Evidence of Multidimensionality in the ALSFRS-R Scale: A Critical Appraisal on Its Measurement Properties Using Rasch Analysis.

Evidence of multidimensionality in the ALSFRS-R Scale: a critical appraisal on its measurement properties using Rasch analysis.

J Neurol Neurosurg Psychiatry. 2013 Mar 20;
Franchignoni F, Mora G, Giordano A, Volanti P, Chiò A

OBJECTIVE: To examine dimensionality, reliability and validity of the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-R) using traditional classical test theory methods and Rasch analysis in order to provide a rationale for possible improvement of its metric quality. METHODS: Methodological research on ALSFRS-R collected in a consecutive sample of 485 patients with amyotrophic lateral sclerosis (ALS) attending three tertiary ALS centres. RESULTS: The ALSFRS-R items showed good internal consistency but dimensionality analysis argues against the use of ALSFRS-R as a single score because the scale lacks unidimensionality. Parallel analysis and exploratory factor analysis revealed three factors representing the following domains: (1) bulbar function; (2) fine and gross motor function; and (3) respiratory function. Rasch analysis showed that all items in each domain fitted the respective constructs to measure, except for item No 9 ‘climbing stairs’ and item No 12 ‘respiratory insufficiency’. Rating categories did not comply with the criteria for category functioning. Collapsing the scale’s 5 level ratings into 3 levels improved its metric quality. CONCLUSIONS: The ALSFRS-R fails to satisfy rigorous measurement standards and should be, at least in part, revised. At present, ALSFRS-R should be considered as a profile of mean scores from three different domains (bulbar, motor and respiratory functions) more than a global total score. Further studies on ALSFRS-R using modern psychometric methods are warranted to confirm our findings and refine the metric quality of this scale, through a step by step process. HubMed – rehab


Neural changes with tactile learning reflect decision-level reweighting of perceptual readout.

J Neurosci. 2013 Mar 20; 33(12): 5387-98
Sathian K, Deshpande G, Stilla R

Despite considerable work, the neural basis of perceptual learning remains uncertain. For visual learning, although some studies suggested that changes in early sensory representations are responsible, other studies point to decision-level reweighting of perceptual readout. These competing possibilities have not been examined in other sensory systems, investigating which could help resolve the issue. Here we report a study of human tactile microspatial learning in which participants achieved >six-fold decline in acuity threshold after multiple training sessions. Functional magnetic resonance imaging was performed during performance of the tactile microspatial task and a control, tactile temporal task. Effective connectivity between relevant brain regions was estimated using multivariate, autoregressive models of hidden neuronal variables obtained by deconvolution of the hemodynamic response. Training-specific increases in task-selective activation assessed using the task × session interaction and associated changes in effective connectivity primarily involved subcortical and anterior neocortical regions implicated in motor and/or decision processes, rather than somatosensory cortical regions. A control group of participants tested twice, without intervening training, exhibited neither threshold improvement nor increases in task-selective activation. Our observations argue that neuroplasticity mediating perceptual learning occurs at the stage of perceptual readout by decision networks. This is consonant with the growing shift away from strictly modular conceptualization of the brain toward the idea that complex network interactions underlie even simple tasks. The convergence of our findings on tactile learning with recent studies of visual learning reconciles earlier discrepancies in the literature on perceptual learning. HubMed – rehab


Comparing routine neurorehabilitation program with trunk exercises based on Bobath concept in multiple sclerosis: Pilot study.

J Rehabil Res Dev. 2013 Jan; 50(1): 133-40
Keser I, Kirdi N, Meric A, Kurne AT, Karabudak R

This study compared trunk exercises based on the Bobath concept with routine neurorehabilitation approaches in multiple sclerosis (MS). Bobath and routine neurorehabilitation exercises groups were evaluated. MS cases were divided into two groups. Both groups joined a 3 d/wk rehabilitation program for 8 wk. The experimental group performed trunk exercises based on the Bobath concept, and the control group performed routine neurorehabilitation exercises. Additionally, both groups performed balance and coordination exercises. All patients were evaluated with the Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), and Multiple Sclerosis Functional Composite (MSFC) before and after the physiotherapy program. In group analysis, TIS, BBS, ICARS, and MSFC scores and strength of abdominal muscles were significantly different after treatment in both groups (p < 0.05). When the groups were compared, no significant differences were found in any parameters (p > 0.05). Although trunk exercises based on the Bobath concept are rarely applied in MS rehabilitation, the results of this study show that they are as effective as routine neurorehabilitation exercises. Therefore, trunk exercises based on the Bobath concept can be beneficial in MS rehabilitation programs. HubMed – rehab


Can static interface pressure mapping be used to rank pressure-redistributing cushions for active wheelchair users?

J Rehabil Res Dev. 2013 Jan; 50(1): 53-60
Hollington J, Hillman SJ

Interface pressure mapping (IPM) is a clinical tool that assists the selection of seat cushions for pressure management for wheelchair users. Clinical pressure measurements are almost always made under static sitting conditions, although this does not consider the time-dependent properties of some cushion materials that may behave differently under the dynamic conditions of self-propulsion. This study investigated the potential for such differences by collecting seat IPM measurements from eight wheelchair users using four different seat cushion designs during static sitting and self-propulsion. Mean pressure corresponding to the approximate anatomical location of the ischial tuberosities was used to rank the four cushions under the two conditions. The two sets of rankings for each participant were then compared using correlation. Dynamic data from four participants was judged too inconsistent to be interpreted reliably and demonstrates the practical difficulties associated with dynamic IPM measurement when variations in individual propulsion technique cannot be controlled. Strong correlations were observed between rank orders for the remaining four participants and suggest that the statically derived pressure measures can be used for clinical decision making when selecting cushions for self-propelling wheelchair users. HubMed – rehab



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