Biomedical subjects

C Kiekens

Publications and source records attributed to C Kiekens.

10 recordsLinked to original sources

PubMed2006

Prediction of driving after stroke: a prospective study.

BACKGROUND: The process of determining whether patients with stroke should drive again often involves off-road evaluations and road tests that usually take about 2 to 3 h to complete. OBJECTIVES: This prospective study sought to identify the combination of tests that best predicts fitness to drive after stroke. The main aim was to develop a short and predictive predriving assessment battery. METHODS: Sixty-eight consecutive stroke patients were studied who performed a mandatory predriving assessment at the Belgian Road Safety Institute, Brussels, within 18 months. Performance in a predriving assessment included medical examination (when needed), visual and neuropsychological evaluations, and an on-road test. Based on these assessments, a physician, psychologist, and the driving safety expert who administered the tests decided if a subject was either "fit to drive,""temporarily unfit to drive," or "unfit to drive." RESULTS: Logistic regression analysis revealed a combination of visual neglect, figure of Rey, and on-road tests as the model that best predicted (R(2) = 0.73) fitness to drive after stroke. Using a discriminant function that included the 3 tests of the logistic model, the fitness to drive judgments of 59 (86.8%) subjects were correctly predicted. The sensitivity and specificity of the predictions were 79.4% and 94.1%, respectively. CONCLUSION: Fitness to drive after stroke can be predicted from performance on a few road-related tests with a high degree of accuracy. However, some individuals require extended assessments and further tests.

Adult↗

PubMed2005

Effect of simulator training on driving after stroke: a randomized controlled trial.

BACKGROUND: Neurologically impaired persons seem to benefit from driving-training programs, but there is no convincing evidence to support this notion. The authors therefore investigated the effect of simulator-based training on driving after stroke. METHODS: Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were randomly allocated to either an experimental (simulator-based training) or control (driving-related cognitive tasks) group. Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training. Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered. RESULTS: Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training. There were no significant differences between both groups in improvements from pre- to post-training except in the "road sign recognition test" in which the experimental subjects improved more. Significant improvements in the three-class decision ("fit to drive," "temporarily unfit to drive," and "unfit to drive") were found in favor of the experimental group post-training. Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental subjects (73%) than control subjects (42%) passed the follow-up official predriving assessment and were legally allowed to resume driving. CONCLUSIONS: Simulator-based driving training improved driving ability, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training.

Accidents, Traffic↗

PubMed2005

A special case on the use of ultrasonography for evaluation of the spinal canal and its contents in adults.

In this article we present a 70-year-old man with a history of severe trauma in the upper thoracic spine. This patient presented at our emergency department with a leaking wound in the lower neck after removal of osteosynthetic material. He had undergone a laminectomy of the third thoracic vertebra in the past. As an incidental finding, while examining the region of the lower neck by transcutaneous ultrasonography, we diagnosed a post-traumatic syrinx of the spinal medulla at this level.

Aged↗

PubMed2004

The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke.

OBJECTIVE: To examine the clinimetric characteristics of the Trunk Impairment Scale (TIS). This newly developed scale evaluates motor impairment of the trunk after stroke. The TIS scores, on a range from 0 to 23, static and dynamic sitting balance as well as trunk co-ordination. It also aims to score the quality of trunk movement and to be a guide for treatment. DESIGN: Two physiotherapists observed each patient simultaneously, but scored independently. Each patient was re-examined by one of the therapists. SUBJECTS: Twenty-eight patients in a rehabilitation setting. RESULTS: Kappa and weighted kappa values for item per item reliability ranged for all but two, from 0.62 to 1. All percentages of agreement exceeded 81%. Intraclass correlations (ICC) for the summed scores of the different subscales were between 0.85 and 0.99. Test-retest and interobserver reliability for the TIS total score (ICC) was 0.96 and 0.99, respectively. The 95% limits of agreement for the test-retest and interexaminer measurement error were -2.90, 3.68 and -1.84, 1.84, respectively. Cronbach alpha coefficients for internal consistency ranged from 0.65 to 0.89. Content validity was defined. Spearman rank correlations with the Barthel Index (r = 0.86) and the Trunk Control Test (r = 0.83) was used to examine construct and concurrent validity, respectively. CONCLUSIONS: Analysis of different clinimetric parameters support the use of the TIS in both clinical use and future stroke research. Guidelines for treatment and level of quality of trunk activity can be derived from the assessment.

Abdomen↗

PubMed2002

Coordination deficits on the ipsilesional side after unilateral stroke: the effect of practice on nonisodirectional ipsilateral coordination.

Previous studies have identified motor deficits on the ipsilesional side of patients recovering from a cerebro-vascular accident (CVA), including deficits in interlimb coordination. In the present study, unilateral stroke patients and a control group of healthy age-matched controls performed nonisodirectional coordination of the ipsilateral limbs across two days of practice with feedback. Findings revealed that control subjects were already quite successful at initiation of practice but further improved the coordination pattern across both days. The group of CVA patients also showed some improvement but problems with coordination of the ipsilateral limb segments persisted across practice. Variability in both timing and amplitude of both limb segments did improve with practice in both groups but these measures remained significantly higher in the CVA patients. Even though isodirectional and nonisodirectional coordination of the ipsilateral limb segments are normally considered to be part of the intrinsic motor repertoire, the present study suggests that nonisodirectional ipsilesional limb coordination poses considerable difficulties for CVA patients that are not easily overcome with feedback-assisted practice.

Aged↗

PubMed2001

Coordination of upper and lower limb segments: deficits on the ipsilesional side after unilateral stroke.

Coordination of the ipsilateral limbs was studied in unilateral stroke patients and a control group of healthy age-matched controls. Cyclical single-limb movements of the forearm and lower leg as well as their coordination, with the segments moving either in the same (isodirectional) or in different directions (nonisodirectional), were investigated under normal vision and blindfolded conditions. Findings revealed that stroke patients experienced difficulties with coordination of the limb segments on the ipsilesional side and this effect was more pronounced during nonisodirectional than during isodirectional coordination. In addition, cycle durations were larger and movement amplitudes shorter in stroke patients as compared to controls. Overall, the present findings clearly demonstrated motor control deficits in stroke patients on the so-called "unaffected side." The availability of normal vision did not alleviate these deficits. Therefore, the more general implication of the present findings appears to be that interlimb coordination is a complex function, requiring the integrity of both hemispheres. Comparison of the left- and right-hemispheric stroke groups revealed that patients with a left-hemisphere lesion tended to be more variable in performing the more difficult nonisodirectional pattern than patients with a right-hemisphere lesion. This possibly hints at a more pronounced involvement of the left hemisphere in the organization of ipsilateral coordination. The spatiotemporal features of movement (cycle duration, amplitude), however, did not differ between both stroke groups.

Adult↗

PubMed2001

Group physiotherapy improves time use by patients with stroke in rehabilitation.

Does feedback about the time use of patients with stroke influence the organisation of services in rehabilitation? An observation was made of the time use by 22 patients with stroke in a specialised rehabilitation unit, feedback was given to the staff, and another observation on 16 patients was made one year later. As a result of the first observation, the physiotherapy staff were urged to organise group sessions for patients with similar levels of disability, allowing practice with a higher patient to staff ratio. During the second observation, patients spent significantly more time on therapy (8%) and with their peers (25%). These results indicate that feedback about patients' time use can substantially influence management and consequently patients' behaviour in rehabilitation.

Adult↗

PubMed2000

Predicting motor recovery of the upper limb after stroke rehabilitation: value of a clinical examination.

BACKGROUND AND PURPOSE: Only a few studies have been conducted to predict motor recovery of the arm after stroke. The aims of this study were to identify which clinical variables, assessed at different points in time, were predictive of motor recovery, and to construct useful regression equations. METHOD: One hundred consecutive stroke patients who had an obvious motor deficit of the upper limb were evaluated on entry to the study (two to five weeks post-stroke) and at two, six and 12 months after stroke. The Brunnström-Fugl-Meyer test was used as the outcome measure. Predictors included demographic data, overall disability, clinical neurological features, neuropsychological factors and secondary shoulder complications. RESULTS: In multiple regression analyses, motor performance was invariably retained as the predictive factor with the highest R-square. Other significant predictive variables were overall disability, muscle tone, proprioception and hemi-inattention. Between 53% and 89% of the total amount of variance was accounted for in all selected models. The accuracy of prediction from clinical measurement in the acute phase diminished as the time span of measurement of outcome increased. Similarly, assessment of the variables at two and six months, rather than in the acute stage, resulted in a considerable improvement in the percentage variance explained at 12 months. The highest accuracy was obtained when predictions were made step-by-step in time. CONCLUSIONS: It is possible to predict motor recovery of the upper limb accurately through the use of a few clinical measures. Predictive equations are proposed, the use of which are practicable in both clinical practice and research.

Adult↗

PubMed1998

Successful treatment of idiopathic anejaculation with electroejaculation after microsurgical vas aspiration.

This case report describes a couple suffering from infertility secondary to psychogenic anejaculation, which was refractory to all conservative treatment modalities. A first trial of microsurgical vas aspiration in combination with in-vitro fertilization (IVF) resulted in a pregnancy. After 2 years, three more trials of microsurgical vas aspiration in combination with either IVF or subzonal insemination (SUZI) resulted in embryo transfer without pregnancy. Finally, after 3 years, spermatozoa obtained by rectal probe stimulation under general anaesthesia were cryopreserved. A second intracytoplasmic sperm injection (ICSI) procedure using these cryopreserved spermatozoa also resulted in a second pregnancy. Although sperm concentration was in the normal range, in all samples obtained by either rectal probe electrostimulation or microsurgical vas aspiration, motility was <30% in all but two samples.

Adult↗

PubMed1996

Pregnancy after electroejaculation in combination with intracytoplasmic sperm injection in a patient with idiopathic anejaculation.

OBJECTIVE: To assess the possibility of achieving a pregnancy in the wife of a patient suffering from idiopathic anejaculation who failed to respond to therapeutical modalities such as psychotherapy, sex therapy, and vibrostimulation. DESIGN: Case report. SETTING: The IVF program at the Leuven University Fertility Centre. PATIENT(S): A patient suffering from idiopathic anejaculation. INTERVENTION(S): Intracytoplasmic sperm injection (ICSI) in combination with electroejaculation. MEAN OUTCOME MEASURE(S): Fertility rate, cleavage rate, clinical pregnancy. RESULT(S): Two IVF procedures were performed of which the second resulted in an ongoing pregnancy and the delivery of a healthy boy. CONCLUSION(S): Electroejaculation may offer fertility chances in a patient suffering from idiopathic anejaculation resistant to conventional treatment modalities. When sperm quality shows very low motility, ICSI should be offered to improve pregnancy chances.

Ejaculation↗