Melodic Intonation Therapy (MIT) is a language production therapy for severely non-fluent aphasic patients using melodic intoning and rhythm to restore language. Although many studies have reported its beneficial effects on language production, randomized controlled trials (RCT) examining the efficacy of MIT are rare. In an earlier publication, we presented the results of an RCT on MIT in subacute aphasia and found that MIT was effective on trained and untrained items. Further, we observed a clear trend in improved functional language use after MIT: subacute aphasic patients receiving MIT improved considerably on language tasks measuring connected speech and daily life verbal communication. Here, we present the results of a pilot RCT on MIT in chronic aphasia and compare these to the results observed in subacute aphasia. We used a multicenter waiting-list RCT design. Patients with chronic (>1 year) post-stroke aphasia were randomly allocated to the experimental group (6 weeks MIT) or to the control group (6 weeks no intervention followed by 6 weeks MIT). Assessments were done at baseline (T1), after 6 weeks (T2), and 6 weeks later (T3). Efficacy was evaluated at T2 using univariable linear regression analyses. Outcome measures were chosen to examine several levels of therapy success: improvement on trained items, generalization to untrained items, and generalization to verbal communication. Of 17 included patients, 10 were allocated to the experimental condition and 7 to the control condition. MIT significantly improved repetition of trained items (β = 13.32, p = 0.02). This effect did not remain stable at follow-up assessment. In contrast to earlier studies, we found only a limited and temporary effect of MIT, without generalization to untrained material or to functional communication. The results further suggest that the effect of MIT in chronic aphasia is more restricted than its effect in earlier stages post stroke. This is in line with studies showing larger effects of aphasia therapy in earlier compared to later stages post stroke. The study was designed as an RCT, but was underpowered. The results therefore have to be interpreted cautiously and future larger studies are needed.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NTR 1961.
Objectives:To describe the course of walking behaviour over a period of 1 year after stroke, using accelerometry, and to compare 1-year data with those from a healthy group. Design: One-year follow-up cohort study. Subjects: Twenty-three stroke patients and 20 age-matched healthy subjects. Methods: Accelerometer assessments were made in the participants' daily environment for 8 h/day during the 1 st (T1), 12 th (T2) and 48 th (T3) weeks after stroke, and at one timepoint in healthy subjects. Primary outcomes were: percentage of time walking and upright (amount); mean duration and number of walking periods (distribution); step regularity and gait symmetry (quality); and walking speed. Step regularity, gait symmetry and gait speed showed a tendency to increase consistently from T1 to T3. At T3, amount and distribution variables reached the level of the healthy group, but significant differences remained (p < 0.02) in step regularity and gait speed. Conclusion: In this cohort, different outcomes of walking behaviour showed different patterns and levels of recovery, which supports the multi-dimensional character of gait.
IntroductionA large proportion of patients experiences a wide range of sequelae after acute COVID-19 infection, especially after severe illness. The long-term health sequelae need to be assessed. Our objective was to longitudinally assess persistence of symptoms and clusters of symptoms up to 12 months after hospitalization for COVID-19, and to assess determinants of the main persistent symptoms.MethodsIn this multicenter prospective cohort study patients with COVID-19 are followed up for 2 years with measurements at 3, 6, 12, and 24 months after hospital discharge. Here, we present interim results regarding persistent symptoms up to 12 months. Symptoms were clustered into physical, respiratory, cognitive and fatigue symptoms.ResultsWe included 492 patients; mean age was 60.2±10.7 years, 335 (68.1%) males, median length of hospital stay 11 (6.0-27.0) days. At 3 months after discharge 97.0% of the patients had at least 1 persisting symptom, this declined to 95.5% and 92.0% at 6 and 12 months, respectively (p=0.010). Muscle weakness, exertional dyspnea, fatigue, and memory and concentration problems were the most prevalent symptoms with rates over 50% during follow-up. Over time, muscle weakness, hair loss, and exertional dyspnea decreased significantly (p<0.001), while other symptoms, such as fatigue, concentration and memory problems, anosmia, and ageusia persisted. Symptoms from the physical and respiratory cluster declined significantly over time, in contrast to symptoms from the fatigue and cognitive clusters. Female gender was the most important predictor of persistent symptoms and co-occurrence of symptoms from all clusters. Shorter hospital stay and treatment with steroids were related with decreased muscle weakness; comorbidity and being employed were related with increased fatigue; and shorter hospital stay and comorbidity were related with memory problems.ConclusionThe majority of patients experienced COVID-19 sequelae up to 12 months after hospitalization. Whereas physical and respiratory symptoms showed slow gradual decline, fatigue and cognitive symptoms did not evidently resolve over time. This finding stresses the importance of finding the underlying causes and effective treatments for post-COVID condition, beside adequate COVID-19 prevention.
Stroke is a major cause of disability in western societies. Besides insight in the effectiveness of stroke inpatient rehabilitation, there is a need for studies evaluating the efficiency of rehabilitation after stroke. We aimed to study the effectiveness of inpatient stroke rehabilitation and evaluated the relative importance of demographic and clinical characteristics to predict (un)successful functional outcome of stroke inpatient rehabilitation. A total of 293 stroke patients were enrolled in this study. We assessed functional ability and quality of life (QoL) before and after inpatient stroke rehabilitation. Functional ability was assessed using the Barthel Index (BI) and the Academic Medical Center Linear Disability Score (ALDS). QoL was measured using the COOPWONCA and the Nottingham Health Profile (NHP). We used multivariable linear regression analysis to develop a model predicting functional outcome as assessed by the ALDS at discharge. We used ROC curve analysis to study the discriminatory power of the regression model for a (un)successful functional outcome. A successful outcome was defined as an ALDS discharge score of 1 or higher, i.e. able to perform difficult functional activities. An unsuccessful outcome was defined as an ALDS discharge score of -1 or lower, i.e. only able to perform simple functional activities. Results show significant improvements on both the functional ability measures (both BI score and ALDS score improved with 52% (p<.001)) and the quality of life measures (COOPWONCA improved with 9-31% (p<.05) and NHP improved with 25-56% (p<.001)). A better ALDS admission score, younger age, less severe stroke, a better BI admission score, less pain and less negative emotional reactions as measured with the NHP on admission turned out as independent predictors of a better ALDS discharge score, explaining 39.2% of its variance. ROC curve analysis showed a discriminatory power of the regression model for a successful or unsuccessful functional outcome of 80% and 93%, respectively. These prognostic factors need to be taken into account to optimize efficiency of stroke inpatient rehabilitation, like focusing on pain and negative emotional reactions, and can provide realistic therapeutic goals for stroke patients.
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