Publications by authors named "Willem De Hertogh"

64 Publications

ICF domains covered by the Tinnitus Questionnaire and Tinnitus Functional Index.

Disabil Rehabil 2021 Sep 15:1-10. Epub 2021 Sep 15.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.

Purpose: Tinnitus frequently causes disability as it affects daily living, which is objectified using several tinnitus questionnaires. To what extent they cover domains of the International Classification of Functioning, Disability and Health (ICF) is currently unknown. Therefore, this study aims to investigate which ICF domains are measured by two questionnaires and to describe the health status of somatic tinnitus patients in ICF terms.

Materials And Methods: All questions of the Tinnitus Questionnaire (TQ) and Tinnitus Functional Index (TFI) were linked to the ICF using linking rules. A count-based method was used to link all individual answers of 80 tinnitus patients, to the ICF categories.

Results: Most of the linked questions concerned "body functions". TFI covered more categories of "activity and participation" than TQ. Patients reported severe impairments in "mental functions", "sensory functions and pain", and "sleep functions". Additionally, severe limitations were scored in "focusing attention".

Conclusions: The TFI and TQ measure distinct domains but can be used complementary or solely, depending on the research question. The TFI identifies a broad spectrum of problems, where the TQ focuses on the psychological impact of tinnitus. Somatic patients in our study reported impairments and disabilities in all covered domains, especially in "onset of sleep" and "sound detection".Implications for RehabilitationThe Tinnitus Functional Index (TFI) and the Tinnitus Questionnaire (TQ) cover different domains of the International Classification of Functioning, Disability and Health.The TFI identifies problems in "body functions" and "activity and participation".The TQ focuses on the psychological impact of tinnitus.
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http://dx.doi.org/10.1080/09638288.2021.1972172DOI Listing
September 2021

Interrater and intrarater reliability of the single arm military press (SAMP) test for upper limb function in patients with non-specific neck pain.

Musculoskelet Sci Pract 2021 Oct 20;55:102428. Epub 2021 Jul 20.

Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK. Electronic address:

Background: Performance measures that assess the upper limb disability (ULD) in patients with neck pain can provide useful information for making clinical decisions regarding the optimal management of those patients. The Single Arm Military Press (SAMP) test is a performance based ULD measure developed specifically for populations with neck pain. In this test, patients are asked to lift a 1 kg weight repetitively overhead for 30 s with repetitions counting as the score. Whilst the test has been shown to be acceptable and feasible for use by clinicians and patients, its reliability in a patient group is still unknown.

Objective: To assess the interrater, intrarater reliability and measurement error of the SAMP test in patients with non-specific neck pain (NSNP).

Methods: A total of 210 patients with NSNP and 81 healthy subjects were recruited for this study. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Neck Disability Index (NDI) were assessed at baseline to ensure eligibility of the participants. The SAMP test was assessed at baseline and repeated 4-7 days later. A VAS symptom score was used to establish the stability of the participants across time. Interrater, intrarater reliability and measurement error were evaluated using Interclass Correlation Coefficient (ICC2,1) and the standard error of measurement (SEM).

Results: The ICCs for interrater and intrarater reliability for the SAMP test ranged from 0.993 to 0.996 in the patient group. The SEM was ≤1 and smaller than the Smallest Detectable Change (SDC) and Bland-Altman plot indicated that the test is accurate.

Conclusion: The almost perfect interrater and intrarater reliability and low levels of measurement error indicate that the 1 kg SAMP test has potential for evaluating upper limb functional capacity in female patients with NSNP. Before the test can be fully recommended, further studies are required to evaluate the validity and responsiveness of the SAMP test in population with NSNP and other neck disorders.
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http://dx.doi.org/10.1016/j.msksp.2021.102428DOI Listing
October 2021

High Definition transcranial Direct Current Stimulation (HD-tDCS) for chronic tinnitus: Outcomes from a prospective longitudinal large cohort study.

Prog Brain Res 2021 30;263:137-152. Epub 2021 Jan 30.

University Department of Otorhinolaryngology and Head & Neck surgery, Antwerp University Hospital, Edegem, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium; Department of Education, Health & Social Work, University College Ghent, Ghent, Belgium.

Background: Transcranial Direct Current Stimulation (tDCS) aims to induce cortical plasticity by modulating the activity of brain structures. The broad stimulation pattern, which is one of the main limitations of tDCS, can be overcome with the recently developed technique called High-Definition tDCS (HD-tDCS).

Objective: Investigation of the effect of HD-tDCS on tinnitus in a large patient cohort.

Methods: This prospective study included 117 patients with chronic, subjective, non-pulsatile tinnitus who received six sessions of anodal HD-tDCS of the right Dorsolateral Prefrontal Cortex (DLPFC). Therapy effects were assessed by use of a set of standardized tinnitus questionnaires filled out at the pre-therapy (T), post-therapy (T) and follow-up visit (T). Besides collecting the questionnaire data, the perceived effect (i.e., self-report) was also documented at T.

Results: The Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) total scores improved significantly over time (p<0.01; p<0.01), with the following significant post hoc comparisons: T vs. T (p<0.05; p<0.05) and T vs. T (p<0.01; p<0.01). The percentage of patients reporting an improvement of their tinnitus at T was 47%. Further analysis revealed a significant effect of gender with female patients showing a larger improvement on the TFI and TQ (p<0.01; p<0.05).

Conclusions: The current study reported the effects of HD-tDCS in a large tinnitus population. HD-tDCS of the right DLPFC resulted in a significant improvement of the tinnitus perception, with a larger improvement for the female tinnitus patients.
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http://dx.doi.org/10.1016/bs.pbr.2020.09.001DOI Listing
January 2021

Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study.

Musculoskelet Sci Pract 2021 04 26;52:102325. Epub 2021 Jan 26.

Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.

Background: Though a large amount of research on the management of headache has been conducted, the clinical effectiveness of these treatments remains unclear.

Objectives: To reach consensus among international musculoskeletal experts on what the most appropriate management is in patients that suffer from headache.

Design: Expert group and Delphi-study.

Methods: A total of 11 experts participated in the expert panel groups, where the role of physiotherapy in the management of headache was discussed. Afterwards, 14 of the initial 25 participants in the field of headache completed the whole Delphi study, which was conducted over 4 rounds. The first round aimed to identify clinical indicators and treatments that are useful in patients with headache. These questions were then categorized and ranked during the second, third, and fourth rounds. Consensual agreement was set at ≥ 80%.

Results: After the final round, 9 interventions were rated as useful by the participants. In the final extra round, 14 clinical indicators were retrieved as important to decide whether or not to start one of the consensual treatments. The top 3 management strategies were (1) upper cervical spine mobilisations in cervivogenic headache, (2) active mobilisation exercises of the cervical spine in cervivogenic headache, and (3) lifestyle advice in tension-type headache and migraine.

Conclusion: International experts agreed that most scientifically established effective treatments are useful in cervicogenic headache. Consensual agreement on treatments for migraine and tension-type headache were only reached for specific treatments. Their recommendations provide a framework for further research and the clinical management of headache.
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http://dx.doi.org/10.1016/j.msksp.2021.102325DOI Listing
April 2021

SWEAT2 study: effectiveness of trunk training on muscle activity after stroke. A randomized controlled trial.

Eur J Phys Rehabil Med 2021 Aug 9;57(4):485-494. Epub 2020 Nov 9.

Department of Rehabilitation Sciences and Physiotherapy (REVAKI/MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Background: Trunk training after stroke is an effective method for improving trunk control, standing balance and mobility. The SWEAT study attempts to discover the underlying mechanisms leading to the observed mobility carry-over effects after trunk training.

Aim: A secondary analysis investigating the effect of trunk training on muscle activation patterns, muscle synergies and motor unit recruitment of trunk and lower limbs muscles, aimed to provide new insights in gait recovery after stroke.

Design: Randomized controlled trial.

Setting: Monocentric study performed in the RevArte Rehabilitation Hospital (Antwerp, Belgium).

Population: Forty-five adults diagnosed with first stroke within five months, of which 39 completed treatment and were included in the analysis.

Methods: Participants received 16 hours of additional trunk training (N.=19) or cognitive training (N.=20) over the course of four weeks (1 hour, 4 times a week). They were assessed by an instrumented gait analysis with electromyography of trunk and lower limb muscles. Outcome measures were linear integrated normalized envelopes of the electromyography signal, the amount and composition of muscle synergies calculated by nonnegative matrix factorization and motor unit recruitment calculated, by mean center wavelet frequencies. Multivariate analysis with post-hoc analysis and statistical parametric mapping of the continuous curves were performed.

Results: No significant differences were found in muscle activation patterns and the amount of muscle synergies. In 42% of the subjects, trunk training resulted in an additional muscle synergy activating trunk muscles in isolation, as compared to 5% in the control group. Motor unit recruitment of the of trunk musculature showed decreased fast-twitch motor recruitment in the erector spinae muscle after trunk training: for the hemiplegic (t[37]=2.44, P=0.021) and non-hemiplegic erector spinae muscle (t[37]=2.36, P=0.024).

Conclusions: Trunk training improves selective control and endurance of trunk musculature after sub-acute stroke.

Clinical Rehabilitation Impact: What is new to the actual clinical rehabilitation knowledge is that: trunk training does not alter muscle activation patterns or the amount of muscle synergies over time; a decrease in fast-twitch motor recruitment in the erector spinae muscle was found during walking after trunk training; trunk training seems to increase the fatigue-resistance of the back muscles and enables more isolated activation.
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http://dx.doi.org/10.23736/S1973-9087.20.06409-6DOI Listing
August 2021

Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus.

Front Neurosci 2020 16;14:561038. Epub 2020 Sep 16.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Introduction: Subjective tinnitus that is influenced by the somatosensory system is called somatosensory tinnitus (ST). When ST is related to the temporomandibular area, multidisciplinary orofacial treatment can reduce tinnitus severity. It is, however, unknown if we can predict this positive outcome. The aim of this study is to look for prognostic indicators that can predict a positive outcome after multidisciplinary orofacial treatment in patients with ST.

Methods: Patients were included when they were diagnosed with temporomandibular-related ST and received a maximum of 18 sessions of orofacial treatment during a 9-week program. Predictors for positive treatment outcome were identified using univariate and multiple logistic regression analyses with the Tinnitus Questionnaire (TQ) and the Tinnitus Functional Index (TFI) as dependent variables.

Results: The results of 101 patients were included in the analysis. Immediately after multidisciplinary orofacial treatment, a clinically relevant decrease in TQ score was significantly associated with "shorter duration of tinnitus" [odds ratio (OR) 0.99], "higher initial score on the TQ somatic subscale" (OR 1.52), and "painful palpation of the temporomandibular joint (TMJ)" (OR 2.46). After 9 weeks of follow-up, the "higher initial score on the TQ somatic subscale" remained as the sole predictor (OR 1.44). A clinically relevant decrease on TFI after 9 weeks of follow-up was predicted by "female gender" (OR 2.70), "younger age" (OR 0.96), "shorter duration of the tinnitus" (OR 0.99), "lower pressure pain thresholds (PPT) on TMJ" (OR 0.99), "lower PPT on sternocleidomastoid origin" (OR 0.99), and "better speech in noise perception" (OR 0.88). A multivariate model comprising "shorter duration of tinnitus" and "higher initial score on the somatic subscale of the TQ" correctly predicts the clinically relevant decrease in TQ score after treatment in 68.5%. A second multivariate model comprising "female gender," "younger age," and "shorter duration of the tinnitus" correctly predicts a clinically significant decrease on TFI after follow-up in 68.1%.

Conclusion: We were able to identify various prognostic indicators. "Younger female patients" with a "shorter duration of tinnitus" and a "higher initial score on the TQ somatic subscale" appear to have the best prognosis after multimodal orofacial therapy.
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http://dx.doi.org/10.3389/fnins.2020.561038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7525007PMC
September 2020

Measuring upper limb disability for patients with neck pain: Evaluation of the feasibility of the single arm military press (SAMP) test.

Musculoskelet Sci Pract 2020 12 8;50:102254. Epub 2020 Sep 8.

Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom. Electronic address:

Background: Non-specific neck pain (NSNP) is frequently associated with upper limb disability (ULD). Consequently, evaluation of ULD using an outcome measure is necessary during the management of patients with NSNP. The Single Arm Military Press (SAMP) test is a performance-based ULD measure developed for populations with neck pain. During the SAMP test, patients are asked to repeatedly lift a weight above their head for 30 s. The number of repetitions is counted. Its clinical utility in a patient group is still unknown.

Objective: This study investigates the feasibility of the SAMP test from patients and clinicians' perspectives.

Methods: Seventy female patients with NSNP were randomly allocated into one of three groups. Participants in each group completed the SAMP test using one of three proposed weights (½kg, 1 kg or 1½kg). The feasibility of the SAMP test was established using structured qualitative exit feedback interviews for patients and administrating clinicians.

Results: Participants using ½kg achieved the highest number of repetitions, but a high proportion reported the weight as extremely light, whereas those who tested using the 1½kg achieved the lowest number of repetitions and participants reported the weight as being heavy. Participants tested using 1 kg achieved an average number of repetitions and a high proportion reported the weight as acceptably heavy. Clinicians and patients reported that the SAMP test was efficient and convenient.

Conclusion: The 1 kg SAMP test is feasible for use in female patients with NSNP. The measurement properties of the SAMP test should be determined in a patient group.
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http://dx.doi.org/10.1016/j.msksp.2020.102254DOI Listing
December 2020

Clinical Balance Testing to Screen for Patients With Vestibular Disorders: A Retrospective Case-control Study.

Otol Neurotol 2020 10;41(9):1258-1265

Translational Neurosciences.

Objective: Identify clinical screening tests to proficiently screen for patients with vestibular disorders.

Study Design: Retrospective case-control study.

Setting: Tertiary referral center.

Patients: 318 healthy individuals and 331 subjects with vestibular disorders.

Interventions: All subjects performed Romberg and Jendrassic maneuver with eyes closed (ROMJec), standing on foam with eyes open (SOFeo) and eyes closed (SOFec), Tandem Romberg with eyes open (TReo) and eyes closed (TRec), single leg stance with eyes open (SLSeo) and eyes closed (SLSec), Tandem gait (TG) and Timed Up and Go (TUG).

Main Outcome Measures: Significant differences in performance on the balance tests.

Results: For the age-group <40 years, TUG >6 seconds (OR 102.4; p <0.0001) and SLSec <30 seconds (OR 48.0; p <0.0001) proved to be the most predictive combination of testing (AUC 0.9; LR+ 15.8; LR- 0.2), with a positive predictive value (PPV) of 88.4%. For the age-group 40-60, TUG >7 seconds (OR 4.0; p = 0.0107) and TRec <30 seconds (OR 63.1; p < 0.0001) was the most predictive combination of tests (AUC 0.9 LR+ 6.0; LR- 0.1), with a PPV of 93.8%. For the age-group >60 the combination of TUG >8 seconds (OR 17.4; p < 0.0001) and SOFec <30 seconds (OR 10.4; p < 0.0001) was the most predictive (AUC 0.9 LR+ 6.3; LR- 0.2), with a PPV of 84.8%.

Conclusions: Combinations of clinical tests are proposed to promptly screen for vestibular disorders in specific age groups. To interpret the results for the individual patient, the physician must take the history and the general examination into consideration.
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http://dx.doi.org/10.1097/MAO.0000000000002757DOI Listing
October 2020

SWEAT2 Study: Effectiveness of Trunk Training on Gait and Trunk Kinematics After Stroke: A Randomized Controlled Trial.

Phys Ther 2020 08;100(9):1568-1581

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, MOVANT/REVAKI; RevArte Rehabilitation Hospital; and Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp.

Objective: Trunk training after stroke is an effective method for improving mobility, yet underlying associations leading to the observed mobility carryover effects are unknown. The purposes of this study were to investigate the effectiveness of trunk training for gait and trunk kinematics and to find explanatory variables for the mobility carryover effects.

Methods: This study was an assessor-masked, randomized controlled trial. Participants received either additional trunk training (n = 19) or cognitive training (n = 20) after subacute stroke. Outcome measures were the Tinetti Performance-Oriented Mobility Assessment (POMA), the Trunk Impairment Scale, spatiotemporal gait parameters, center-of-mass excursions, and trunk and lower limb kinematics during walking. Multivariate analysis with post hoc analysis was performed to observe treatment effects. Correlation and an exploratory regression analysis were used to examine associations with the mobility carryover effects.

Results: Significant improvements after trunk training, compared with the findings for the control group, were found for the Trunk Impairment Scale, Tinetti POMA, walking speed, step length, step width, horizontal/vertical center-of-mass excursions, and trunk kinematics. No significant differences were observed in lower limb kinematics. Anteroposterior excursions of the trunk were associated with 30% of the variability in the mobility carryover effects.

Conclusions: Carryover effects of trunk control were present during ambulation. Decreased anteroposterior movements of the thorax were the main variable explaining higher scores on the Tinetti POMA Gait subscale. However, the implementation and generalizability of this treatment approach in a clinical setting are laborious and limited, necessitating further research.

Impact: Trunk training is an effective strategy for improving mobility after stroke. Regaining trunk control should be considered an important treatment goal early after stroke to adequately prepare patients for walking.
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http://dx.doi.org/10.1093/ptj/pzaa110DOI Listing
August 2020

Sex Differences in the Response to Different Tinnitus Treatment.

Front Neurosci 2020 12;14:422. Epub 2020 May 12.

Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.

Introduction: Tinnitus is a complex symptom requiring a thorough multidisciplinary assessment to construct an individual's tinnitus profile. The Antwerp University Hospital hosts a tertiary tinnitus clinic providing intensive, multidisciplinary tinnitus care in the form of combinational psychological treatment with either Tinnitus Retraining Therapy (TRT)/Cognitive Behavioral Therapy (CBT) or TRT/eye movement desensitization and reprocessing therapy (EMDR), high-definition transcranial direct current stimulation (HD-tDCS), and physical therapy treatment (in cases of somatic influence of the neck or the temporomandibular area). Several factors may contribute to therapy effect of which the role of gender has recently gained more interest. As such, the current manuscript explores gender differences in the outcome of different tinnitus treatments.

Methods: Data on treatment outcome of four distinct tinnitus treatments (1. HD-tDCS; 2. orofacial physical therapy; 3. combination TRT + CBT; and 4. combination TRT + EMDR) were pooled and compared. Treatment outcome was assessed via the Tinnitus Functional Index (TFI). Participants completed the TFI at baseline, immediately after treatment and after 9 weeks (±3 weeks) follow-up. To explore the effect of gender on different treatment outcomes, a linear mixed model was designed including , , and as fixed factors as well as all interactions between these factors.

Results: TFI scores improved significantly over time regardless of therapy group ( < 0.0001). A mean TFI decrease of at least 13 points was obtained by all participants except by those in the HD-tDCS. Significant interactions between Gender and Time point were identified in all groups except for the TRT +EMDR group. Female subjects improved more extensively than males in the HD-tDCS ( = 0.0009) and orofacial therapy group ( = 0.0299). Contrarily, in the TRT +CBT group, male participants showed a significant improvement whereas the mean TFI scores of female subjects remained on baseline levels ( = 0.0138).

Conclusion: Our data suggest that male and female tinnitus patients seem to react differently to different therapy options. We strongly encourage further prospective studies to discern the relevance of gender in therapy outcome.
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http://dx.doi.org/10.3389/fnins.2020.00422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235341PMC
May 2020

Trunk biomechanics during walking after sub-acute stroke and its relation to lower limb impairments.

Clin Biomech (Bristol, Avon) 2020 05 19;75:105013. Epub 2020 Apr 19.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Multidisciplinary Motor Centre Antwerp (M(2)OCEAN), University of Antwerp, Belgium.

Background: Trunk function and lower limb strength seem to be the primary predictors for functional independence in acute stroke patients. Gaining a better understanding of their relationship during walking aids in the identification of intrinsic trunk control deficits and underlying lower limb deficits resulting in compensatory trunk movements.

Methods: Fifty-seven subjects with stroke and 57 age- and gender-matched subjects without disability were included. Participants underwent an instrumented gait analysis with a standard total body Plug-In-Gait model, a clinical examination of the lower limbs based on range of motion, strength, muscle tone and several clinical assessment scales such as the Trunk Impairment Scale, Tinetti test and Functional Ambulation Categories. Spatiotemporal parameters and joint angular time profiles were compared between healthy adults and stroke survivors with severe and mild to moderate lower limb impairments. Spm1d was used to compare the joint angular time profiles between groups.

Findings: Truncal deviations are present during hemiplegic walking, sub-acute stroke survivors walked with increased thoracic tilt, a neutral frontal position of the pelvis during stance, a pelvic hike during swing, and a more rotated position without crossing of the midline. Patients with more severe lower limb impairments had more pronounced deficits in truncal motion.

Interpretation: Setting accurate rehabilitation goals is of major importance during stroke, as well as understanding the underlying mechanisms and causes of the truncal impairments. Although more compensatory trunk deviations were seen in participants with severe lower limb impairments, they should not be considered as the sole contributor of trunk impairments during walking. Results of this study suggest that intrinsic trunk deficits during walking are also present after stroke.
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http://dx.doi.org/10.1016/j.clinbiomech.2020.105013DOI Listing
May 2020

Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program.

J Clin Med 2020 Mar 5;9(3). Epub 2020 Mar 5.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Edegem, Antwerp, Belgium.

Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity. The purpose of this study was to evaluate the effect of orofacial treatment on tinnitus complaints in patients with TST.

Methods: Adult patients with TST were included, and all patients received information and advice about tinnitus and conservative orofacial treatment consisting of physical therapy, and, in case of grinding, occlusal splints were applied. Included patients were randomly assigned to an early start group and a delayed start group according to our delayed treatment design.

Results: In total, 40 patients were included in each group. The treatment effect on tinnitus severity was investigated using the tinnitus questionnaire (TQ) and Tinnitus Functional Index (TFI). Regarding the TQ score, no clinically relevant reductions were observed, and no significant differences in the decrease were observed between the early start group and delayed start group. Contrarily, a significantly higher percentage of patients showed a decrease in the TQ degree in the early start group compared to the delayed start group (30.0% versus 2.8%, = 0.006). The TFI score did show a significantly greater and clinically relevant reduction in the early start group compared to the delayed start group ( = 0.042).

Conclusion: A multidisciplinary non-invasive orofacial treatment was able to reduce tinnitus severity in patients with temporomandibular related somatosensory tinnitus.
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http://dx.doi.org/10.3390/jcm9030705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141361PMC
March 2020

The identification of preliminary prognostic indicators that predict treatment response for exercise therapy in patients with nonspecific chronic low back pain: A multiple-arm cohort study design.

J Back Musculoskelet Rehabil 2020 ;33(5):829-839

Faculty of Medicine and Health Sciences, Rehabilitation and Physiotherapy, University of Antwerp, 2610 Wilrijk, Belgium.

Background: For patients with nonspecific chronic low back pain (CLBP), exercise therapy is stated to be the most effective intervention strategy but it is unclear which kind of exercise therapy is most beneficial.

Objective: To identify preliminary prognostic indicators that predict outcome for exercise therapy in patients with nonspecific CLBP.

Methods: Patients were recruited in two hospitals and received 18 intervention sessions: stabilization therapy, isometric training therapy or a combination therapy. The primary outcome measure was the change in the Modified Low Back Pain Disability Questionnaire after nine weeks.

Results: A total of 59 patients completed the study which represents a statistical power of 90%. In total, 30 patients were categorized as having treatment success and 29 as treatment failure. After using regression analyses to determine the association between standardized examination variables and treatment response status, prognostic indicators were identified for predicting therapy success (positive likelihood ratio [LR], 3.8) and failure (negative LR, 0.19).

Conclusions: The most important variables were the prone instability test, pelvic tilt test, straight leg raise, body weight, visual analogue scale and the short form 36 health survey.
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http://dx.doi.org/10.3233/BMR-181370DOI Listing
February 2021

Manual therapy as a prophylactic treatment for migraine: design of a randomized controlled trial.

Trials 2019 Dec 27;20(1):785. Epub 2019 Dec 27.

Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres (location VUmc), Van der Boechorststraat 7, 1018BT, Amsterdam, The Netherlands.

Background: People with migraine often experience disability with serious consequences for their social life and work productivity. The pharmacological prophylactic management of migraine is effective in reducing migraine attacks. However, many people are reluctant to use daily prophylactic medication, leading to a demand for non-pharmacological treatment options. We present the design for and discuss the feasibility of a pragmatic, randomized controlled trial on the effectiveness of a multimodal manual therapy (MT) treatment compared to usual care by the general practitioner (GP) for the prophylactic treatment of migraine.

Methods: Eligible participants will be recruited in primary care using the International Classification of Headache Disorders III criteria for migraine of the International Headache Society. Participants will be randomized to either multimodal MT treatment or usual care provided by the GP. GPs will be asked to treat the usual care group according to the Dutch GP guideline for headache. The multimodal MT intervention will include manual pressure techniques, neck muscle-strength exercises and mobilization of the cervical and thoracic spine. The trial will consist of a 12-week treatment period and follow-up measurements at 12, 26 and 52 weeks. The primary outcome measure is the number of migraine days per 4 weeks, assessed with a headache diary. Secondary outcome measures are the number of migraine attacks, medication use, disability due to headache, headache intensity, number of participants reporting a 50% migraine reduction, measurement of cervical pressure pain thresholds, presence of allodynia, endurance of cervical flexor muscles, days of absence of work and global perceived effect.

Discussion: The results of the trial will show whether a multimodal MT intervention is an effective non-pharmacological treatment option for people with migraine.

Trial Registration: Dutch Trial Register, NL7504. Registered on 7 February 2019.
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http://dx.doi.org/10.1186/s13063-019-3937-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935086PMC
December 2019

Sensitivity to change and convergent validity of the Tinnitus Functional Index (TFI) and the Tinnitus Questionnaire (TQ): Clinical and research perspectives.

Hear Res 2019 10 3;382:107796. Epub 2019 Sep 3.

University Dept. of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Dept. of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Dept. of Education, Health & Social Work, University College Ghent, Ghent, Belgium. Electronic address:

Background: Complete alleviation of tinnitus perception is rarely achieved by current therapeutic interventions. However, adequate therapy may induce a small or large decrement of the tinnitus. The assessment of the therapeutic effect is challenging due to large interindividual variability. Multiple tinnitus questionnaires are available to describe functional effects of tinnitus pre and post-therapeutic intervention, of which the Tinnitus Functional Index (TFI) and Tinnitus Questionnaire (TQ) are two very commonly used questionnaires by clinicians and researchers.

Objective: To recommend either TFI or TQ as an outcome measure for the investigation of tinnitus treatments by investigating the consistency between the TFI and TQ, as well as comparing the responsiveness of both scales after therapeutic intervention.

Methods: Data from the validated Dutch versions of the TFI and the TQ of 100 chronic subjective tinnitus patients who underwent 6 sessions of neuromodulation at the Antwerp University Hospital were included. The patients reported their perceived effect and filled out the TFI and TQ at the pre-therapy, post-therapy and follow-up visit (i.e. ± seven weeks post-therapy). The intra-class correlation (ICC) was determined, measuring consistency between the TFI and TQ. Furthermore, the responsiveness was compared by use of mixed effects analysis. Finally, the agreement between the total scores of the questionnaires and the perceived effect was evaluated by use of their receiver operating characteristic (ROC) curve.

Results: The total scores of the TFI and TQ showed a good agreement at pre-therapy (ICC = .82) and post-therapy visit (ICC = 0.82). The ICC indicated a lower, but still good agreement at follow-up (ICC = 0.79). Furthermore, the total scores of the TFI and TQ significantly changed over time (pTFI < .05; p < .05). In the patients who verbally reported at follow-up visit that their tinnitus complaints decreased after treatment, the percentage of patients showing a clinically significant decrease on the TFI (i.e. a decrease of ≥13 points) and the TQ (i.e. decrease of ≥12 points) was 50% and 33% respectively, however, not statically significant different (p = .13). Finally, the analysis of the agreement between the perceived effect and the clinically significant improvement on the questionnaires showed a kappa-value of 0.36 for the TFI and 0.29 for the TQ.

Conclusion: The TFI and TQ have high convergent validity and are both suitable as an outcome measure to quantify a change in the self-perceived tinnitus burden. The TFI is shorter and shows a slightly higher agreement with the self-reported perceived effect. Therefore, this comparison is in favor of the TFI for research purposes.
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http://dx.doi.org/10.1016/j.heares.2019.107796DOI Listing
October 2019

Cognitive Performance in Chronic Tinnitus Patients: A Cross-Sectional Study Using the RBANS-H.

Otol Neurotol 2019 10;40(9):e876-e882

Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, Campus Drie Eiken, Antwerp University, Antwerp.

Objective: Many tinnitus patients report cognitive deficits such as concentration and attention difficulties. The aim of this study was to comprehensively assess cognitive functioning in tinnitus patients using a standardized test battery, the repeatable battery for the assessment of neuropsychological status adjusted for hearing impaired individuals (RBANS-H).

Study Design: Cross-sectional study.

Setting: Tertiary referral center.

Participants: Twenty-eight chronic tinnitus patients and 28 control participants, matched for sex, age, hearing loss, and education level.

Intervention: Diagnostic.

Main Outcome Measures: All participants completed the RBANS-H, which includes subtests probing immediate and delayed memory, visuospatial capabilities, language, and attention. The tinnitus patients completed the tinnitus functional index (TFI), a visual analogue scale (VAS) measuring subjective mean tinnitus loudness and the hyperacusis questionnaire (HQ).

Results: The total RBANS-H scores did not differ between tinnitus patients and controls. However, on the language subscale, mean scores of the tinnitus group (97.6 ± 11.0) were significantly lower than those of controls (104.4 ± 12.0), with correction for sex, age, hearing level, and education level (general linear model: p = 0.034). Post hoc t tests revealed a specific deficit concerning the semantic fluency subtest (tinnitus: 19.5 ± 6.2; control: 23.1 ± 5.9; p = 0.015). VAS scores for tinnitus loudness were negatively correlated to scores on the RBANS-H attention subscale (r = -0.48, p = 0.012).

Conclusions: The current study successfully employed the RBANS-H to provide a broader view on cognitive functioning in tinnitus patients. The results showed a specific negative influence of tinnitus on verbal fluency, which could be related to a deficit in executive cognitive control. Moreover, patients experiencing louder tinnitus performed worse on specific subtests concerning attention.
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http://dx.doi.org/10.1097/MAO.0000000000002403DOI Listing
October 2019

An Exploratory Study on the Use of Event-Related Potentials as an Objective Measure of Auditory Processing and Therapy Effect in Patients With Tinnitus: A Transcranial Direct Current Stimulation Study.

Otol Neurotol 2019 10;40(9):e868-e875

University Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem.

Objective: Treatment effect in tinnitus research is commonly evaluated by use of self-report questionnaires. As this is a solely subjective assessment method, the need for an objective measurement is paramount to genuinely evaluate the effects of therapeutic interventions. The current study explores the value of event-related potentials (ERPs) in the evaluation of high-definition transcranial direct current stimulation (HD-tDCS) for tinnitus treatment.

Study Design: Prospective exploratory study.

Setting: Tertiary referral center.

Patients: Twenty-two chronic tinnitus patients.

Intervention: HD-tDCS.

Main Outcome Measures: ERPs.

Results: The results show a significant shortening of the N1, P2, N2, and P3 latencies after HD-tDCS treatment. Moreover, the increased amplitude of the P2 and N2 peaks result in more salient and clear peaks, with the amplitude of N2 being significant larger after HD-tDCS. However, the ERP changes are not significantly correlated with the change in tinnitus functional index (TFI) total score.

Conclusions: The current study was the first to explore ERPs as objective measure in a study with HD-tDCS in tinnitus patients. Adding ERPs to the outcome measures in tinnitus research may lead to a better understanding of the therapeutic effect in the future. The results showed a shortening of ERP latencies and an increased N2 amplitude, possibly reflecting more effective sound processing with higher recruitment of synchronized neurons in the auditory cortex. Future studies should elaborate on these results, by collecting control data and adding a sham group, to provide a better insight in the underlying mechanism of the ERP changes after tinnitus treatment.
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http://dx.doi.org/10.1097/MAO.0000000000002380DOI Listing
October 2019

Convergent validity of clinical tests which are hypothesized to be associated with physical functioning in patients with nonspecific chronic low back pain.

J Back Musculoskelet Rehabil 2020 ;33(2):313-322

Antwerp University Hospital, Physical Medicine and Rehabilitation, 2650 Edegem, Belgium.

Background: Up until now, assessment of physical functioning in patients with low back pain is mostly completed with the use of patient reported outcome measurements (PROMs). There are however limitations to the use of these measurements such as inaccuracies due to recall bias, social desirability bias and errors in self-observation. A recent review indicated seven clinical tests as having good test retest reliability. These tests can now be further investigated for their validity.

Objectives: To investigate the convergent validity of seven clinical tests (extensor endurance, flexor endurance, 5 minute walking, 50 foot walking, shuttle walk, sit to stand and the loaded forward reach test) in patients with nonspecific chronic low back pain (CLBP).

Methods: Patients filled in a series of PROMs and performed all included clinical tests during a specific test moment. Convergent validity was firstly investigated by assessing Pearson correlations between the seven included clinical tests and secondly by assessing the correlations between the predefined PROMs and the clinical tests.

Results: Twenty-five patients were included in this study representing a power of 84%. The best overall evidence for convergent validity could be identified for the extensor endurance, sit to stand and the loaded forward reach test. However, when all study results were combined, evidence for convergent validity was found for all included clinical tests except for the shuttle walk test.

Conclusion: The current study was able to provide evidence that multimethod and multidimensional approaches should be used as a more comprehensive assessment of physical function in patients with nonspecific CLBP.
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http://dx.doi.org/10.3233/BMR-181318DOI Listing
September 2020

Does Conservative Temporomandibular Therapy Affect Tinnitus Complaints? A Systematic Review.

J Oral Facial Pain Headache 2019 12;33(3):308–317. Epub 2019 Apr 12.

Aims: To investigate whether temporomandibular disorders treatment can positively influence tinnitus complaints.

Methods: Four online databases (PubMed, Web of Science, Scopus, and the Cochrane Library) were searched up to August 2018 for relevant studies. Two independent reviewers extracted the data and performed a risk of bias assessment.

Results: A total of 11 studies were included. These studies showed an overall positive effect of the combination of splint therapy and exercise treatment on tinnitus severity and intensity (as measured on a visual analog or numeric rating scale), as well as on global perceived effect. One study specified that the treatment effect was only present in patients with severe to very severe tinnitus, while the others found an effect in the overall study group. The risk of bias in the included studies was high, mainly due to lack of statistical analyses between groups and before vs after treatment, incomplete presentation of the data, and selective reporting. Additionally, most included studies showed a lack of information concerning blinding of the subjects, therapists, and investigators. The heterogeneity of the inclusion criteria, outcome measurements, and treatments made data pooling and meta-analysis impossible.

Conclusion: There is low-quality evidence for a positive effect of conservative temporomandibular disorders treatment on tinnitus complaints. The combination of splint therapy and exercise treatment is currently the best investigated treatment approach, showing a decrease in tinnitus severity and intensity. Despite the low level of evidence and the methodologic issues in the included studies, it is noteworthy that all included studies show positive treatment effects.
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http://dx.doi.org/10.11607/ofph.2055DOI Listing
November 2019

A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain.

Front Neurol 2019 26;10:276. Epub 2019 Mar 26.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.

The most prevalent primary headaches tension-type headache and migraine are frequently associated with neck pain. A wide variety of treatment options is available for people with headache and neck pain. Some of these interventions are recommended in guidelines on headache: self-management strategies, pharmacological and non-pharmacological interventions. Physical treatment is a frequently applied treatment for headache. Although this treatment for headache is predominantly targeted on the cervical spine, the neurophysiological background of this intervention remains unclear. Recent knowledge from neuroscience will enhance clinical reasoning in physical treatment of headache. Therefore, we summarize the neuro- anatomical and-physiological findings on headache and neck pain from experimental research in both animals and humans. Several neurophysiological models (referred pain, central sensitization) are proposed to understand the co-occurrence of headache and neck pain. This information can be of added value in understanding the use of physical treatment as a treatment option for patients with headache and neck pain.
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http://dx.doi.org/10.3389/fneur.2019.00276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443880PMC
March 2019

The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis.

J Headache Pain 2019 Feb 14;20(1):16. Epub 2019 Feb 14.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Background: In patients with frequent migraine, prophylactic treatments are used. Patients often request non-pharmacological alternatives. One treatment option can be aerobic exercise. The value of aerobic exercise as prophylactic treatment however needs to be determined.

Methods: A systematic review and meta-analysis was performed to investigate the result of aerobic exercise on the number of migraine days, duration and pain intensity in patients with migraine. After screening three online databases, PubMed, Cochrane library and Web of Science, using predefined in- and exclusion criteria, six studies were retained. Pooling of data was performed when possible.

Results: Significant reductions in the number of migraine days after aerobic exercise treatment were found with a mean reduction of 0.6 ± 0.3 migraine days/month. Other outcomes were too variable to pool due to heterogeneity of outcome measurements. Unpooled data revealed small to moderate reductions in attack duration (20-27%) and pain intensity (20-54%) after aerobic exercise intervention. Various exercise intensities are applied.

Conclusion: There is moderate quality evidence that in patients with migraine aerobic exercise therapy can decrease the number of migraine days. No conclusion for pain intensity or duration of attacks can be drawn. Effect sizes are small due to a lack of uniformity. For future studies, we recommend standardized outcome measures and sufficiently intense training programs.

Trial Registration: CRD42018091178 .
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http://dx.doi.org/10.1186/s10194-019-0961-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734345PMC
February 2019

Conservative therapy for the treatment of patients with somatic tinnitus attributed to temporomandibular dysfunction: study protocol of a randomised controlled trial.

Trials 2018 Oct 12;19(1):554. Epub 2018 Oct 12.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Background: Tinnitus is a highly prevalent symptom affecting 10-15% of the adult population. It often affects patient quality of life and frequently causes distress. When subjective tinnitus can be elicited by the somatosensory system of the cervical spine or temporomandibular area it is termed somatic tinnitus. The first aim of the current study is to investigate the effect of the best evidence conservative temporomandibular disorder (TMD) treatment on tinnitus in patients with co-existence of tinnitus and TMD or oral parafunctions compared to no treatment. The second aim is to identify a subgroup of patients with tinnitus that benefits from the conservative temporomandibular joint treatment.

Methods And Design: This study is a randomised controlled trial with a delayed treatment design. Patients with a TMD (TMD pain screener ≥ 3 points) or oral parafunctions (such as clenching and bruxism), who are suffering from moderate to severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), will be recruited from the tertiary tinnitus clinic of the University Hospital of Antwerp, Edegem, Belgium. Patients will be excluded in case of clear otological or neurological causes of the tinnitus, progressive middle ear pathology, intracranial pathology, traumatic cervical spine or temporomandibular injury in the past 6 months, severe depression as diagnosed by a psychologist, tumours, previous surgery in the orofacial area, substance abuse that may affect the outcome measures, any contra-indication for physical therapy treatment directed to the orofacial area or when they received TMD treatment in the past 2 months. After screening for eligibility, baseline data among which scores on the TFI, tinnitus questionnaire (TQ), mean tinnitus loudness as measured with visual analogue scale (VAS), TMD pain screener, and a set of temporomandibular joint tests will be collected. Patients will be randomised in an early-start group and in a delayed-start group of therapy by 9 weeks. Patients will receive conservative TMD treatment with a maximum of 18 sessions within 9 weeks. At baseline (week 0), at the start of therapy (weeks 0 or 9), 9 weeks after therapy (weeks 9 or 18), and at follow-up (weeks 18 or 27) data from the TFI, TQ, VAS mean tinnitus loudness and the TMD pain screener will be collected.

Discussion: Herein, we aim to improve the quality of care for patients with tinnitus attributed to TMD or oral parafunctions. By evaluating the effect of state-of-the-art TMD treatment on tinnitus complaints, we can investigate the usefulness of TMD treatment in patients with somatic tinnitus.

Trial Registration: 3 July 2017, version 1 of the protocol, ClinicalTrials.gov NCT03209297 .
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http://dx.doi.org/10.1186/s13063-018-2903-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186065PMC
October 2018

Diagnostic Criteria for Somatosensory Tinnitus: A Delphi Process and Face-to-Face Meeting to Establish Consensus.

Trends Hear 2018 Jan-Dec;22:2331216518796403

16 NIHR Nottingham Biomedical Research Centre, Nottingham, UK.

Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient's tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitus. Due to a lack of unambiguous clinical tests, many authors and clinicians use their own criteria for diagnosing ST. This resulted in large differences in prevalence figures in different studies and limits the comparison of clinical trials on ST treatment. This study aimed to reach an international consensus on diagnostic criteria for ST among experts, scientists and clinicians using a Delphi survey and face-to-face consensus meeting strategy. Following recommended procedures to gain expert consensus, a two-round Delphi survey was delivered online, followed by an in-person consensus meeting. Experts agreed upon a set of criteria that strongly suggest ST. These criteria comprise items on somatosensory modulation, specific tinnitus characteristics, and symptoms that can accompany the tinnitus. None of these criteria have to be present in every single patient with ST, but in case they are present, they strongly suggest the presence of ST. Because of the international nature of the survey, we expect these criteria to gain wide acceptance in the research field and to serve as a guideline for clinicians across all disciplines. Criteria developed in this consensus paper should now allow further investigation of the extent of somatosensory influence in individual tinnitus patients and tinnitus populations.
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http://dx.doi.org/10.1177/2331216518796403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144502PMC
February 2019

The effect of a single botulinum toxin treatment on somatosensory processing in idiopathic isolated cervical dystonia: an observational study.

J Neurol 2018 Nov 8;265(11):2672-2683. Epub 2018 Sep 8.

Department of Physical Therapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

Background: Patients with idiopathic cervical dystonia (CD) experience involuntary neck muscle contractions, abnormal head position and pain accompanied by dysfunctions in somatosensory processes such as postural control, cervical sensorimotor and perception of visual verticality. First-line treatment is injection with botulinum toxin (BoNT). It remains unclear whether this affects sensorimotor processes.

Aim: To investigate the effect of first-line care on deficiencies in somatosensory processes.

Methods: In this observational study, 24 adult patients with idiopathic CD were assessed three times over a treatment period of 12 weeks following a single treatment with BoNT. Disease severity was assessed by a disease-specific questionnaire, rating scale and the visual analogue scale. Seated postural control was assessed with posturography, cervical sensorimotor control was assessed by the joint repositioning error with an eight-camera infrared motion analysis system during a head repositioning accuracy test and perception of visual verticality was assessed with the subjective visual vertical test.

Results: Disease symptoms significantly improved following BoNT injections and deteriorated again at 12 weeks. This improvement was not accompanied by improved postural control, cervical sensorimotor control and perception of visual verticality. A trend toward improvement was seen; however, it did not reach the level of the control population.

Conclusion: The peripheral and central treatment effects of BoNT have little to no effect on postural and cervical sensorimotor control in CD. Further research may explore whether sensory training or specialized exercise therapy improves somatosensory integration and everyday functioning in patients with CD.
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http://dx.doi.org/10.1007/s00415-018-9045-yDOI Listing
November 2018

Age-related differences in muscle activity patterns during walking in healthy individuals.

J Electromyogr Kinesiol 2018 Aug 26;41:124-131. Epub 2018 May 26.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Belgium.

Objective: To examine how muscle activity over the entire gait cycle changes with increasing age.

Methods: Electromyography data of the erector spinae, rectus femoris, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius muscles were collected by an instrumented gait analysis during over ground walking in healthy adults aged between 20 and 89 years. Participants were categorized per decade (n = 105, 15 per decade, decades 3-9). Normalized integrated linear envelopes of the electromyographic signal were calculated for one stride. A one way ANOVA using spm1d statistics explored the differences between age groups, followed by a post hoc analysis.

Results: While initiation of decline commenced at the age of 60 for erector spinae and tibialis anterior, age-related changes are most pronounced after the age of 80. Concerning timing of muscle activity, subjects in decade 7-9 had prolonged activity and/or early activity of the erector spinae, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius compared to other decades. Regarding amplitude of muscle activity, decreased peak amplitudes of the erector spinae, rectus femoris, vastus lateralis and gastrocnemius were observed in decades 7-9 compared to other decades.

Conclusion: Both timing and amplitude of muscle activation patterns need to be considered to understand the aging process. Regarding the erector spinae, tibialis anterior and vastus lateralis, a decrease in muscle activation coincides with prolonged activity, compared to the gastrocnemius where decreased muscle activation is associated with early activation.
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http://dx.doi.org/10.1016/j.jelekin.2018.05.008DOI Listing
August 2018

Answer to the comment on Castien et al. (2018) pressure pain thresholds over the cranio-cervical region in headache - a systematic review and meta-analysis.

J Headache Pain 2018 04 18;19(1):32. Epub 2018 Apr 18.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, D.S.022, Universiteitsplein 1, Wilrijk, 2610, Belgium.

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http://dx.doi.org/10.1186/s10194-018-0858-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906413PMC
April 2018

Pressure pain thresholds over the cranio-cervical region in headache: a systematic review and meta-analysis.

J Headache Pain 2018 Jan 26;19(1). Epub 2018 Jan 26.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, D.S.022, Universiteitsplein 1, 2610, Wilrijk, Belgium.

Background: Sensitivity of tissues can be measured by algometry. Decreased pressure pain thresholds over the cranio-cervical area are supposed to reflect signs of sensitization of the trigemino-cervical nucleus caudalis. A systematic review was conducted to assess the current scientific literature describing pressure pain threshold (PPT) values over the cranio-cervical region in patients with migraine, tension-type headache (TTH), and cervicogenic headache (CeH). A literature search was executed in three databases. The search strategy included the following keywords: migraine, TTH, CeH, PPT and algometry. A total of 624 papers was identified of which relevant papers were subsequently assessed for methodological quality. Twenty-two selected papers were assessed by two independent reviewers and the majority of studies scored low risk of bias on the selected items. Mean PPT values of several sites measured in the cranio-cervical region in patients with migraine, chronic TTH and CeH scored lower values compared to controls. The trapezius muscle (midpoint between vertebrae C7 and acromion) was the most frequently targeted site and showed significantly lower PPT values in adults with migraine (pooled standardized mean difference kPa: 1.26 [95%CI -1.71, -0.81]) and chronic TTH (pooled standardized mean difference kPa: -2.00 [95%CI -2.93, -1.08]). Most studies found no association between PPT values and headache characteristics such as frequency, duration or intensity. Further standardization of PPT measurement in the cranio-cervical region is recommended.
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http://dx.doi.org/10.1186/s10194-018-0833-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786597PMC
January 2018

Is perception of visual verticality intact in patients with idiopathic cervical dystonia?

Acta Neurol Belg 2018 Mar 3;118(1):77-84. Epub 2017 Nov 3.

Universiteit Antwerpen, Antwerp, Belgium.

Idiopathic cervical dystonia (CD) is a focal dystonia characterized by an abnormal tilted or twisted head position. This abnormal head position could lead to a distorted perception of the visual vertical and spatial orientation. The aim of this cross-sectional study was to investigate whether the perception of the visual vertical is impaired in patients with CD. The subjective visual vertical test (SVV) was measured in 24 patients with CD and 30 controls. The SVV test is conducted in a completely darkened room. A laser bar is projected on an opposing white wall, which is deviated from the earth's gravitational vertical. Participants were seated with their head unrestrained and were instructed to position this bar vertically. The deviations in degrees (°) are corrected for the side of laterocollis in order to measure the E-effect. We found that patients were able to position the laser bar as equally close to the earth's gravitational vertical as controls (+ 0.67° SD ± 2.12 vs + 0.29° SD ± 1.08, p = 0.43). No E-effect was measured. Notwithstanding the abnormal position of the head, the perception of the visual vertical in patients with idiopathic CD is intact, possibly because of central neural compensatory mechanisms.
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http://dx.doi.org/10.1007/s13760-017-0853-0DOI Listing
March 2018
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