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The imagination of motor actions forms not only a theoretical challenge for cognitive neuroscience but may also be seen as a novel therapeutic tool in neurological rehabilitation, in that it can be used for relearning motor control after damage to the motor system. However, since the majority of rehabilitation patients consist of older individuals it is relevant to know whether the capacity of mental imaging is compromised by age. Scores on the vividness of movement imagery questionnaire were obtained for 333 participants, divided in three age groups. Results showed that elderly participants were slightly worse in motor imagery capacity than younger participants, particularly in relation to motor imagery from an internal (first person) perspective. Furthermore, a possible relation between the level of physical activities and motor imagery capacity is discussed.

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BACKGROUND: In ageing populations fear of falling is an important issue. International studies and collaborations require scales suitable to more cultures. Scales developed in one culture require adaptation and additional investigation of psychometric properties for use in other countries. OBJECTIVE: To investigate the psychometric properties of a Dutch version of the Activities-specific Balance Confidence scale (ABC-NL) and whether adding questions about complex/dual tasks improves the discriminatory power. METHOD: Subjects were 106 men and 140 women aged 65-92 years. Measures were the 16-item ABC-NL and seven additional more complex items, fall history, general and physical self-efficacy, a functional reach test and a balance platform test. RESULTS: The ABC-NL had a weak ceiling effect. Internal consistency (Cronbachs alpha) was high. The relationship between ABC-NL and physical self-efficacy was significantly stronger than between the ABC-NL and general self-efficacy. Relationships with performance-based measures of balance were moderate. Differences between fallers and non-fallers and between activity avoiders and non-avoiders were significant. Adding questions about complex tasks hardly improved discriminatory power, reliability and validity. CONCLUSION: Psychometric properties of the ABC-NL were satisfactory. Further research is needed for use in high-functioning older persons.

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Is the Activities-specific Balance Confidence Scale suitable for Dutch older persons living in the community? Background: In ageing populations fear of falling is an important issue. International studies and collaborations require scales suitable to more cultures. Scales developed in one culture require adaptation and additional investigation of psychometric properties for use in other countries.Objective: To investigate the psychometric properties of a Dutch version of the Activities-specific Balance Confidence scale (ABC-NL) and whether adding questions about complex/dual tasks improves the discriminatory power.Method: Subjects were 106 men and 140 women aged 65-92 years. Measures were the 16-item ABC-NL and seven additional more complex items, fall history, general and physical self-efficacy, a functional reach test and a balance platform test.Results: The ABC-NL had a weak ceiling effect. Internal consistency (Cronbachs alpha) was high. The relationship between ABC-NL and physical self-efficacy was significantly stronger than between the ABC-NL and general self-efficacy. Relationships with performance-based measures of balance were moderate. Differences between fallers and non-fallers and between activity avoiders and non-avoiders were significant. Adding questions about complex tasks hardly improved discriminatory power, reliability and validity.Conclusion: Psychometric properties of the ABC-NL were satisfactory. Further research is needed for use in high-functioning older persons.

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OBJECTIVES: To describe the quality of life (QOL) of stroke patients and to distill neuropsychologic predictors for poor QOL. DESIGN: A cohort study in which patients were neuropsychologically assessed at a mean of 72.2 days after stroke, with follow-up at a mean of 9.8 months after stroke. SETTING: Research department of a rehabilitation center. PATIENTS: A consecutive sample of 164 stroke patients (mean age, 55.2yr) recruited from a university hospital, a regional hospital, and a rehabilitation center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Orientation, memory, attention and concentration, visuospatial and visuoconstructive functions, language, and arithmetic skills were assessed with neuropsychologic tests. QOL was assessed with the Sickness Impact Profile (SIP). RESULTS: An overall mean SIP score +/- standard deviation of 20 +/- 11 showed that stroke has a high impact on everyday functioning. Further analyses indicated that QOL is related in particular to tests measuring spatiotemporal and/or sequential aspects of behavior. Forward/backward stepwise regression analysis (n = 106) showed that poor QOL was more likely if patients had a poor result on the Trailmaking Test (TMT) B and/or were women. CONCLUSION: The predictive value of the TMT is most effective and very useful because the TMT is a short and economical procedure. However, the gender-related aspects of recovery deserve more attention, as does the possible bias that can be caused by the composition of a measurement. Further research is needed to refine predictive models that are needed to facilitate the development of more adequate, individual rehabilitation programs.

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This article stresses the plasticity of the adult sensorimotor cortex in response to various injuries or environmental changes. The dominant role of sensory input is discussed. A number of studies are presented that show how input may lead to learning and change. Learning is discussed in relation to recovery. It is shown how concepts from the field of motor control and learning may be used for improving neurological rehabilitation. Specific attention is given to the variability of input, the meaningfulness of input, and the role of the learning context. The learning context and the application context should have essential characteristics in common, otherwise transfer of learning will be non-optimal. It is argued that learning landscapes are necessary in order to treat patients in such a way that the learned skills are transferable to situations outside the hospital.

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Regaining independent mobility is one of the most important goals in physical therapy with patients suffering from the consequences of stroke. Both physical therapy and occupational therapy are learning processes in which the patient has to remaster old skills or has to learn novel skills. It is argued that the (re-)learning of motor control is a process in which motor aspects continuously interact with sensory and cognitive processes. It is therefore necessary that neuropsychological knowledge should be integrated in the therapy in order to create the most optimal situation for learning. In this article the most prominent neuropsychological consequences are described and suggestions are given as to how a therapist may use this knowledge to improve the therapy.

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OBJECTIVE: To examine the effect of a stroke in the basal ganglia on cognitive functioning. DESIGN: As part of a larger prospective study on the neuropsychological and psychosocial consequences of stroke, 12 patients with a stroke confined to the basal ganglia were examined. SETTING: The patients were assessed in one of the three participating hospitals. SUBJECTS: The results of 12 patients with a stroke in the basal ganglia (mean age 55 years), were compared to 24 controls (mean age 54.3 years). MAIN OUTCOME MEASURES: Different aspects of memory, attention and concentration, visuospatial and visuoconstructive functions, language and arithmetic were assessed using neuropsychological tests. RESULTS: The data show a significant abnormality in cognitive functioning on all cognitive domains. CONCLUSIONS: The results stress the notion that subcortical damage may lead to substantial neuropsychological disorders and have clear implications for neurological rehabilitation.

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General insight into the frequency and gravity of cognitive dysfunctions following stroke and its influencing factors is still lacking. With an extensive neuropsychological battery 229 patients who had suffered a stroke were assessed. More than 70% of the patients showed a marked slowness of information processing, whereas at least 40% of all patients had difficulty with memory, visuospatial and constructive tasks, language skills, and arithmetic. A significant effect was found for side and type of stroke, gender, and the presence of aphasia. No significant effect was found for cortical versus subcortical lesions, having one versus multiple strokes, having lowered consciousness on admission, the presence of risk factors, a paresis of the hand, or the interval between the stroke and the neuropsychological assessment.

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OBJECTIVE: To find out what the late implications of a stroke were for patients and relatives and whether specific requests for help existed. DESIGN: Cross sectional study. SETTING: Academic Hospital Nijmegen, department of Neurology and Sint Maartenskliniek (rehabilitation centre), The Netherlands. METHOD: Patients who had sustained a cerebrovascular accident (CVA) in the last five years were asked, using the sickness impact profile (SIP), about their subjective functioning and the effect of the CVA on daily life. They were also asked about the degree to which they experienced their complaints as a problem, and whether they needed help. RESULTS: In this study 165 patients and their close relatives filled out the SIP. Stroke had a very high impact on everyday functioning as indicated by a total SIP score of 20. The results further showed that psychosocial problems arise independently of the degree of physical problems, that these problems were chronic, and that psychosocial problems hindered 52% of the patients often to always. The physical problems hindered 60% of them often to always. A third of the patients wanted help for their physical problems, a quarter for their psychosocial problems. CONCLUSION: The impact of stroke on both patients and their relatives was extensive and appeared chronic. There was need for physical and psychosocial help in a third or quarter of the cases.

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