The PhD defence of J. IJspeert is on 15 January 2025 at 02:30 pm."This dissertation by Jos IJspeert discusses the development of a treatment program for residual symptoms following Neuralgic Amyotrophy (NA), alongside the creation of two clinical measurement tools for evaluating patient recovery. NA is marked by sudden, intense pain in the shoulder and arm due to nerve inflammation, typically followed by muscle weakness and atrophy, affecting about 1 in 1000 people annually. Many patients continue to experience residual issues like weakness and limited mobility, with approximately half finding standard physiotherapy ineffective or aggravating.
Chapter 1 outlines NA, suggesting that therapy may be more beneficial when focused on maladaptive compensatory movements and cerebral reorganization rather than strength and endurance, which are less modifiable due to axonal damage.
Chapter 2 presents a cohort study of 248 patients aimed at developing recommendations for outcome measures and rehabilitation. Findings indicate a high prevalence of persistent pain, limitations, and a significant link between pain, scapular instability, and fatigue. Over half of the patients reported that standard physiotherapy was ineffective or worsened their symptoms.
In Chapter 3, a pilot study evaluates a new 16-week multidisciplinary intervention, combining physiotherapy and occupational therapy. Eight participants showed significant improvements in Canadian occupational performance measure: performance and satisfaction scores, Shoulder rating questionnaire , and health change (SF-36). Although muscle strength showed only a trend of improvement, coordination and behavioral adaptations likely contributed to progress.
Chapter 4 is a clinimetric study assessing handheld dynamometry of the serratus anterior muscle, testing three modified positions for validity and reliability. A seated test position with the tested arm in the scapular plain, yielded the most isolated EMG activity for the serratus anterior, although reliability was moderate.
Chapter 5 examines the feasibility of reachable workspace (RWS) measurements to assess motion restrictions in NA patients. Comparisons revealed significant limitations in the affected arm's active range of motion compared to healthy controls. RWS was found useful for quantifying functional impairments and showed moderate correlations with other functional measures.
Chapter 6 provides an overview of current knowledge and developments in NA, including clinical phenotypes, epidemiology, possible etiology, and treatment options. Acute phase treatments involve corticosteroids and analgesics, while the chronic phase focuses on physiotherapy and occupational therapy for energy conservation and movement coordination. In cases of severe nerve damage, surgical interventions may be considered. The dissertation concludes that NA is a manageable condition requiring a specialized treatment approach.