UZ Leuven

Stroke rehabilitation in Europe: what do physiotherapists and occupational therapists actually do? De Wit L, Putman K, Lincoln N, Baert I, Berman P, Beyens H, et al. Stroke 2006;37(6):1483-9. Epub 2006 Apr 27. Abstract: BACKGROUND AND PURPOSE: Physiotherapy (PT) and occupational therapy (OT) are key components of stroke rehabilitation. Little is known about their content. This study aimed to define and compare the content of PT and OT for stroke patients between 4 European rehabilitation centers. METHODS: In each center, 15 individual PT and 15 OT sessions of patients fitting predetermined criteria were videotaped. The content was recorded using a list comprising 12 therapeutic categories. A generalized estimating equation model was fitted to the relative frequency of each category resulting in odds ratios. RESULTS: Comparison of PT and OT between centers revealed significant differences for only 2 of the 12 categories: ambulatory exercises and selective movements. Comparison of the 2 therapeutic disciplines on the pooled data of the 4 centers revealed that ambulatory exercises, transfers, exercises, and balance in standing and lying occurred significantly more often in PT sessions. Activities of daily living, domestic activities, leisure activities, and sensory, perceptual training, and cognition occurred significantly more often in OT sessions. CONCLUSIONS: This study revealed that the content of each therapeutic discipline was consistent between the 4 centers. PT and OT proved to be distinct professions with clear demarcation of roles.

Effect of simulator training on driving after stroke: a randomized controlled trial. Akinwuntan AE, De Weerdt W, Feys H, Pauwels J, Baten G, Arno P, Kiekens C.  Neurology 2005;65(6):843-50. Summary for patients in: Neurology 2005;65(6):E13-4. Abstract: 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 posttraining. 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.

The validity of a road test after stroke. Akinwuntan AE, De Weerdt W, Feys H, Baten G, Arno P, Kiekens C. Arch Phys Med Rehabil 2005;86(3):421-6. Abstract: OBJECTIVES: To determine the validity of a road test performed by stroke patients in Belgium and to reestablish its reliability. DESIGN: Prospective study of a predriving evaluation. SETTING: University hospital in Belgium. PARTICIPANTS: Thirty-eight patients with sequelae of first-ever stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Performance in the Stroke Driver Screening Assessment (SDSA) and on a road test. RESULTS: Interrater reliability of the road test subitems was moderate to substantial (weighted kappa range, .44- .78). Item-per-item reliability varied from moderately high (intraclass correlation coefficient [ICC]=.63) to very high (ICC=.87). The reliability of the overall performance in the road test was very high (ICC=.83). For the criterion validity of the road test, 78.9% of the subjects were correctly classified when the judgments of the principal evaluator were compared with outcomes of the SDSA. Agreement in classification between the principal evaluator and a state-registered evaluator’s judgments was 81.6%. The sensitivity and specificity of the agreement were very high (80.6%) and perfect (100%), respectively. CONCLUSIONS: The road test is a reliable and valid test of driving ability after stroke.

Early and repetitive stimulation of the arm can substantially improve the long-term outcome after stroke: a 5-year follow-up study of a randomized trial. Feys H, De Weerdt W, Verbeke G, Steck GC, Capiau C, Kiekens C, Dejaeger E, Van Hoydonck G, Vermeersch G, Cras P.  Stroke 2004;35(4):924-9. Epub 2004 Mar 4. Abstract: BACKGROUND AND PURPOSE: Several studies have investigated the effect of therapeutic interventions for the arm in the acute phase after stroke, with follow-ups at a maximum of 12 months. The aim of this study was to examine the effect of repetitive sensorimotor training of the arm at 5 years after stroke. SUBJECTS AND METHODS: One hundred consecutive stroke patients were randomly allocated either to an experimental group that received daily additional sensorimotor stimulation of the arm or to a control group. The intervention period was 6 weeks. Assessments of the patients were made before, midway, and after intervention, and at 6 and 12 months after stroke. In this study, 62 patients were reassessed at 5 years after stroke. The Brunnstrom- Fugl-Meyer (BFM) test, Action Research Arm (ARA) test, and Barthel index (BI) were used as the primary outcome measures. RESULTS: At the 5-year followup, there was a statistically significant difference for both the BFM and ARA tests in favor of the experimental group. The mean differences in improvement between the groups from the initial evaluation to the 5-year assessment corresponded to 17 points on the BFM and 17.4 on the ARA. No effect was found for the BI. The treatment was most effective in patients with a severe initial motor deficit. CONCLUSIONS: Adding a specific intervention for the arm during the acute phase after a stroke resulted in a clinically meaningful and long-lasting effect on motor function. The effect can be attributed to early, repetitive, and targeted stimulation.

Case report and review of the literature. Steenberghs J, Kiekens C, Menten J, Monstrey J. Intradural chordoma without bone involvement. J Neurosurg 2002;97(1 Suppl):94-7. Review. Abstract: Chordomas are most commonly of extradural origin and associated with bone destruction. The authors describe a rare case of an intradural chordoma. To the best of their knowledge, this is the first case in which multiple lesions were found intradurally without bone involvement; the lesions were disseminated through the thoracolumbosacral spinal cord and extended into the paraspinal muscles, and metastatic lesions in the cervical cord were also present.

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