Simple and choice reaction times of healthy adults and patients after stroke during simulated driving.

We examined whether driving-related reaction times differ between 26 healthy adults (university students) and 26 patients after stroke, and how distractors and leg-dominance affect reaction time and correctness of reactions of healthy adults. Reaction times were measured with the Fiat Mediatester driving simulator using 18-lamps reaction test (simple reaction time measurement) and choice reaction test (scored as reaction time and number of correct reactions). There was no statistically significant difference between the groups in simple reaction time. As expected, choice reaction times of the healthy adults were shorter on average and their reactions more accurate than those of the patients. Under the influence of distractors, healthy adults had statistically significantly longer choice and simple reaction times and made fewer correct choices compared to normal conditions. Leg dominance statistically significantly affected choice reaction times and correctness of reactions, but not simple reaction times. Our results confirm validity and usefulness of the Fiat Mediatester driving simulator for research purposes.

Compensatory mechanisms during walking in response to muscle weakness in spinal muscular atrophy, type III.

Our knowledge on altered neurological control of walking due to weakness of various muscle groups of the lower extremities is limited. The aim of this study was to assess kinematic, kinetic and electromyographic (EMG) walking patterns in a functionally homogeneous group of seven subjects with spinal muscular atrophy, type III (SMA group) and compare them with normal data obtained from nine healthy subjects (CONTROL group) in order to identify characteristic compensatory changes. Muscle strength at the ankle and knee joints was assessed using isokinetic dynamometry to determine variability in muscle strength: this was found to be similar in the two groups. Kinematic, kinetic and EMG patterns were assessed during walking in the SMA and CONTROL groups. The results showed changes in the activity of ankle plantarflexors and associated control of the center of pressure during loading response and midstance, which facilitated minimization of the external flexion moment acting on the knee and hip in the SMA group. Additionally, we identified distinct and consistent changes in the control of hip rotators that act to rapidly extend the hip early in stance phase and in the control of contralateral hip abductors that act delay weight shift onto the leg entering the stance phase. From these results we can conclude that the most important muscle groups compensating for reduced strength in knee and hip muscles are the ankle plantarflexors, hip rotators and hip abductors. This finding would have direct application in rehabilitation treatment programs.

Effects of dynamic balance training during standing and stepping in patients with hereditary sensory motor neuropathy.

PURPOSE: To quantitatively evaluate the effects of dynamic balance training in patients with hereditary sensory motor neuropathy (HSMN). METHODS: Sixteen patients with HSMN were randomly assigned to either an experimental or control group. The intervention session consisted of passive stretching, muscle strengthening and dynamic balance training during standing and stepping, which differed in that the experimental group used commercially available balance training mechanical apparatus while the patients from the control group were physically managed by a physiotherapist. The intervention period was 12 days. Balance and mobility functions were assessed by means of Berg Balance Scale, Up&go test and 10-m walk test before and after the intervention period. RESULTS: The within-group comparison (1-way repeated measures ANOVA) for the experimental group showed statistically significant improvement (p < 0.05) in Berg Balance Scale, Up&go test and 10-m walk test, while within-group comparison for the control group showed statistically significant improvement only in Berg Balance Scale (p < 0.05). The between-group comparison (2-way ANOVA) showed larger improvement in the experimental group, however, these differences were not statistically significant. CONCLUSION: Dynamic balance training is useful training modality for patients with HSMN. When exercised in the balance training mechanical apparatus used in this study enables efficient balance and mobility training without requiring physical assistance from a physiotherapist or a caregiver, which opens new possibilities for continuing and more frequent physical exercise and mobility training of patients with HSMN also at their homes.

Applicability of the pediatric evaluation of disability inventory in Slovenia.

In the process of developmental (re)habilitation, determination of the functional abilities of an individual is an important step. For that we need appropriate measurement instruments. Because we do not have such measurement instruments in Slovenia, we chose the Pediatric Evaluation of Disability Inventory (PEDI), translated it, and applied it in daily practice to assess its usefulness and applicability. The purpose of the study was to find out whether the functional abilities of the population of Slovene children evaluated with the Pediatric Evaluation of Disability Inventory is comparable to the American normative data. We also wanted to assess the possible influence of gender, parent education, community size, and the presence of siblings on children's functional abilities. The Pediatric Evaluation of Disability Inventory was administered in the form of a structured interview to the parents of 147 healthy children in three age groups (0.5-1 year, 3-3.5 years, and 5-5.5 years) in different health care centers in Slovenia. Data analysis showed significant differences in functional skills and caregiver assistance scale scores when comparing the Slovene sample with the American normative data, particularly in the youngest age group. Slovene children were found consistently to be different (scoring either higher or lower) from American children at comparable ages in several functional skills and caregiver assistance scales. The analysis also confirmed the importance of gender and the presence of siblings for gaining higher scores on some of the functional skills and caregiver assistance scales. The level of parent education did not prove to have a significant impact on the results. Our results suggest that the American normative data are not completely appropriate for reference purposes in Slovenia. The results are in agreement with the findings of other studies, demonstrating the importance of ascertaining intercultural differences. We believe that adaptation and norming of the Slovene version of the Pediatric Evaluation of Disability Inventory are necessary before using the instrument in clinical practice in our country.

Force tracking system for the assessment of grip force control in patients with neuromuscular diseases.

BACKGROUND: The majority of hand functionality assessment methods consist of the maximal voluntary grip force measurement. Additional knowledge on sensory-motor control can be obtained by capturing functional grip force in a time frame. Tracking methods have been successfully used for the assessment of grip force control in stroke patients and patients with Parkinson's disease. METHODS: A novel tracking system for the evaluation of grip force control is presented. The system consists of a grip-measuring device with the end-objects of different shapes which was used as input to a tracking task where the patient applied the grip force according to the visual feedback. The grip force control was assessed in 20 patients with neuromuscular diseases and 9 healthy subjects. The performance of two tracking tasks was analysed in five grips. The ramp-tracking task was designed to assess the grip strength and muscle fatigue. The sinus-tracking task was used to evaluate grip force control during periodic muscle activation. FINDINGS: The results suggest that in some patients the disease did not affect their grip force control despite evident muscular weakness. Most patients produced larger tracking errors in precision grip while the healthy subjects showed less significant differences in performance among the grips tested. INTERPRETATION: The current study investigated force control in patients with neuromuscular diseases where detection of small changes in motor performance is important when following the progress of disease. The presented evaluation method can provide additional information on muscle activation and fatigue as compared to traditional grip strength testing.

Parental evaluation of processes of care in relation to the child, parent and family characteristics.

The Measure of Processes of Care (MPOC) is a questionnaire for parents used to evaluate the behaviours of healthcare providers. We applied its 20-item version (MPOC-20) to explore the associations between parental evaluation of processes of care and child, parent and family characteristics in Slovenia. A novelty of our approach was the emphasis on the role of a key person. Parents of 235 children who were admitted as inpatients or outpatients of six institutions (hospitals and health centres) because of chronic illness or disability participated in the study. Parents were asked to fill in a general questionnaire on several characteristics of the child, child's health problems, the family and the therapy programmes, and MPOC-20. Univariate associations of the five MPOC-20 scale scores with child, parent and family characteristics were tested first. Multiple linear regression was used for modelling scale scores in relation to child, parent and family characteristics. The analyses singled out availability of a key person as the factor most consistently and unequivocally influencing parental satisfaction. We also found a general positive effect of male sex of the child on the MPOC-20 scores. Neither the present age of children nor age at the onset of health problems was found to be associated with MPOC-20 scores. We found no notable association of the number of health problems with the MPOC-20 scores, but observed clear differences when comparing parental satisfaction with processes of care between different participating institutions.

Force exertion capacity measurements in haptic virtual environments.

An objective test for evaluating functional status of the upper limbs (ULs) in patients with muscular distrophy (MD) is presented. The method allows for quantitative assessment of the UL functional state with an emphasis on force exertion capacity. The experimental measurement setup and the methodology for the assessment of maximal exertable force utilizing the Phantom 1.5 haptic interface has been developed. The measurement setup consists of a powerful virtual reality simulator, capable of providing haptic, visual and audio feedback. The patient's task in the virtual environment is goal oriented and includes stretching a virtual spring in six different directions. The Phantom 1.5 haptic interface serves as a kinematic measuring device and as a force feedback generator. By moving the haptic interface control stick the patient exerts the force in six radial directions to the best of his or her abilities. The new test offers numerical as well as graphic results. The method has been applied to 32 MD patients. Several typical force exertion capacity characteristics, affected by neuro-muscular disorders are shown in a quantitative manner. Data mining was used to demonstrate good content validity of the proposed test. The method allows for a quick, accurate, repeatable and objective measurements of the UL force exertion capability.

A method for selection of appropriate assistive technology for computer access.

Assistive technologies (ATs) for computer access enable people with disabilities to be included in the information society. Current methods for assessment and selection of the most appropriate AT for each individual are non standardized, lengthy, subjective, and require substantial clinical experience of a multidisciplinary team.This manuscript presents and evaluates an objective approach to test and select an appropriate AT for computer access for people with disabilities. Six user interfaces(standard keyboard, mini and large joystick, mini and large trackball, and head-operated mouse and keyboard) were tested on the control group of 29 people without disabilities and on 63 people with neuromuscular and muscular diseases, using purpose-built software for testing the speed of sentence typing. Different criteria for selecting the optimal AT were tested and compared with the skilled clinician's choice. The learning curves of the people with disabilities proved to follow those of the healthy controls, but with lower performance. Daily computer use was not associated with AT selection, but corresponded nearly perfectly to the level of functional ability of upper limbs. Agreement between clinician's choice and learning-based AT selection was noteworthy,but far from perfect. If partial agreement was taken into account, that is, AT was considered as an ordinal variable based on the corresponding functional ability level, and the second best learning-based choice was taken into account,the agreement was high for highest median typing speed as AT selection criterion. In conclusion, the developed method for AT assessment and selection seems to be an efficient guide for an unskilled clinician to choose an appropriate AT.

Measurements of respiratory capacity in patients with neuromuscular diseases.

Weakening of the respiratory muscles in patients with neuromuscular diseases (NMDs) threatens them with respiratory failure. The respiratory capacity of these patients is estimated by pulmonary functional tests. One of the most frequently used tests is the measurement of vital capacity (VC) and determination of the percentage share of the VC reference value (%VC). Different body parameters such as body height and body weight are used for determining the %VC. It is difficult to measure these parameters in wheelchair-bound NMD patients, especially those in more advanced stages of disease. Another reason for questioning the objectivity of spirometric testing in NMD patients is that many of them manifest severely weakened facial muscles and consequently have trouble with blowing. This article describes alternative testing of respiratory capacity and calculation (mathematical model) of predicted pulmonary functional values that is not based on the body height but on other more objectively measured anthropometrical parameters.