In upper motor neuron diseases, like spinal cord injury, cerebral palsy and stroke, motor areas in the brain and/or spinal cord are damaged or fail to develop normally. Patients suffer from... Show moreIn upper motor neuron diseases, like spinal cord injury, cerebral palsy and stroke, motor areas in the brain and/or spinal cord are damaged or fail to develop normally. Patients suffer from increased joint stiffness, diminished range of motion and flexion deformity. The underlying neural reflexive and non-neural tissue (i.e. muscle slack length and stiffness) contributors of these motor disorders cannot be distinguished by current clinical tests. This distinction of contributors is however important for treatment selection and to understand the mechanism of functional recovery. To quantify the neural and non-neural contributors, an instrumented electromyography driven non-linear neuromuscular modeling approach was developed, validated and applied in patients with stroke and cerebral palsy. The clinical potential of the modeling approach was illustrated by the development over time of neural and non-neural contributors in the sub-acute phase post-stroke and by the effect of botulinum toxin A treatment on these contributors in chronic stroke patients. The results from longitudinal assessments are a step forward in answering “when” to treat a stroke patient. The results also give direction to the question “how” to treat stroke patients, i.e. which treatment option is most effective in each individual patient. Both are a prerequisite for personalized treatment. Show less
The aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical... Show moreThe aim of this thesis was to explore the neuromechanics of recovery of arm-hand function after stroke. A literature review revealed six articles that measured biomechanical and electromyographical outcome measures simultaneously, while applying active and passive tasks and multiple movement velocities to separate neural and non-neural contributors to movement disorders after stroke. Therefore, a neuromechanic assessment protocol was developed. Parameters were responsive to clinical status and had good to excellent test-retest reliability. Selective muscle activation was assessed with high measurement reliability and was significantly lower in chronic stroke patients compared to healthy participants. Longitudinally, neuromechanical parameters were combined with data on arm-hand function at six months after stroke. Paresis and diminished modulation of reflexes were associated with poor functional outcome. Changes in tissue properties were represented by a shift in wrist rest angle towards flexion and decline in passive range of motion. Increase in active range of motion and steady rest angle contributed most to prediction of functional outcome. The precision diagnostics provided by a neuromechanical assessment protocol could support clinical decision making and should be used in prediction models and as biomarkers in recovery of arm-hand function after stroke, for example by improving the selection of time-window and patients. Show less
Gooijer-van de Groep, K.L. de; Vlugt, E. de; Krogt, H.J. van der; Helgadottir, A.; Arendzen, J.H.; Meskers, C.G.M.; Groot, J.H. de 2016
Interpretation: Non-invasive quantitative analysis, including estimation of optimal muscle lengths, enables to identify neural and non-neural changes in chronic stroke patients. Monitoring these... Show moreInterpretation: Non-invasive quantitative analysis, including estimation of optimal muscle lengths, enables to identify neural and non-neural changes in chronic stroke patients. Monitoring these changes in time is important to understand the recovery process and to optimize treatment. (C) 2016 Elsevier Ltd. All rights reserved. Show less
Oomen, P.J.A.; Loerakker, S.; Geemen, D. van; Neggers, J.; Goumans, M.J.T.H.; Bogaerdt, A.J. van den; ... ; Baaijens, F.P.T. 2016
