Erwin van Wegen

• Dr.
• Associate Professor at Amsterdam University Medical Center

A comprehensive and multidisciplinary guide to understanding and treating a wide range of movement disorders, including parkinsonisms, tremor, tics, dystonia, chorea, ballism and myoclonus. Split into five sections, the first is a basic introduction to the subject, covering the principles of human motor behavior and functional anatomy. The next thr...

Objective To assess the added value of caregiver-mediated exercises combined with telerehabilitation in addition to usual care compared to usual care alone on the self-reported mobility outcome after subacute stroke. Design Multicentre, observer-blinded, parallel randomised controlled trial. An off-site researcher allocated treatments using minimi...

Non-pharmacological interventions, including cognitive-behavioral therapy (CBT), non-invasive brain stimulation (NIBS), electroconvulsive therapy (ECT), light therapy (LT), and physical rehabilitation/exercise, have shown promise as effective approaches to treat symptoms of depression and anxiety in individuals with Parkinson’s disease (PD). In thi...

Background Individuals with advanced multiple sclerosis (MS) have complex care requirements and are more likely to use long-term facilities. This study determined the associations between mood and social-care–related quality of life (SCRQOL), and healthrelated quality of life (HRQOL) and examined the association between HRQOL and SCRQOL. Methods B...

Introduction: Exercise therapy may increase brain-derived neurotrophic factor (BDNF) levels and improve clinical outcomes in people living with Parkinson's disease (PD). This systematic review was performed to investigate the effect of exercise therapy on BDNF levels and clinical outcomes in human PD and to discuss mechanisms proposed by authors....

Introduction: Physical exercise is receiving increasing interest as an augmentative non-pharmacological intervention in Parkinson's disease (PD). This pilot study primarily aimed to quantify individual response patterns of motor symptoms to alternating exercise modalities, along with non-motor functioning and blood biomarkers of neuroplasticity an...

Fatigue is a common complaint and a disabling symptom among patients following transient ischemic attack (TIA) or minor stroke. In patients with stroke, decreased cardiorespiratory fitness (CRF) is believed to be related to increased severity of post-stroke fatigue (PSF). However, this association between PSF and CRF in patients with TIA or minor s...

We often interact with our environment through manual handling of objects and exploration of their properties. Object properties (OP), such as texture, stiffness, size, shape, temperature, weight, and orientation provide necessary information to successfully perform interactions. The human haptic perception system plays a key role in this. As virtu...

Background Patients with a transient ischemic attack (TIA) or ischemic stroke are at increased risk of developing cognitive impairment in the subacute phase. At present, the effects of exercise on cognitive functioning following a TIA or stroke are not fully known. The purpose of this trial was to investigate the effect of exercise on global cognit...

Background Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods A mixed methods study was con...

Background Exercise training may affect the blood levels of brain-derived neurotrophic factor (BDNF), but meta-analyses have not yet been performed comparing pre- and post-intervention BDNF concentrations in patients with multiple sclerosis (PwMS). Objective To perform a meta-analysis to study the influence of exercise on BDNF levels and define co...

Background: Cognitive decline affects up to 50% of patients with Parkinson's disease (PD) in the course of the disease and may be amenable to exercise interventions. To accurately set adequate training intensities, standardized exercise testing is required but such testing takes considerable time and effort. The aim of this pilot study was to inve...

Background: Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allow...

Background The evidence for rehabilitation interventions poststroke lack sufficient robustness. However, variation in treatment effects across countries have been given little attention. Objective To compare two identically protocolized trials conducted in different western countries in order to identify factors that may have caused variation in s...

Background Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-...

This paper describes the design of the Armed4Stroke program. Patients after stroke and their caregivers are included as a couple. The caregiver is trained as a co-therapist by a physiotherapist experienced in providing caregiver-mediated exercises (CME) to support and motivate the patient. The program consists of 8 weeks of gait and gait-related ex...

BACKGROUND Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. OBJECTIVE This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. METHODS A mixed methods study was con...

Background Stroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity pa...

Background: Proprioception is important for regaining motor function in the paretic upper extremity after stroke. However, clinical assessments of proprioception are subjective and require verbal responses from the patient to applied proprioceptive stimuli. Cortical responses evoked by robotic wrist perturbations and measured by electroencephalogra...

Introduction Anxiety disorders occur in approximately one third of people with Parkinson’s disease (PD), and have a major impact on patient and caregiver wellbeing. In order to better understand and diagnose anxiety in PD patients, we investigated the generalizability of the results of a previous factor analysis on anxiety symptoms to a sample of P...

Background Smoothness is commonly used for measuring movement quality of the upper paretic limb during reaching tasks after stroke. Many different smoothness metrics have been used in stroke research, but a ‘valid’ metric has not been identified. A systematic review and subsequent rigorous analysis of smoothness metrics used in stroke research, in...

Patients with poor upper limb motor recovery after stroke are likely to develop increased resistance to passive wrist extension, i.e., wrist hyper-resistance. Quantification of the underlying neural and non-neural elastic components is of clinical interest. This cross-sectional study compared two methods: a commercially available device (NeuroFlexo...

Background The cause of smoothness deficits as a proxy for quality of movement post stroke is currently unclear. Previous simulation analyses showed that spectral arc length (SPARC) is a valid metric for investigating smoothness during a multi-joint goal-directed reaching task. The goal of this observational study was to investigate how SPARC value...

Purpose The aim of this study was to assess the effects of experimentally induced photothrombotic stroke on structural and mechanical properties of rat m. flexor carpi ulnaris . Methods Two groups of Young-adult male Sprague–Dawley rats were measured: stroke ( n = 9) and control ( n = 7). Photothrombotic stroke was induced in the forelimb region o...

Background Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological d...

Introduction Botulinum toxin‐A (BoNT) is widely used to manage focal upper limb spasticity and is effective in reducing resistance to passive movement, as measured with the modified Ashworth scale. Discrimination and quantification of the underlying neural and non‐neural components of hyper‐resistance may further improve understanding of the effect...

Background A better understanding of the subjective experience of living with Parkinson’s disease (PD) and the factors that influence this experience can be used to improve wellbeing of people with PD (PwP). Objective To gain more insight in the subjective experience of PD from the PwP’s perspective, and the factors that contribute to this experie...

Introduction Predicting upper limb capacity recovery is important to set treatment goals, select therapies and plan discharge. We introduce a prediction model of the patient-specific profile of upper limb capacity recovery up to 6 months poststroke by incorporating all serially assessed clinical information from patients. Methods Model input was r...

Background The growing societal and economic impact of Alzheimer’s disease (AD) is further compounded by the present lack of disease-modifying interventions. Non-pharmacological intervention approaches, such as exercise, have the potential to be powerful approaches to improve or mitigate the symptoms of AD without added side effects or financial bu...

Objectives Investigate whether resting-state EEG parameters recorded early poststroke can predict upper extremity motor impairment reflected by the Fugl-Meyer motor score (FM-UE) after six months, and whether they have prognostic value in addition to FM-UE at baseline. Methods Quantitative EEG parameters delta/alpha ratio (DAR), brain symmetry ind...

Background: People with Parkinson's disease (PD) experience not only motor problems but also non-motor problems that seriously impede their daily functioning and quality of life. The current pharmacologic treatment of PD is symptomatic, and alternative rehabilitation treatments, which preferably also have a disease-modifying effect and promote neur...

Aim: We studied the longitudinal associations between freezing of gait (FoG), fear of falling (FoF) and anxiety, and how these associations are influenced by confounding factors. Materials & methods: We analyzed longitudinal motor and nonmotor measurements from 153 Parkinson’s disease patients. Possible confounding factors were divided into three s...

Background. Patients with an upper limb motor impairment are likely to develop wrist hyper-resistance during the first months post stroke. The time course of wrist hyper-resistance in terms of neural and biomechanical components, and their interaction with motor recovery, is poorly understood. Objective. To investigate the time course of neural and...

Background. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It is unknown whether poststroke upper-limb motor and somatosensory impairment both reflect spontaneous neurobiological recovery or if somatosensory impairment and/or recove...

Background. The time course of cortical activation and its relation with clinical measures may elucidate mechanisms underlying spontaneous neurobiological recovery after stroke. Objective. We aimed to investigate (1) the time course of cortical activation as revealed by EEG-based spectral characteristics during awake rest and (2) the development of...

Background. Addressing the role of somatosensory impairment, that is, afferent pathway integrity, in poststroke motor recovery may require neurophysiological assessment. Objective. We investigated the longitudinal construct validity of position-cortical coherence (PCC), that is, the agreement between mechanically evoked wrist perturbations and elec...

Primary Objective: To investigate the level of agreement and differences regarding the perception of family functioning between patients with acquired brain injury and their partners. Our hypothesis was that patients would report better family functioning than their partners. Research Design: Cross-sectional study Methods and Procedures: Baseline d...

BACKGROUND Persons with Multiple Sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins or writing, impacting, therefore, the health-related quality of life. Mobile Health (mHealth) solutions, such as tablet apps may be used to train impaired dexterous s...

Background: Persons with multiple sclerosis (MS) often experience dexterous difficulties during the performance of activities of daily living, such as fastening buttons, handling coins, or writing, therefore impacting their health-related quality of life. Mobile health (mHealth) solutions, such as tablet apps, may be used to train impaired dextero...

The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb mo...

The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb mo...

Bij de ziekte van Parkinson zijn evenwichtsproblemen niet ongewoon. Aanvullende visuele feedback over de zwaaibewegingen van het lichaam tijdens het staan kan de prestatie op een houdingstaak verbeteren en balanstraining ondersteunen. Tegelijkertijd lijken mensen met parkinson extra afhankelijk te zijn van visuele informatie. Ze zijn daarmee mogeli...

Introduction: Differentiating between the components of wrist hyper-resistance post stroke, i.e., pathological neuromuscular activation (“spasticity”) and non-neural biomechanical changes, is important for treatment decisions. This study aimed to assess the reliability and construct validity of an innovative measurement device that quantifies these...

Ambulatory sensing of gait kinematics using inertial measurement units (IMUs) usually uses sensor fusion filters. These algorithms require measurement updates to reduce drift between segments. A full body IMU suit can use biomechanical relations between body segments to solve this. However, when minimising the sensor set, we lose a lot of this info...

Objective: Psychological distress has a high impact on quality of life in patients with multiple sclerosis (MS), Parkinson's disease (PD), and Huntington's disease (HD). Studies have shown that cognitive behavioral therapy (CBT) and mindfulness-based therapies (MBTs) are successful in reducing psychological distress in patients with anxiety, depre...

Background and purpose: Many individuals with Parkinson disease (PD) suffer from impaired dexterity, which impacts activities of daily living and quality of life. Exergaming, video game-based training with augmented virtual reality, may have value for improving function. The aim of the present pilot study was to comprehensively evaluate the feasib...

Objective: To classify patients with stroke into subgroups based on their characteristics at the moment of discharge from inpatient rehabilitation in order to predict community ambulation outcome 6 months later. Design: Prospective cohort study with a baseline measurement at discharge from inpatient care and final outcome determined after 6 mont...

Background and purpose We designed an 8-week caregiver-mediated exercise program with e-health support after stroke (CARE4STROKE) in addition to usual care with the aim to improve functional outcome and to facilitate early supported discharge by increasing the intensity of task specific training. Methods An observer-blinded randomized controlled t...

Absolute values of outcomes, reported as means and standard deviations (SD), Beta (SE = Standard error) and P-values of outcome measures. (DOCX)

Study protocol CARE4STROKE. (PDF)

Checklist physiotherapist intake exercise session. (DOCX)

CARE4STROKE database. (XLSX)

Self-reported exercise time over 8 weeks (in minutes), reported as medians and interquartile ranges (IQR). (DOCX)

Rationale: Restoration of adequate standing balance after stroke is of major importance for functional recovery. POstural feedback ThErapy combined with Non-invasive TranscranIAL direct current stimulation (tDCS) in patients with stroke (POTENTIAL) aims to establish if cerebellar tDCS has added value in improving standing balance performance early...

Introduction: Patients with Multiple Sclerosis exhibit disturbed dexterity, leading to difficulties in fine motor skills such as buttoning a T-shirt or hand-writing. Consequently, activities of daily living and quality of life are affected. The aim of the present study is to investigate the effectiveness of a tablet app-based home-based training in...

Objective: We investigated the potential added value of high-density resting-state EEG by addressing differences with healthy individuals and associations with Fugl-Meyer motor assessment of the upper extremity (FM-UE) scores in chronic stroke. Methods: Twenty-one chronic stroke survivors with initial upper limb paresis and eleven matched contro...

Objective: To provide a comprehensive overview of reported effects and scientific robustness of botulinum toxin (BoNT) treatment regarding the main clinical goals related to poststroke upper limb spasticity, using the International Classification of Functioning, Disability and Health. Data sources: Embase, PubMed, Wiley/Cochrane Library, and Ebs...

Oefenen met een naaste (caregiver-mediated exercises, CME) in aanvulling op de reguliere therapie is een nieuwe vorm van oefenen voor patiënten met een beroerte. Deze exploratieve kwalitatieve studie, onderdeel van de CARE4STROKE trial, richt zich op de ervaring van het samen oefenen. De onderzoeksvragen waren: 1) Hoe oefenen patiënt en naaste same...

Background Animal models of exercise and Parkinson’s disease (PD) have found that the physiologic use of exercise may interact with the neurodegenerative disease process, likely mediated by brain derived neurotrophic factor (BDNF). No reviews so far have assessed the methodologic quality of available intervention studies or have bundled the effect...

Purpose: Caregiver-mediated exercises are a novel way of delivering augmented exercise therapy for patients with stroke, in which patients do additional therapeutic exercises together with a caregiver. This explorative qualitative study is part of the CARE4STROKE trial and focused on how participants manage these exercises together. The research qu...

Transcranial direct current stimulation (tDCS) may serve as an adjunct approach in stroke rehabilitation. The cerebellum could be a target during standing balance training due to its role in motor adaptation. We tested whether cerebellar tDCS can lead to short-term effects on standing balance performance in patients with chronic stroke. Fifteen pat...

Background: Stroke rehabilitation aims to reduce impairments and promote activity and participation among patients. A major challenge for stroke rehabilitation research is to develop interventions that can reduce patients' neurological impairments. Until now, there has been no breakthrough in this research field. To move stroke rehabilitation forw...

Nederlandstalige samenvatting van de oorspronkelijke Cochrane review "Respiratory muscle training for MS" Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD009424

Objective: In patients with Parkinson’s disease (PD), augmented visual feedback (VF) can improve functional motor performance. Conversely, they appear to rely more on visual information than healthy subjects, which is unfavorable when this information is unreliable. Cortical beta activity is thought to be associated with the need for motor adaptati...

Fysiotherapie in VUmc, focus op centrale neurologie.

De ziekte van Parkinson gaat gepaard met zowel motorische als niet-motorische symptomen, die interacties met elkaar aangaan, en na verloop van tijd in ernst en aanwezigheid gaan fluctueren. Dit geeft stress, wat een grote impact heeft op de kwaliteit van leven van zowel patiënten als mantelzorgers/partners. Om te leren omgaan met de interacties en...

Objective To investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as w...

Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system, affecting approximately 2.5 million people worldwide. People with MS may experience limitations in muscular strength and endurance - including the respiratory muscles, affecting functional performance and exercise capacity. Respiratory muscle weakness can also...

Background Approximately 70–80% of stroke survivors have limited activities of daily living, mainly due to dexterous problems. Videogame-based training (VBT) along with virtual reality seems to be beneficial to train upper limb function. Objective To evaluate the usability of VBT using the Leap Motion Controller (LMC) to train fine manual dexterit...

Background In Parkinson's disease (PD) patients, fluctuations in symptoms commonly occur after many years of dopamine replacement therapy. The so-called wearing-off phenomenon exists of both motor and non-motor symptoms, such as rigidity and anxiety. Current treatment options are limited and an integrated approach is needed to address the complex i...

Finding, testing and demonstrating efficacy of new treatments for stroke recovery is a multifaceted challenge. We believe that to advance the field, neurorehabilitation trials need a conceptually rigorous starting framework. An essential first step is to agree on definitions of sensorimotor recovery and on measures consistent with these definitions...

This book, especially designed for people with Parkinson's Disease, offers a source for exercises, advice and instructions for daily exercises and mobility. Furthermore, it provides a great resource for other health care professionals such as physiotherapists, PD-nurses and occupational therapists. The instructions, exercises and advice are meant t...

Finding, testing and demonstrating efficacy of new treatments for stroke recovery is a multifaceted challenge. We believe that to advance the field, neurorehabilitation trials need a conceptually rigorous starting framework. An essential first step is to agree on definitions of sensorimotor recovery and on measures consistent with these definitions...

Introduction: A stooped posture is one of the characteristic motor symptoms of patients with Parkinson's disease, and has been linked to impairments in daily activities and quality of life. We aimed to test the efficacy, safety, practical utility and user-friendliness of a posture correction and vibrotactile trunk angle feedback device (the UpRigh...