swing phase, whereas it was significantly shortened during the actual swing phase. For the GS muscle, a similar pattern of premature activation and termination was found during the stance phase before a freeze. GS activity also showed prolonged bursts of activity during the swing phase, not present during the normal and stop condition. Total iEMG activity of both TA and GS was significantly reduced during the pre-freezing gait cycles. However, when controlling for the altered duration of the bursts, the average iEMGnormt increased, as did the peak EMG in TA. In GS, iEMGnormt was not different in the three conditions. In conclusion, our data show that a consistent pattern of premature timing of TA and GS activity occurred before freezing, which was interpreted as a disturbance of central gait cycle timing. The total amount of EMG activity was reduced in both lower limb muscles due to the shortened time in which the muscles were active. In contrast to GS, activity in TA showed increased amplitudes of the EMG bursts, indicating a compensation strategy of pulling the leg into swing. The observed changes contribute to insufficient forward progression, deceleration and eventually a breakdown of movement.

Aged↗
PubMed2004

Attending to the task: interference effects of functional tasks on walking in Parkinson's disease and the roles of cognition, depression, fatigue, and balance.

OBJECTIVE: To evaluate the interference effects on walking of functional activities in the home in people with Parkinson's disease (PD) and the contribution of clinical symptoms to disturbance of gait. DESIGN: A repeated-measures trial, using a dual-task paradigm to evaluate the attentional demands of functional activities. SETTING: Participants' homes and a clinic. PARTICIPANTS: Twenty subjects with idiopathic PD and 10 age-, sex-, and education-matched controls. INTERVENTIONS: Subjects performed a simple walking task, a dual-motor task, a dual-cognitive task, and a multiple task, all of which were real-world activities. Main outcome measures Walking speed, mean step length, and step frequency were compared across different tasks for each subject. A battery of clinical outcome measures hypothesized to compete for attention were also conducted: cognition (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression test), fatigue (Multidimensional Fatigue Inventory), balance (Berg Balance Scale), and disease severity (Hoehn and Yahr score). RESULTS: PD subjects walked at a significantly slower speed (26.5%, P<.001) and reduced step length (23%, P<.001) than did the controls. Performance of a concurrent cognitive and multitask resulted in significantly slower gait speed (P=.022; P<.015) and reduced mean step length (P=.022; P=.001) in PD subjects. Cognitive function, depression, physical fatigue, and balance were significantly related to walking speed for the functional tasks. Multiple regression analysis showed that the Brixton test, physical fatigue, and depression accounted for up to 39% of the variation in walking speed during functional tasks in PD and control subjects and balance accounted for 54% of variance for walking in PD subjects. CONCLUSIONS: Competition for attention through additional activities, decreased executive function, depression, fatigue, and impaired balance will increase difficulty in walking for PD subjects. Evaluation of performance during complex functional activities in an appropriate environment should be a focus of therapeutic assessment. Furthermore, functional performance may be influenced by several other symptoms that should also be considered.

Attention↗
PubMed2002

Prediction of outcome of physiotherapy in advanced Parkinson's disease.

OBJECTIVE: Prediction of the effect of a home physiotherapy intervention on the basis of four clinical characteristics of patients with advanced Parkinson's disease. DESIGN: A repeated measures design comparing six weeks without treatment with six weeks of physiotherapy and a follow-up of 12 weeks. SUBJECTS: Persons with Parkinson's disease without dementia and suffering from considerable functional disability. INTERVENTION: Community physiotherapists treated patients in the home situation three times a week teaching cueing and conscious movement control for walking and carrying out transfers in and out of beds and chairs. MAIN OUTCOME MEASURES: Mental status, disease severity, age and mood were included as predictor variables. A new functional scale developed as part of a previous study was used as the dependent variable administered in both the hospital and the home to determine whether the outcome generalized from the learning to a different environment. RESULTS: Only disease severity was a negative predictor of treatment outcome at home. In the hospital setting none of the factors predicted the immediate effect of treatment but cognitive ability and age were determinants of whether the treatment effects were maintained in the long term. CONCLUSIONS: Using cueing and cognitive strategies benefited younger and older patients with Parkinson's disease alike. However, the findings indicate targeting of treatment at patients with milder disease severity and providing follow-up treatment for older and cognitively less able patients.

Age Factors↗