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ABSTRACT: The goal of this study was to investigate the attentional load of using the upper limb in moderately and mildly affected patients after stroke, with and without arm support. Ten patients with stroke (4 mild and 6 moderate paresis) and ten healthy, gender- and age-matched control subjects performed a dual-task experiment that consisted of a circle drawing task and an auditive Stroop task. Complexity of the motor task was manipulated by supporting the arm against gravity. Individual motor (area×speed) and cognitive (accuracy/reaction time) scores during the dual-task conditions were converted into percentage scores relative to the respective single-task scores and then combined in a single measure of net dual-task performance. Without arm support, only moderately affected patients showed significantly greater side differences in dual-task performance to the detriment of the affected upper limb. With arm support, no side differences were found for any of the three groups. Thus, the hypothesis that patients with moderate upper-limb paresis suffer from a lack of automaticity of motor control was substantiated by the dual-task condition. Furthermore, supporting the arm reduced the attentional load of using the affected side.
Human movement science 04/2013; · 2.15 Impact Factor
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ABSTRACT: Startle pathways may contribute to rapid accomplishment of postural stability. Here we investigate the possible influence of a startling auditory stimulus (SAS) on postural responses. We formulated four specific questions: (1) can a concurrent SAS shorten the onset of automatic postural responses; and if so (2) is this effect different for forward versus backward perturbations; (3) does this effect depend on prior knowledge of the perturbation direction; and (4) is this effect different for low- and high-magnitude perturbations?. Balance was perturbed in 11 healthy participants by a movable platform that suddenly translated forward or backward. Each participant received 160 perturbations, 25% of which were combined with a SAS. We varied the direction and magnitude of the perturbations, as well as the prior knowledge of perturbation direction. Perturbation trials were interspersed with SAS-only trials. The SAS accelerated and strengthened postural responses with clear functional benefits (better balance control), but this was only true for responses that protected against falling backwards (i.e. in tibialis anterior and rectus femoris). These muscles also demonstrated the most common SAS-triggered responses without perturbation. Increasing the perturbation magnitude accelerated postural responses, but again with a larger acceleration for backward perturbations. We conclude that postural responses to backward and forward perturbations may be processed by different neural circuits, with influence of startle pathways on postural responses to backward perturbations. These findings give directions for future studies investigating whether deficits in startle pathways may explain the prominent backward instability seen in patients with Parkinson's disease and progressive supranuclear palsy.
Neuroscience 04/2013; · 3.38 Impact Factor
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ABSTRACT: Dysphagia is reported in advanced stages of Duchenne muscular dystrophy (DMD). The population of DMD is changing due to an increasing survival. We aimed to describe the dysphagia in consecutive stages and to assess the underlying mechanisms of dysphagia in DMD, in order to develop mechanism based recommendations for safe swallowing. In this cross-sectional study, participants were divided into: early and late ambulatory stage (AS, n = 6), early non-ambulatory stage (ENAS, n = 7), and late non-ambulatory stage (LNAS, n = 11). Quantitative oral muscle ultrasound was performed to quantify echo intensity. Swallowing was assessed with a video fluoroscopic swallow study, surface electromyography (sEMG) of the submental muscle group and tongue pressure. Differences in outcome parameters among the three DMD stages were tested with analysis of variance. Oral muscles related to swallowing were progressively affected, starting in the AS with the geniohyoid muscle. Tongue (pseudo) hypertrophy was found in 70 % of patients in the ENAS and LNAS. Oral phase problems and post-swallow residue were observed, mostly in the LNAS with solid food. sEMG and tongue pressure data of swallowing solid food revealed the lowest sEMG amplitude, the longest duration and lowest tongue pressure in the LNAS. In case of swallowing problems in DMD, based on the disturbed mechanisms of swallowing, it is suggested to (1) adjust meals in terms of less solid food, and (2) drink water after meals to clear the oropharyngeal area.
Journal of Neurology 12/2012; · 3.47 Impact Factor
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ABSTRACT: Various authors have referred to an association between neglect and non-spatial components of attention. It has been suggested that an increase in attentional load could exacerbate neglect symptoms and reveal subtle, well-compensated neglect. In the present study, 21 RH and 22 LH subacute stroke patients and 20 controls performed a computerized single-detection task (CVRT) and a dual task (CVRT-D) combining the detection task with a driving simulation task. Omissions, reaction times (RTs) and RT asymmetries were analysed to investigate the influence of increasing attentional load on neglect symptoms. RT asymmetries were most pronounced in RH patients. Although a clear increase in RT asymmetries between CVRT and CVRT-D was observed, the amount of increase did not differ between both patient groups. Within both patient groups, correlations between RT asymmetries and ipsilesional RTs as a measure of general attention were significant in the single task but not in the dual task, indicating that increased attentional load may result in different degrees of lateralized and general attentional problems. Half of the patients with neglect on the BIT (Behavioural Inattention Test) showed increased RT asymmetries from CVRT to CVRT-D. Moreover, two LH and RH patients without neglect symptoms on the BIT and CVRT showed distinctively increased asymmetries in the CVRT-D, fostering the idea of an emergence of subtle neglect under increased attentional load. Dual-task performance may draw attention towards patients who, without obvious signs of neglect, may show visuospatial attention deficits in complex situations.
Journal of Neuropsychology 11/2012; · 1.74 Impact Factor
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ABSTRACT: Aim To investigate the validity and reliability of the revised Video-Observation Aarts and Aarts module: Determine Developmental Disregard (VOAA-DDD-R). Method Upper-limb capacity and performance were assessed in children with unilateral spastic cerebral palsy (CP) by measuring overall duration of affected upper-limb use and the frequency of specific behaviours during a task in which bimanual activity was demanded ('stringing beads') and stimulated ('decorating a muffin'). Developmental disregard was defined as the difference in duration of affected upper-limb use between both tasks. Raters were two occupational and one physical therapist who received 3 hours of training. Construct validity was determined by comparing children with CP with typically developing children. Intrarater, interrater, and test-retest reliability were determined using the intraclass correlation coefficient. Standard errors of measurement and smallest detectable differences were also calculated. Results Twenty-five children with CP (15 females, 10 males; mean age 4y 9mo [SD 1y 7mo], range 2y 9mo-8y; Manual Ability Classification System levels I-III) scored lower on capacity (p=0.052) and performance (p<0.001), and higher on developmental disregard (p<0.001) than 46 age- and sex-matched typically developing children (23 males; mean age 5y 3mo [SD 1y 5mo], range 2y 6mo-8y). The intraclass correlation coefficients (0.79-1.00) indicated good reliability. Absolute agreement was high, standard errors of measurement ranged from 4.5 to 6.8%, and smallest detectable differences ranged from 12.5 to 19.0%. Interpretation The VOAA-DDD-R can be reliably and validly used by occupational and physical therapists to assess upper-limb capacity, performance, and developmental disregard in children (2y 6mo-8y) with CP.
Developmental Medicine & Child Neurology 10/2012; · 2.92 Impact Factor
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ABSTRACT: Mobility limitations are common in persons with Intellectual Disabilities (ID). Differences in balance and gait capacities between persons with ID and controls have mainly been demonstrated by instrumented assessments (e.g. posturography and gait analysis), which require sophisticated and expensive equipment such as force plates or a 3D motion analysis system. Most physicians and allied healthcare professionals working with persons with ID do not have such equipment at their disposal, so they must rely on clinical tests to determine whether balance and gait are affected. The aim of this study was to investigate whether existing clinical balance and gait tests are feasible in older persons with mild to moderate ID and to examine whether these tests are able to show limitations in balance and gait capacities in the ID population compared to age-matched peers in the general population. Furthermore, it was aimed to identify the most important determinants of balance and gait disability in persons with the ID. A total of 76 older persons with mild to moderate ID (43 male, mean age 63.1±7.6years) and 20 healthy controls (14 male, mean age 62.2±5.6years) participated. Balance and gait abilities were assessed with the Berg Balance Scale (BBS), the Functional Reach test (FR), the Timed Up and Go Test (TUGT), the timed Single Leg Stance (SLS) and the Ten Metre Walking Test (TMWT). Our study showed that it is feasible to conduct standard clinical balance and gait tests in older persons with mild to moderate ID. Balance and gait performance of persons with ID is substantially worse compared to older persons of the general population. Age, number of co-morbidities, Body Mass Index (BMI), body sway and fear of falling are associated with balance and gait performance in persons with ID. These factors might help in the selection of subjects to be monitored on their balance and gait capacities.
Research in developmental disabilities 09/2012; 34(1):276-285. · 4.41 Impact Factor
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ABSTRACT: Equinovarus foot deformity following stroke or traumatic brain injury compromises walking capacity, interfering with activities of daily living. In soft-tissue surgery the imbalanced muscles responsible for the deviant position of the ankle and foot are lengthened, released and/or transferred. However, knowledge about the effectiveness of surgical correction is limited. The aim of the present study was to carry out a systematic review of the literature to assess the effects of surgical correction of equinovarus foot deformity in patients with stroke or traumatic brain injury.
A systematic search of full-length articles in the English, German or Dutch languages published from 1965 to March 2011 was performed in PubMed, EMBASE, CINAHL, Cochrane and CIRRIE. The identified studies were analysed following the International Classification of Functioning, Disability and Health criteria.
A total of 15 case series, case control and historically controlled studies (CEBM level 4) were identified, suggesting that surgical correction of equinovarus foot deformity is a safe procedure that is effective in terms of re-obtaining a balanced foot position, improving walking capacity and diminishing the need for orthotic use.
Further validation of surgical correction of equinovarus foot deformity following stroke or traumatic brain injury is required, using higher level study designs with validated assessment tools. Comparing surgical techniques with other interventions is necessary to generate evidence upon which treatment algorithms could be based.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2012; 44(8):614-23. · 1.88 Impact Factor
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ABSTRACT: The objective of the present study was to examine the attentional demands of gait adaptations required to walk over irregular terrain in community-dwelling people with chronic stroke. Eight community ambulators (>6 months post-stroke, aged 57 ± 15 years) and eight age-matched healthy controls participated in the study. As the primary motor task, participants walked on a treadmill while they quickly reacted to a sudden obstacle in front of the affected (in the stroke group) or left (in healthy controls) leg. The secondary, cognitive task was an auditory Stroop task. Outcomes were avoidance success rate and muscle reaction times of the biceps and rectus femoris (motor task), and a composite score of accuracy and verbal reaction time (cognitive task). Success rates did not differ between single- and dual-task conditions in either group, while muscle reaction times deteriorated equally during the dual task in both groups. However, compared with the Stroop scores just before and after obstacle crossing, the scores while crossing the obstacle deteriorated more in the stroke group than in the controls (p=0.012). The higher dual-task costs on the Stroop task reflect greater attentional demands during walking and crossing obstacles. The absence of dual-task effects on obstacle avoidance performance suggests that the people with stroke used a "posture-first strategy". The results imply that common daily life tasks such as obstacle crossing while walking require disproportionate attention even in well-recovered people with stroke.
Gait & posture 03/2012; 36(1):127-32. · 2.58 Impact Factor
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ABSTRACT: The biomechanics of swallowing saliva and substances of different consistencies were investigated in healthy children and adults. To this end, the duration and mean amplitude value (MAV) of surface electromyography (sEMG) of the submental muscle group (SMG) activity, the maximum anterior tongue pressure (ATP), and the rise and release slopes of ATP were measured while participants (39 female and 39 male participants, age 5-65 years) swallowed saliva, 5 mL water (reference), 5 mL thick liquid, and 5 mL solid food. Mean outcome parameters varied with the consistency of the liquid or food swallowed, with the exception of the rise slope of ATP. Moreover, outcome variables were not substantially affected by age with children of 5 years and older showing similar biomechanical events to those of adults. It is important to gain insight into the biomechanics of swallowing saliva and substances of different consistencies in order to understand the underlying mechanisms of dysphagia children and adults.
Physiology & Behavior 02/2012; 106(2):285-90. · 2.87 Impact Factor
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ABSTRACT: A common problem in children with hemiplegic cerebral palsy (CP) is the asymmetrical development of arm and hand capacity caused by the lack of use of the affected upper limb, or developmental disregard. In this paper, we provide a neuropsychological model that relates developmental disregard to attentional processes and motor learning. From this model, we hypothesize that high attentional demands associated with the use of the affected upper limb might hinder its use in daily life, and therefore may be a factor in developmental disregard. This can be assessed with a dual-task paradigm. However, until now, this has not been applied to children with CP. We provide recommendations for using a dual-task paradigm in children with CP based on empirical studies in typically developing children and children with developmental coordination disorder. Ultimately, these dual-task studies may be used to improve interventions aimed at reducing developmental disregard.
Research in developmental disabilities 08/2011; 32(6):2157-63. · 4.41 Impact Factor
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ABSTRACT: Objective. To obtain a psychosocial profile of patients with poststroke fatigue (PSF), which could aid in optimizing treatment strategies. Methods. Eighty-eight outpatients with severe PSF measured with the Checklist Individual Strength-fatigue subscale (CIS-f) and the Fatigue Severity Scale (FSS) were selected. Depression and anxiety, psychological distress, coping, social support, and self-efficacy of this group were compared to reference groups of healthy controls and patients with other chronic diseases. Associations between psychosocial characteristics and fatigue were calculated. Results. Compared to healthy controls, patients with PSF reported more psychological distress, less problem-focused coping, and more positive social support. Minor or no differences were found in comparison with other chronic patients. The CIS-f correlated with somatic complaints and the FSS with cognitive complaints. Conclusion. Patients with PSF show a psychosocial profile comparable to patients with other chronic disease. Implications for diagnosis and treatment are discussed.
ISRN neurology. 01/2011; 2011:627081.
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ABSTRACT: Spinal cord-injured (SCI) individuals demonstrate an increased baseline leg vascular resistance (LVR). In addition, despite the lack of sympathetic control, an increase in LVR is observed during orthostatic challenges. On the basis of the vasoconstrictive characteristics of angiotensin II, we examined the hypothesis that angiotensin II contributes to the LVR at baseline and during head-up tilt (HUT) in SCI individuals.
Supine baseline leg and forearm blood flow were measured using venous occlusion plethysmography and leg blood flow during 30° HUT using duplex ultrasound. Measurements were performed before and 4 h after an angiotensin II antagonist (irbesartan, 150 mg) administered in eight SCI individuals and eight age-matched and sex-matched able-bodied controls. Vascular resistance was calculated as the arterial-venous pressure gradient divided by blood flow.
Angiotensin II blockade significantly decreased baseline LVR in SCI individuals (P = 0.02) but not in controls, whereas no changes in forearm vascular resistance were found in both groups. Angiotensin II blockade did not alter the increase in LVR during HUT in SCI individuals nor in controls.
Our results indicate that angiotensin II contributes to the increased baseline LVR in SCI individuals. As angiotensin II does not contribute to forearm vascular resistance, the contribution to LVR may relate to the extreme inactivity of the legs in SCI individuals. Angiotensin II does not contribute to the increase in LVR during HUT in SCI individuals nor in controls.
Journal of hypertension 10/2010; 28(10):2094-101. · 4.02 Impact Factor
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ABSTRACT: Motor imagery (MI) refers to the mental rehearsal of a movement without actual motor output. MI training has positive effects on upper limb recovery after stroke.However, until now it is unclear whether this effect is specific to the trained task or a more general motors kill improvement. This study was set up to advance our insights into the efficacy of MI training and the specificity of its effects. We investigated whether MI training affected the trained hand exclusively, or both hands. Four stroke participants received a 15-min MI training four times a week for 3 weeks. Hand function was measured before and after the training using three measurement of increasing complexity. Hand function improved after MI training, thus confirming the earlier studies. Second, we found specific effects of the MI training for two of the three measurements. These results suggest that MI specificity is dependent on the complexity of the hand function task.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 05/2010; 33(4):359-62. · 0.36 Impact Factor
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ABSTRACT: Autonomic dysreflexia is a hypertensive episode in spinal cord-injured individuals induced by exaggerated sympathetic activity and thought to be alpha-adrenergic mediated. alpha-Adrenoceptor antagonists have been a rational first choice; nevertheless, calcium channel blockers are primarily used in autonomic dysreflexia management. However, alpha-adrenoceptor blockade may leave a residual vasoconstrictor response to sympathetic nonadrenergic transmission unaffected. The aim was to assess the alpha-adrenergic contribution and, in addition, the role of supraspinal control to leg vasoconstriction during exaggerated sympathetic activity provoked by autonomic dysreflexia in spinal cord-injured individuals and by a cold pressure test in control individuals. Upper leg blood flow was measured using venous occlusion plethysmography during supine rest and during exaggerated sympathetic activity in 6 spinal cord-injured individuals and 7 able-bodied control individuals, without and with phentolamine (alpha-adrenoceptor antagonist) and nicardipine (calcium channel blocker) infusion into the right femoral artery. Leg vascular resistance was calculated. In spinal cord-injured individuals, phentolamine significantly reduced the leg vascular resistance increase during autonomic dysreflexia (8+/-5 versus 24+/-13 arbitrary units; P=0.04) in contrast to nicardipine (15+/-10 versus 24+/-13 arbitrary units; P=0.12). In controls, phentolamine completely abolished the leg vascular resistance increase during a cold pressure test (1+/-2 versus 18+/-14 arbitrary units; P=0.02). The norepinephrine increase during phentolamine infusion was larger (P=0.04) in control than in spinal cord-injured individuals. These results indicate that the leg vascular resistance increase during autonomic dysreflexia in spinal cord-injured individuals is not entirely alpha-adrenergic mediated and is partly explained by nonadrenergic transmission, which may, in healthy subjects, be suppressed by supraspinal control.
Hypertension 03/2010; 55(3):636-43. · 6.21 Impact Factor
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ABSTRACT: In order to determine the influence of somatosensory impairments, due to the loss of large myelinated fibres, on the postural stability of Charcot-Marie-Tooth 1A (CMT) patients, a cross-sectional balance assessment was done. Nine CMT patients were compared with eight patients with a distal type of Spinal Muscular Atrophy (SMA), and 11 healthy control subjects. The balance assessment consisted of four tasks: quiet barefoot standing on a stable versus compliant surface, with eyes opened or closed. Force plate signals were used to calculate the velocity of the centre of pressure of the ground reaction forces. The patients' distal muscle force (MRC scale), vibration detection threshold (Rydel-Seiffer tuning fork) and superficial tactile sensation (Semmes-Weinstein monofilaments) were clinically assessed. Compared to the healthy subjects, postural stability of both patient groups was seriously impaired, however, increased visual dependency was only found in the CMT patients. The postural instability of the CMT patients correlated significantly with decreased vibration sense only. The strength of the correlation increased with task complexity. It is concluded that somatosensory deficits substantially contribute to impaired postural stability and increased visual dependency in CMT patients.
Gait & posture 03/2010; 31(4):483-8. · 2.58 Impact Factor
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ABSTRACT: The aim of this study was to evaluate whether community-dwelling chronic stroke patients wearing an ankle-foot orthosis would benefit from changing to functional electrical stimulation of the peroneal nerve.
In 26 community-dwelling chronic (> 6 months post-onset) patients after stroke, their ankle-foot orthosis was replaced by a surface-based functional electrical stimulation device (NESS L300). Comfortable walking speed over 10 m was measured at baseline with the ankle-foot orthosis and after 2 and 8 weeks with both ankle-foot orthosis and functional electrical stimulation. The level of physical activity was assessed with a pedometer, and patients' satisfaction was assessed with a questionnaire at baseline and at week 8 regarding ankle-foot orthosis and functional electrical stimulation, respectively.
Ankle-foot orthosis and functional electrical stimulation were equally effective with regard to walking speed and activity level. The participants were more satisfied with functional electrical stimulation than with their ankle-foot orthosis regarding the effort and stability of walking, quality of the gait pattern, walking distance, comfort of wearing and appearance of the device.
The patients judged functional electrical stimulation superior to their ankle-foot orthosis, but measurements of walking speed and physical activity could not objectify the experienced benefits of functional electrical stimulation. Other outcome measures focusing on the stability and effort of ambulation may objectify the perceived benefits of functional electrical stimulation in community-dwelling chronic stroke patients.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 02/2010; 42(2):117-21. · 1.88 Impact Factor
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ABSTRACT: In facioscapulohumeral dystrophy (FSHD) muscle function is impaired and declines over time. Currently there is no effective treatment available to slow down this decline. We have previously reported that loss of muscle strength contributes to chronic fatigue through a decreased level of physical activity, while fatigue and physical inactivity both determine loss of societal participation. To decrease chronic fatigue, two distinctly different therapeutic approaches can be proposed: aerobic exercise training (AET) to improve physical capacity and cognitive behavioural therapy (CBT) to stimulate an active life-style yet avoiding excessive physical strain. The primary aim of the FACTS-2-FSHD (acronym for Fitness And Cognitive behavioural TherapieS/for Fatigue and ACTivitieS in FSHD) trial is to study the effect of AET and CBT on the reduction of chronic fatigue as assessed with the Checklist Individual Strength subscale fatigue (CIS-fatigue) in patients with FSHD. Additionally, possible working mechanisms and the effects on various secondary outcome measures at all levels of the International Classification of Functioning, Disability and Health (ICF) are evaluated.
A multi-centre, assessor-blinded, randomized controlled trial is conducted. A sample of 75 FSHD patients with severe chronic fatigue (CIS-fatigue > or = 35) will be recruited and randomized to one of three groups: (1) AET + usual care, (2) CBT + usual care or (3) usual care alone, which consists of no therapy at all or occasional (conventional) physical therapy. After an intervention period of 16 weeks and a follow-up of 3 months, the third (control) group will as yet be randomized to either AET or CBT (approximately 7 months after inclusion). Outcomes will be assessed at baseline, immediately post intervention and at 3 and 6 months follow up.
The FACTS-2-FSHD study is the first theory-based randomized clinical trial which evaluates the effect and the maintenance of effects of AET and CBT on the reduction of chronic fatigue in patients with FSHD. The interventions are based on a theoretical model of chronic fatigue in patients with FSHD. The study will provide a unique set of data with which the relationships between outcome measures at all levels of the ICF could be assessed.
Dutch Trial Register, NTR1447.
BMC Neurology 01/2010; 10:56. · 2.17 Impact Factor
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ABSTRACT: Ankle-foot orthoses are often provided to improve walking in stroke patients, although the evidence of effects on walking and balance control is still inconsistent. This could be caused by a lack of insight into the influence of orthoses on the underlying impairments. These impairments can be assessed with dual plate posturography to determine the relative contribution of each lower limb to balance control and weight-bearing. This study examined the effects of ankle-foot orthoses on functional balance, static and dynamic weight-bearing asymmetry and dynamic balance control of the paretic and non-paretic lower limbs.
Twenty stroke subjects (time since stroke 5-127 months) completed the study. Subjects were assessed with and without ankle-foot orthosis. Functional balance was assessed using the Berg Balance Scale, Timed Up & Go test, Timed Balance Test, 10-m walking test and Functional Ambulation Categories. Weight-bearing asymmetry and dynamic balance control were assessed with force plates on a movable platform.
No significant effects of ankle-foot orthoses were found for weight-bearing asymmetry and dynamic balance control, but significant differences in favour of ankle-foot orthosis use were found for most functional tests.
Although ankle-foot orthoses had no effect on weight-bearing asymmetry or dynamic balance contribution of the paretic lower limb, functional tests were performed significantly better with orthoses. Apparently, improvements at functional level cannot be readily attributed to a greater contribution of the paretic lower limb to weight-bearing or balance control. This finding suggests that ankle-foot orthoses influence compensatory mechanisms.
Clinical biomechanics (Bristol, Avon) 09/2009; 24(9):769-75. · 1.76 Impact Factor
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ABSTRACT: The reorganisation of standing balance after a lower limb amputation is considered, with emphasis on persons with an acquired unilateral amputation above the ankle and below the hip joint. In the first section, three major peripheral motor and sensory impairments are discussed: (a) a lack of ankle torque generation to restore equilibrium in the sagittal plane, (b) a lack of weight-shifting capacity to control posture in the frontal plane and (c) a distorted somatosensory input from the side of amputation. In the second part of die paper, it is argued that a lower limb amputation, as any other serious peripheral lesion, also affects the highest levels of the sensorimotor system, because the functional recovery after amputation requires a central adaptation to the alterations of peripheral motor and sensory conditions. A reduction in the cognitive regulation of posture as well as a decrease in visual dependency are proposed as two of the most critical parameters of the long-term central adaptation process and as relevant indicators of the restoration of (the safe performance of) gross motor skills. In the final section, some implications for the management, balance assessment and training of persons with a lower limb amputation are mentioned.
07/2009; 8(3):145-157.
