Van Lieshout Test Research Articles

Internal consistency and validity of the Italian version of the Jebsen-Taylor hand function test (JTHFT-IT) in people with tetraplegia.

Psychometric study. This study aimed to evaluate the internal consistency and validity of the Italian version of the Jebsen-Taylor hand function test (JTHFT-IT) in people with tetraplegia. Italian spinal units. Psychometric properties of the JTHFT-IT were assessed following international guidelines. The internal consistency was examined using Cronbach's alpha coefficient. Pearson's correlation coefficient was calculated for the concurrent validity of JTHFT-IT with a dynamometer, while the construct validity was calculated in comparison to that of the Van Lieshout test short version in Italian (VLT-SV-IT). The test was administered to 48 right-hand dominant people with tetraplegia. Cronbach's alpha calculation resulted in a value of 0.96 for the right hand and 0.94 for the left hand. In terms of the validity of the scale, the Pearson's correlation, as measured in relation to the VLT-SV-IT and dynamometer, showed statistically significant results (range for the correlation coefficient of between -0.96 and -0.12, p < 0.05). The findings of this study support the internal consistency and validity of the JTHFT-IT and its use among a population with cervical SCI as a measure of hand functionality.

Upper limb motor and functional recovery in patients with tetraplegia

To study the recovery of the upper limb motor function and functional independence in patients with cervical spinal cord injury. The study included 49 patients with subacute tetraplegia, mean age 33±14.8 years, 42 men and 7 women, admitted to the Preodolenie Rehabilitation Center. The follow-up was up to 2 years. The clinical and functional states were assessed after 3, 6, 12 and more than 12 months after spinal injury, using the ASIA neurological standard scale, the motor subscale of Functional Independence Scale (FIM) and short form of Van Lieshout Test (VLT). All patients received continuous rehabilitation courses that included physiotherapy, occupational therapy, social support, psychological rehabilitation. Upper limb motor recovery occurred in the first 6 months after spinal cord injury at 5±3.9 points (ASIA), while in 49% patients motor level decreased by one segment of the spinal cord, in 8% patients completeness of spinal cord injury improved. The improvement of functional independence was found during the first 12 months: according to FIM, in the period of 3-6 months by 18±11.1 points, in the period of 6-12 months by 8±8.1 points; according to VLT in the period of 3-6 months by 19±14.4 points, in the period of 6-12 months by 5.6±6.02 points. Upper limb motor recovery mostly occurs in the first 6 months while the functional independence improvement lasts during the first 12 months after a spinal cord injury.

Значение теста Ван-Люшот в оценке функции верхней конечности у пациентов с цервикальной тетраплегией

Значение теста Ван-Люшот в оценке функции верхней конечности у пациентов с цервикальной тетраплегией

Validation of the short version of the Van Lieshout Test in an Italian population with cervical spinal cord injuries: a cross-sectional study.

Psychometric study. To validate the Italian version of the Van Lieshout Test Short Version (VLT-SV) with a spinal cord injury population. Three Italian spinal units. The Italian version of the VLT-SV (VLT-SV-IT) was administered to a sample of people with cervical spinal cord injuries (C-SCI) and the test-retest was performed. Reliability was assessed using Cronbach's alpha for internal consistency and the intraclass correlation coefficient for repeatability assessment (test-retest). Pearson's correlation coefficient was calculated for concurrent validity with the Italian version of the Jebsen-Taylor Hand Function Test (JTHFT) and for construct validity with the Italian version of the Spinal Cord Injury Independence Measure (SCIM III). The VLT-SV-IT was administered to 61 individuals and all psychometric properties were significant: Cronbach's alpha was 0.95 (left hand and right hand) and the intraclass correlation coefficient for test-retest reliability was 0.90 for the right hand, the left hand, and the total score. Pearson's correlation coefficient of the VLT-SV-IT with the JTHFT was significant, while the correlation with SCIM III was not. The obtained values are considered acceptable and consistent with international guidelines. The VLT-SV-IT was shown to be a reliable and valid assessment tool for measuring hand function in the Italian population with C-SCI. This result suggests that it could be used as a starting point for hand therapy and to assist in clinical decision-making regarding treatment policy.

Wheelchair Skills Training for Functional Activity in Adults with Cervical Spinal Cord Injury.

Wheelchair skills training can improve independent wheeled mobility for daily living activities as well as functional and social participation of adults with cervical spinal cord injury (C-SCI). The objective of this study was to examine the effectiveness of wheelchair skills training in improving both wheelchair skills and upper arm skilled performance in adults with C-SCI. In a randomized controlled study, 24 adults with tetraplegia were randomized and allocated to training group (n=13) or control group (n=11). The training group attended wheelchair skills training sessions, whereas the control group attended conventional exercise sessions. All interventions lasted 8 weeks, with a frequency of 3 days per week. All individuals were tested with the Wheelchair Skills Test (WST) and the Van Lieshout Test (VLT). The test was repeated at pre- and post-training (after 4 weeks and 8 weeks). For WST, univariate analysis demonstrated significant main effects in between-group, within-group, and group-by-time interaction (p<0.05). VLT showed no significant effect in between-group comparison (p>0.05), whereas within-group comparison of test times and group-by-time interaction showed significant main effects (p<0.05). Thus, wheelchair skills training is more beneficial for adults with C-SCI than conventional exercise.

Validation and cross-cultural adaptation of the Van Lieshout test in an Italian population with cervical spinal cord injury: a psychometric study.

Psychometric study. To assess the reliability and validity of the Italian-translated and adapted version of the Van Lieshout test (VLT) in a population of people with cervical spinal cord injury (C-SCI). Multicenter study in multiple hospitals in Italy. The original scale was translated from English to Italian according to international guidelines. The internal consistency, test-retest reliability, and responsiveness of the Italian version of the VLT (IT-VLT) were examined. The IT-VLT was administered to 50 individuals with C-SCI, and its construct and convergent validity were evaluated using Pearson correlation coefficients with the Italian version of the Spinal Cord Injury Measure version III (SCIM III). All psychometric properties of the IT-VLT showed significant values, including the Cronbach's α, which was 0.95 (left hand) and 0.94 (right hand). Furthermore, the test-retest reliability showed an intraclass correlation coefficient of 0.89, 0.81, and 0.87 for the right hand, left hand, and total value, respectively. The Pearson correlation coefficient of the IT-VLT and the Italian version of the SCIM III showed all significant results r = 0.559 (p < 0.01). The IT-VLT score improved significantly during in-patient rehabilitation In fact the mean (95% CI) change between T0 and T1 was - 13.2 ± 28.6 (- 21.38; - 5.10). The IT-VLT was a reliable and a valid outcome measure for assessing hand function in the Italian population with C-SCI. The present study lays the grounds to investigate the psychometric properties of the short version of the IT-VLT.

Robot-assisted arm assessments in spinal cord injured patients: a consideration of concept study.

Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the “Graded and Redefined Assessment of Strength, Sensibility and Prehension” (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

Assisted Movement With Proprioceptive Stimulation Reduces Impairment and Restores Function in Incomplete Spinal Cord Injury

ObjectiveTo test whether treatment with assisted movement with enhanced sensation (AMES) using vibration to the antagonist muscle would reduce impairments and restore upper limb function in people with incomplete tetraplegia. DesignProspective, pre-post study. SettingLaboratory and rehabilitation hospital. ParticipantsWe recruited 15 arms from 10 individuals (8 men; mean age, 40.5y; mean years postspinal cord injury [SCI], 3) with chronic, incomplete tetraplegia. InterventionTwo or three 20-minute sessions per week over 9 to 13 weeks (25 sessions total) on the AMES device, which combines repeated movement with targeted vibration to the antagonist muscle. Main Outcome MeasuresStrength and active motion tests on the AMES device; International Standards for the Neurological Classification of SCI (ISNCSCI) motor and sensory examinations; Modified Ashworth Scale (MAS); grasp and release test (GRT); Van Lieshout Test (VLT); and Capabilities of Upper Extremity questionnaire (CUE). ResultsThe AMES strength test scores improved significantly in metacarpophalangeal flexion (P=.024) and extension (P=.007) and wrist flexion (P=.001) and extension (P<.000). The AMES active motion scores improved in the hand (P=.001) and wrist (P=.001). The MAS and ISNCSCI scores remained unchanged, whereas the GRT scores increased (P=.025). Post hoc analysis showed a trend from pre- to posttreatment (P=.068) and a significant change from pretreatment to 3-month follow-up (P=.046). There was no significant change in the VLT (P=.951) or the CUE (P=.164). Five of the 10 participants reported a return of sensation to the digits after the first, second, or third treatment session. ConclusionsPeople with chronic, incomplete tetraplegia may experience improvements in impairments and function after treatment on a device combining assisted movement and proprioceptive stimulation. Further investigation is warranted.

Arm hand skilled performance in persons with a cervical spinal cord injury—long-term follow-up

Retrospective cohort study. To assess development of arm hand skilled performance (AHSP) during and after in-patient rehabilitation in persons with cervical spinal cord injury (CSCI) and to determine factors that influence the outcome. Eight rehabilitation centres in the Netherlands with specialised spinal cord injury departments. AHSP was assessed using the Van Lieshout test (VLT) in persons admitted with recent CSCI. Assessment was carried out at the beginning (t1), after 3 months (t2), at the end (t3) of in-patient rehabilitation, and 1 and 5 years thereafter (t4, t5). Multilevel regression analysis was performed to determine development of AHSP and associations between AHSP and age, gender, motor completeness, lesion level (high or low CSCI), motor scores of upper extremity (MSUE), and pain in the tested arm. Fifty-five participants were included with mean age 38 years (range 18–64). There were 73% male, 80% had high CSCI (C3–C6) and 69% had motor complete lesion. Scores of VLT improved significantly during in-patient rehabilitation (mean: t1=25; t3=33) (P=0.005), scores remained unchanged at 1 year (t4=32) and 5 years (t5=32) (P=0.903) after in-patient rehabilitation. Motor completeness, MSUE and pain were significantly related to the VLT score (P<0.001, P<0.001, P=0.015, respectively). Age, gender and lesion level had no significant relationship. AHSP improved during in-patient rehabilitation. It was then stable during the next 5 years after discharge. Persons with an incomplete lesion, high MSUE and no pain in the tested arm perform best on the VLT.

Evaluation of a task-oriented client-centered upper extremity skilled performance training module in persons with tetraplegia

Clinical intervention study. Arm hand skilled performance (AHSP) has a major role in the rehabilitation of persons with cervical spinal cord injury (C-SCI). A task-oriented client-centered upper extremity skilled performance-training (ToCUEST) module was developed. The present study aims to evaluate effects of ToCUEST on specific and general AHSP in C-SCI, during and after rehabilitation. Adelante Rehabilitation Centre (The Netherlands). C-SCI persons, either during or after rehabilitation, completed the ToCUEST training; a control group of patients during rehabilitation received standard rehabilitation. The training module was focused on patient's individual needs, combining principles of motor learning and training physiology. Three self-selected goals were trained 3 days per week, in three sessions of 30 min per day for 8 weeks. Measures were taken at 3 months after the start of the active rehabilitation (T0), before training (T1), after training (T2), at follow-up (3 months post-training; T3) and at discharge. For both ToCUEST groups during (n=11) and after (n=12) rehabilitation, an improvement (P<0.001) on specific AHSP (using the Goal Attainment Scale and the Canadian Occupational Performance Measure (satisfaction and performance)) was found between T1-T2 and T1-T3. Also an improvement (P<0.02) in general AHSP (using the Van Lieshout Test, the QIF and the motor FIM) was found in the total ToCUEST group between T1-T2 and T1-T3. No significant difference in improvement of general AHSP was found between the ToCUEST rehab and control group. The ToCUEST module leads to improvement in AHSP, not only persons with C-SCI during rehabilitation, but also after finishing rehabilitation. These effects remain at follow-up.

Measuring change in arm hand skilled performance in persons with a cervical spinal cord injury: responsiveness of the Van Lieshout Test

To asses whether the Van Lieshout Test (VLT) is responsive to measure changes in arm hand skilled performance (AHSP) over time during active rehabilitation in persons with cervical spinal cord injury (C-SCI) and in different subgroups of persons with C-SCI according to lesion completeness and to lesion level. Longitudinal cohort study. Spinal Cord Injury Units in eight rehabilitation centres across the Netherlands. In the present study, data from a national SCI cohort study are used. Data from the VLT, the Grasp Release Test (GRT), the Functional Independence Measure (FIM) and the Quadriplegia Index of Function (QIF) were recorded at three moments during active rehabilitation: at the start of active rehabilitation (t1), 3 months after t1 (t2) and at discharge (t3). Data have been analysed using three responsiveness measures, that is, the standardized response mean, the effect size and comparison of test scores measured at different times. The VLT is responsive for the intervals t1-3, t1-2 and t2-3. The VLT can be used to measure changes in AHSP in persons with a C-SCI with an American Spinal Injury Association Impairment Scale (AIS) A or B score or an AIS C or D score, as well as in persons with a C3-C6 lesion or a C7-T1 lesion. The responsiveness of the VLT is significantly correlated to the GRT, but not to the FIM and the QIF. The VLT is responsive in measuring changes in AHSP during rehabilitation in persons with C-SCI.

Measurement properties of the short version of the Van Lieshout test for arm/hand function of persons with tetraplegia after spinal cord injury

Two validation studies. To assess the measurement properties of the short version of the Van Lieshout test (VLT-SV), a new test for arm/hand function of persons with tetraplegia after spinal cord injury (SCI). Two specialized rehabilitation centres in The Netherlands. Study 1 (N=12)--assessment of inter-rater reliability (intraclass correlations (ICC); weighted kappa; Bland-Altman plots). Study 2 (N=55)--assessment of convergent validity by computing Spearman's correlations with the Grasp-Release test (GRT; criterion standard) and with motor level of injury, ASIA impairment scale, international classification for surgery of the hand, and the self-care and transfer scales of the functional independence measure. All statistics were computed separately for the right- and the left-hand scores. Inter-rater reliability was excellent (ICC 0.98 and 0.99). Agreement was independent of the height of the scores and the limits of agreement were +/-0.5 points on a 0-5 scale. Convergent validity was very good with a Spearman correlation of 0.87 and 0.90 between the VLT-SV and the GRT and correlations between 0.35 and 0.85 with the other indicators of arm/hand function. The VLT-SV seems a reliable and valid test to assess arm/hand function of persons with tetraplegia after SCI.