Sensorized assessment of bilateral hand movements in patients with stroke driven by rhythmic auditory or visual-auditory stimulation.

There is a growing body of literature about the efficacy in neurorehabilitation of the devices providing rhythmic auditory stimulations or visual-auditory stimulations, such as videogames, for guiding the patients' movements. Despite being presented as tools able to motivate patients, their efficacy was not been proven yet, probably due to the limited knowledge about the factors influencing the capability of patients to move the upper limbs following an external stimulus. In this study, we used a marker less system based on two infrared sensors to assess the kinematics of up and down in-phase and anti-phase bilateral hand oscillations synchronized or not with an external stimulus. A group of stroke survivors, one of age-matched healthy subjects and one of young healthy subjects were tested in three conditions: no stimulus, auditory stimulus, and video-auditory stimulus. Our results showed significant negative effects of visual-auditory stimulus in the frequency of movements (p = 0.001), and of auditory stimulus in their fluidity (p = 0.013). These results are conceivably related to the attentional overload required during the execution of bilateral movements driven by an external stimulus. However, a positive effect of external stimulus was found in increasing the range of movements of the less functional hand in all subjects (p = 0.023). These findings highlight as the type of stimulus may play a crucial role in the patient's performance with respect to movements that are not-externally driven.

Development of a patient-centered questionnaire for post-stroke spasticity assessment: a reliability study.

In the emerging scenario of patient-centered medicine, it is becoming increasingly important to involve patients in the management of chronic diseases. The rehabilitation field currently has no assessment tool for evaluating the functional impact of post-stroke spasticity on activities of daily living. The aim of this study was to identify a tool to fill this gap. The "Spasticity Questionnaire in Real Life" (SPQR) was administered, twice, to 39 patients with poststroke spasticity. Statistical analysis showed internal consistency and reliability of the questionnaire, with values greater than 0.96 and 0.76, respectively. These results show that the SPQR is a promising tool for evaluating the functional impact of post-stroke spasticity.

Individualized quality of life of severely affected multiple sclerosis patients: practicability and value in comparison with standard inventories.

PURPOSE: Individualized quality of life (QoL) measures differ from traditional inventories in that QoL domains/weights are not predetermined, but identified by the individual. We assessed practicability of the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW) interview in severely affected multiple sclerosis (MS) patients; the key QoL dimensions identified; and the correlation of the SEIQoL-DW index score with standard patient-reported outcome measures (PROMs). METHODS: Participants were people with severe MS who performed the baseline visit of the PeNSAMI trial (ISRCTN73082124). The SEIQoL-DW was administered at the patient's home by a trained examiner. Patients then received the following PROMs: the Core-Palliative care Outcome Scale (Core-POS), the Palliative care Outcome Scale-Symptoms-MS (POS-S-MS), the European Quality of Life Five Dimensions-3L (EQ-5D-3L), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Of 59 enrolled patients, 11 (19 %) did not receive the SEIQoL-DW (and the other PROMs) because of severe cognitive compromise or inability to communicate. SEIQoL-DW administration was completed and deemed valid in all 48 cases (mean age 60 years, 58 % women, median Expanded Disability Status Scale score 8.5). Mean SEIQoL-DW index score was 59.1 (SD 25.5). The most commonly nominated SEIQoL-DW areas were family (94 % of the patients), relationships, and leisure activities (both 65 %). Core-POS and POS-S-MS contained 70 % of the SEIQoL-DW-nominated areas. Nevertheless, correlations between SEIQoL-DW index, Core-POS, and POS-S-MS (and the other PROMs) were negligible. CONCLUSIONS: Individualized QoL can be assessed in severely affected MS patients, providing information that is not tracked by the standard inventories Core-POS, POS-S-MS, EQ-5D-3L, and HADS.