2012 | 05 - Nederlandse Vereniging van Revalidatieartsen

Transcription

INNOVATION
From creation to
implementation
VRA Annual Congress 2012
Thursday November 1st and Friday November 2nd, 2012
2012 | 05
PROGRAMME THURSDAY
34th volume
Nederlands tijdschrift voor Revalidatiegeneeskunde
Congress Reader
öCongress Programme Overview
öKeynote Speakers
öWorkshops & Minisymposia
öFree Papers
öPoster Presentations
Nederlands Tijdschrift voor Revalidatiegeneeskunde
Index
colofon
214
Editorial
217
Programme
Organisation
218
Keynote Speakers
S.H. Berdenis van Berlekom MBA
Professor T. van der Weijden MD PhD
Professor F.C.T. van der Helm PhD
Professor J. Harlaar PhD
Professor B.R. Bloem MD PhD
219
220
222
223
225
1b. Minisymposium
Rehabilitation and virtual environments: a love affair or just a one night stand? 227
1c. Minisymposium
228
SCI: innovation in sitting, standing and walking
1d. Workshop
Problems and pitfalls in the vocational training of specialists are there
to be solved
231
1e. Minisymposium
Evaluation, prediction and treatment of walking ability in children
232
with spina bifida 1f. Minisymposium
‘It’s my life!’ Innovation of care for young adults with childhood onset disabilities 233
1g. Workshop
234
Rehabilitation medicine: rehab is fun!
2b. Workshop
Effective exercises in rehabilitation medicine: how does it work?
2c. Minisymposium
From innovation to implementation in paediatric rehabilitation:
playfulness and flow
2d. Workshop
Changes in educational program VRA for residents in PM&R
2e. Minisymposium
Physician Assistants in rehabilitation: from innovation to implementation
2f. Workshop
Clinical assessment of walking energy cost and fitness in children
and adolescents with cerebral palsy or other motor impairments:
application in pediatric rehabilitation
235
Poster presentations
Thursday
Friday
De redactie wordt gevormd door
Drs. Vera Baadjou
Drs. Gerlof Balk
Dr. Hans Bussmann
Drs. Ben Drentje
Hans Groen
Dr. Lily Heijnen
Drs. Esther Jacobs
Dr. Ron Meijer
Prof. dr. Rob Smeets
Dr. Anne Visser-Meily
Heidi Wals
Hoofdredacteur
Drs. Ben Drentje
Redactieadres
Redactiesecretariaat t.a.v. Heidi Wals
Nederlandse Vereniging voor
Revalidatieartsen (VRA)
Postbus 9696
3506 GR Utrecht
Tel: (030) 273 96 96
E-mail: [email protected]
238
Opmaak
dchg medische communicatie, Haarlem
239
266
280
213
Het NTR is een mededelingen- en infor
matieperiodiek van de Nederlandse Vereni
ging van Revalidatieartsen (VRA).
237
236
245
252
259
Parallel Session 1
Parallel Session 2
Parallel Session 3
Nederlands Tijdschrift voor Revalidatie
geneeskunde (NTR)
The Netherlands journal of Physical and
Rehabilitation Medicine
Uitgever, advertenties en abonnementen
dchg medische communicatie
Hendrik Figeeweg 3G-20
2031 BJ Haarlem
Tel. (023) 551 48 88
www.dchg.nl
E-mail: [email protected]
3b. Minisymposium
240
Rehabilitation robotics: a promise for the near future?
3c. Minisymposium
RCT’s and alternative study designs in rehabilitation medicine; from design to
implementation and all the bumps on the way 241
3d. Minisymposium
242
Wheeled mobility: an ergonomics perspective 3e. Workshop
243
Introduction of IFMS in a medical staff of rehabilitation physicians
3f. Minisymposium
244
Lifespan expectations for individuals with cerebral palsy
Free Papers
Thursday afternoon
Friday morning
Friday afternoon
2012|5
Abonnement
Jaarabonnement € 80.
Schriftelijke opzegging ten minste 4 weken
voor het eind van de termijn. Het NTR
verschijnt zesmaal per jaar.
Inzending kopij
Per e-mail met attachments.
Complete tekst met eventuele afbeeldingen
of tabellen in de tekst aanleveren. Teksten in
Word (niet in pdf). Daarnaast tevens figuren,
foto’s of andere afbeeldingen, ook los van
de tekst aanleveren als jpg of tiff.
Richtlijnen voor auteurs
Deze richtlijnen zijn te downloaden op
www.revalidatiegeneeskunde.nl
Verschijning
Februari, april, juni, augustus, oktober en
december.
Niets uit deze uitgave mag worden overge
nomen zonder toestemming van de uitgever
of de hoofdredacteur. De uitgever is niet aan
sprakelijk voor de inhoud van deze uitgave.
34e jaargang nummer 5
ISSN 2211-3665
2012|5
Editorial
Innovation: from creation to
implementation
The theme of the International Annual Congress
of the Netherlands Society of Rehabilitation
Medicine 2012 emphasizes the outmost
importance for our profession not to stand still
but to look for new avenues to face the several
current and future challenges. For example,
the expected increase of the aging population,
the higher prevalence of co-morbidity and the
consequences of advanced medical technology
will result in a tremendous growth of patients
with disability and restrictions in participation.
Furthermore, a scarcity of health care workers
is foreseen, which will make it impossible to
take care of all these demands. Even more
important, we seem to have reached the limits
of the budget for health care and disability management. So we will have to disappoint many of our patients,
unless we are able to come up with new concepts how to attract and educate new colleagues, find innovative
solutions to enhance collaboration with other health care professionals, increase the effectiveness and
efficiency of our interventions by incorporating knowledge from other medical specialists and other fields
like technology such as IT and Virtual Reality. We must realise that today’s
problems cannot be solved with the same way of thinking that caused those
problems. Innovation leads to change and we need to explore new clinical
"Innovation distinguishes
paths and broaden the borders of our specialty without loosing focus on the
between a leader and a
essence of our profession. The healthcare changes constantly and it offers
follower"
Steve Jobs
us the possibility to actively contribute to this change and to be a
co-designer of new methods. Let’s face that challenge.
For our Annual Congress the scientific committee succeeded in putting together a very exciting program with
five excellent and renowned keynote speakers who shared their points of view on the opportunities, challenges
and pitfalls of innovation. Besides, the highest number of symposia/workshops (19) ever, including 3 sessions
with in total 24 excellent free paper presentations were scheduled.
This issue of NTR reflects the high quality of the last congress of our Society, and invites us to boost our
energy to create and innovate!
Prof. Rob Smeets MD PhD, Chair Scientific Committee
Dr. Juan Martina, MD, Chairman of the VRA
214
VRA ANNUAL CONGRESS 2012
Thursday November 1st
09.00 – 10.00 Registration of the participants
10.00 – 10.10 Opening congress
10.10 – 10.40 The art of possibility
10.40 – 11.10 Challenges in knowledge transfer
13.15 – 15.15 Parallel session 1
1a. Free Papers
1b. Mini-symposium: Rehabilitation and virtual environments:
a love affair or just a one night stand?
1c. Mini-symposium: SCI: innovation in sitting, standing and
walking
1d. Workshop: Problems and pitfalls in the vocational training
of specialists are there to be solved
1e. Mini-symposium: Evaluation, prediction and treatment of
walking ability in children with Spina Bifida
1f. Mini-symposium: ‘It’s my life’. Innovation of care for young
adults with childhood onset disabilities
1g. Workshop: Rehabilitation Medicine: Rehab is fun!
11.10 – 11.35 Poster presentations
15.15 – 16.00 Tea break and visiting commercial exhibition
11.35 – 13.15 Visiting posters and commercial exhibition
Lunch
16.00 – 18.00 General Assembly VRA
18.00 – 19.30 Free time
19.30 – 24.00 Dinner and live-music
Friday November 2nd
2a. Free Papers
2b. Workshop: Effective Exercises in Rehabilitation Medicine:
How does it work?
2c. Mini-symposium: From innovation to implementation in
pediatric rehabilitation: playfulness and flow
2d. Workshop: Changes in Educational program VRA for
residents in PM&R.
2e. Mini-symposium: Physician Assistants in rehabilitation:
from innovation to implementation
2f. Workshop: Clinical assessment of walking energy cost and
fitness in children and adolescents with cerebral palsy or
other motor impairments: Application in pediatric
rehabilitation
10.30 – 11.15 Coffee break and visiting commercial
exhibition
11.15 – 11.45 Force and position feedback mechanisms in
neuromuscular control
Professor F.C.T. van der Helm PhD
11.45 – 12.10 Poster presentations
12.10 – 13.15 Visiting posters and commercial exhibition
Lunch
3a. Free Papers
3b. Mini-symposium: Rehabilitation Robotics: a promise for
the near future?
3c. Mini-symposium: RCT’s and alternative study designs in
Rehabilitation Medicine; From design to implementation
and all the bumps on the way
3d. Mini-symposium: Wheeled mobility: an ergonomics
perspective
3e. Workshop: Introduction of IFMS in a medical staff of
rehabilitation physicians
3f. Mini-symposium: Lifespan expectations for individuals
with cerebral palsy
15.15 – 15.45 Tea break and visiting commercial exhibition
15.45 – 16.00 Awarding:
‘best presentation’ and ‘best poster’
PhD Award Rehabilitation Medicine
16.00 – 16.30 Clinical Movement Analysis in
Rehabilitation Medicine: the road to
implementation
Professor J. Harlaar PhD
16.30 – 17.00 Healthcare new style: a different role for
healthcare professionals and patients
17.00
217
Closing of the VRA Annual Congress
2012|5
PROGRAMME OVERVIEW
PROGRAMME OVERVIEW
Programme
2012|5
Organisation
Organizing Society
Netherlands Society of Physical and Rehabilitation Medicine
Scientific Committee Netherlands Society of Physical and
Rehabilitation Medicine
Prof. R.J.E.M Smeets MD PhD
M.J. Andela MD
W.X.M. Faber MD
J.F.M. Fleuren MD PhD
I.J.M. de Groot MD PhD
J.H. de Groot MSc PhD
V. de Groot MD PhD
S.I.G. van Haaster-Houwing, MSc (VRA bureau)
J. van Meeteren MD PhD
A. Mert MD PhD
G.M. Ribbers MD PhD
M.E. Roebroeck PhD
J. Stolwijk-Swüste MD PhD
A.H. Vrieling MD PhD
Postal address
Postbus 9696
3506 GR Utrecht
The Netherlands
T +31 (0)30 - 273 96 96
www.revalidatiegeneeskunde.nl
[email protected]
Congress venue
NH Conference Centre Leeuwenhorst
Langelaan 3
2211 XT Noordwijkerhout
The Netherlands
T +31 (0)25 - 237 88 88
Congress registration and acquisition sponsoring
T +31 (0)6 - 14 47 52 82
T +31 (0)6 - 42 43 07 99
F +31 (0)182 - 63 43 42
www.janssensenvandeutekom.nl
[email protected]
Accreditation
Accreditation has been granted for at the Netherlands Society of Physical and Rehabilitation Medicine and the
European Accreditation Council for Continuing Medical Education (EACCME).
218
Keynote Speakers
2012|5
Keynote Speaker
S.H. Berdenis van Berlekom
The art of possibility
While professionals in rehabilitation medicine are
busy implementing the current best practice, they
always have to be aware of signals indicating that a
next practice is at hand. Innovators have a nose for
this next trend, but do our organisations and their
rehabilitation specialists have a nose for innovators?
In his presentation, Steven van Berlekom will state
that innovation is performing the art of possibility, a
positive attitude towards ideas eventually changing
the rules of the game (or not). He will reflect on a
variety of topics, such as the difference between
‘solving a problem’ and ‘accomplishing an ambition’,
the manageability of the weather and the importance
of passing. He will wander through questions as:
How can we ensure improvements and innovations
in the increasingly production-based environment
of a rehabilitation centre? What organisational and
cultural conditions invite professionals to become
innovators? What kind of leaders and, as important,
followers do we need to build an innovational
environment? Which part can patients play in
the search of the next practice? And last but not
least: Are rehabilitation specialists equipped for
performing the art of possibilities and if not, what
can be done to support them?
Curriculum Vitae
Steven Berdenis van Berlekom (1959) is member
of the executive board of De Hoogstraat Revalidatie
in Utrecht. His focus in the board is on quality and
safety, innovation and scientific research.
Since he became a physiotherapist in 1983,
Steven van Berlekom has been working in the
field of rehabilitation medicine. In the eighties
mainly as paediatric physiotherapist, in the
nineties as a manager of rehabilitation teams at
Sophia Revalidatie and later on at De Hoogstraat.
In this period he earned a Masters of Business
Administration Degree (MBA) from Henley
Business School - Brunel University.
In 2003 Steven van Berlekom became as
Manager Center of Excellence the ‘mr. Fixit’
(de regelneef) of Professor Eline Lindeman,
establishing and developing the Center of
Excellence for Rehabilitation Medicine Utrecht.
Here his experience as a professional met
his organisational skills in topics as quality
improvement, implementation and innovation.
Due to an excellent team the Center of Excellence
became a frontrunner in research and innovation
in rehabilitation in the Netherlands. Steven van
Berlekom was involved in well-known projects
as the development and dissemination of the
USER, the project Gezin in Zicht for paediatric
rehabilitation teams, the development of the
Beslishulp Beroerte in association with the WCN
and - still running - two national projects for the
implementation of the guidelines for Stroke and
Cerebral Palsy.
Steven van Berlekom joined the executive board
of the Hoogstraat in 2009. He is member of the
advisory committee for research, innovation
and quality (BOIK) of Revalidatie Nederland,
vice-chairman of the programme-commission for
the innovation-programme for rehabilitation at
ZonMw, member of the advisory committee for
quality at NVZ and member of the editorial board
of Revalidatie Magazine.
219
Keynote Speakers
2012|5
Keynote Speaker
Prof. T. van der Weijden
Challenges in knowledge transfer
Curriculum Vitae
Trudy van der Weijden received her medical
degree in 1989 and made a choice for fulltime
research early in her career. She certified as
epidemiologist. In 1997 she defended her thesis
‘Implementation of the Cholesterol clinical practice
guideline in general practice’ for which she
received the CaRe Award 1997, the dissertation
award of the Netherlands School of Primary Care.
In 2005, she was appointed as Program Leader in
the research school for public health and primary
care (CAPHRI) of Maastricht University, and in
2010 as professor in Implementation of Clinical
Practice Guidelines at the department of General
Practice. She is leading the CAPHRI research
program 'Implementation of evidence'. In 2010
Trudy van der Weijden was awarded with a ZonMW
Parel for the IMPALA project ‘Shared Decision
Making in lifestyle counseling’. In 2011 she chaired
the International Conference on Shared Decision
Making in Maastricht.
Research evidence on the effectiveness of medical
interventions is published in large quantities
every year. This does not automatically lead to
improvements in patient care. Unwarranted interdoctor variation that has been documented since
the 1940’s, continues to persist in many health care
settings.
Systematic implementation efforts are needed to
achieve and sustain high quality of care. Clinical
practice guidelines are seen as a strategy of first
choice in this field. The development of guidelines is
a challenge; evidence-based information regarding
effectiveness, efficiency, patient preferences, and
safety has to be appraised, and subsequently related
to national or local experiences on best practices to
assure feasibility, timeliness and equity. Research
is therefore needed on the preferred methods for
development of multidisciplinary guidelines and
quality of care indicators.
Dissemination of guidelines does not lead to
significant improvements in quality of care.
Physicians may experience a conflict between the
adherence to guidelines (with population-based
220
She has (co-)authored over 120 international
scientific papers in peer reviewed international
journals, which include the highest impact medical
journals such as British Medical Journal and
Journal American Medical Association.
She is visiting senior fellow at Nijmegen IQ
Scientific Institute for Quality of Health Care,
working with Gert Westert, and at the Cardiff
Department of Primary Care and Public Health,
working with Glyn Elwyn, UK. She is visiting
professor at Hoge School Zuyd Heerlen, working
for the Platform Quality of Life with Sandra
Beurskens.
recommendations) and patient-centred work
(applying the guideline to a unique patient). Health
care should be delivered according to accepted
professional guidelines, with specific benchmarks
for the quality indicators. However, health care
should also meet objective and subjective needs of
individual patients.
Keynote Speakers
2012|5
Keynote Speaker
Prof. F.C.T. van der Helm
Force and position feedback mechanisms in
neuromuscular control
Curriculum Vitae
Professor Frans C.T. van der Helm PhD
The simultaneously modulation of the strength of
the force and position feedback loops determines the
postural control of the human limbs. Force feedback
originates from the Golgi tendon organs, and position
feedback from the muscle spindles. Position tasks
require a high stiffness of the human limb (‘resist’),
whereas force tasks require a low stiffness (‘give
way’). Using closed-loop system identification
mechanisms in combination with force perturbations,
the quantitative contribution of the various feedback
loops can be determined. In force tasks, the stiffness
becomes lower than in passive conditions showing
that the reflexive feedback is actively ‘giving way’.
Remarkedly, experimental results show a switch of
the sign of position and force feedback gains between
position and force tasks.
A theoretical model was developed which can
explain the symptoms of dystonia, like preferred
position and high resistance against displacement.
The model assumes a-symmetric feedback gains
between flexors and extensors, and the lack of
positive force feedback gains settings. Experiments
with CRPS patients with dystonia showed that they
222
Frans C.T. van der Helm is professor in
Biomechatronics and Bio-robotics, Delft
University of Technology, and also adjunctprofessor at the University of Twente, LUMC,
Northwestern University (Chicago) and Case
Western Reserve University (Cleveland). He has
a MSc in Human Movement Science (1985), and
a PhD in Mechanical Engineering (1991). He was
member of the board of the International Society
of Biomechanics (2005-2009), and participates
in the board of the Technical Group of Computer
Simulation (TGCS) and the International Shoulder
Group (ISG). He is one of programme leaders in
the Medical Delta, the collaboration between
Leiden Unversity Medical Center (LUMC), Erasmus
Medical Center Rotterdam and TU Delft. He is
Principal Investigator in the TREND research
consortium, investigating Complex Regional
Pain Syndrome as a neurological disorder, the
NeuroSIPE (System Identification and Parameter
Estimation in Neurophysiological systems)
program and H-Haptics (Human centered Haptics)
program, sponsored by the Dutch National Science
Foundation. In 2011 he received an ERC grant for
a research project ‘4D EEG’, improving temporal
and spatial resolution of EEG source localization.
In 2012 he received the ‘Simon Stevin Meester’
prize, the most prestigious award for research
in the technical sciences in the Netherlands. He
has published over 150 papers in international
journals on topics as biomechanics of the upper
and lower extremity, neuromuscular control, eye
biomechanics, pelvic floor biomechanics, human
motion control, posture stability, etc.
could significantly less modulate their force feedback
strength.
It is concluded that Golgi tendon feedback has a
similar important role for the stiffnes behaviour of
the human limbs as muscle spindles, and they should
be simultaneously quantified in order to understand
neuromuscular control.
Keynote Speakers
2012|5
Keynote Speaker
Prof. J. Harlaar
Clinical movement analysis in rehabilitation
medicine: the road to implementation
Curriculum Vitae
Professor Jaap Harlaar PhD
Laboratory for Clinical Movement Analysis
dept. Rehabilitation Medicine, VU University
Medical Centre, Amsterdam
MOVE Research Institute Amsterdam
Human movement analysis is the scientific analytical
method to reduce human motion to the mechanical
behaviour of the (neuro-)musculoskeletal system.
Whether or not application of such methods is useful
in the clinical practise of rehabilitation medicine,
requires a close interaction of application designers
and physiatrists. It is obvious that the complexity
of the human movement system in action, cannot
be understood from observation and physical
examination alone. However, simply measuring all
information that can be acquired, is not automatically
meaningful.
The road behind: over the last 20 years the
introduction of clinical movement analysis in the
Netherlands has been governed by this interaction
and has evaluated into an unique concept. Adapted
technologies for clinical feasible solutions were
developed and a network of clinical gait labs and
multidisciplinary courses is now established.
223
Jaap Harlaar (1956) is biomedical engineer and
professor in clinical movement analysis. He is
heading the laboratory of clinical movement
analysis at the Department of Rehabilitation
Medicine at the VU University Medical Center. He is
also co-heading the musculoskeletal biomechanics
research group of the MOVE research institute
Amsterdam. He is also lecturer at the faculty of
human science of VU University Amsterdam. Jaap
was trained at Twente University as an electrical
engineer and specialized in measurement and
signal processing of EMG during movement. At
VUmc he designed and build instrumentation
for clinical movement analysis in the context of
rehabilitation medicine, receiving a PhD on this
topic in 1998. In his work Jaap highly values
close collaboration with clinicians to establish
innovations that must lead to meaningful
applications. His current research focuses on the
application of new technologies, i.e. computational
biomechanics, Virtual Reality and inertial
sensing, with an emphasis on orthotics. Jaap is
co-founder of SMALLL, the Dutch-Flemish society
of movement analysis laboratories. Furthermore
Jaap serves ISPO Netherlands as chairman and
is president of ESMAC (European Society for
Movement Analysis in Adults and Children).
The road ahead: short term developments will
include even closer national collaborations involving
datasharing, and the conception of guidelines for
sensible clinical use. Technological developments will
contribute to cost effectiveness, while computational
biomechanical modelling will support the physiatrist
in informed decision making. The challenge of
this road ahead is not to get lost in technological
opportunities, but to stay critically focused on the
need to provide better care for our patients. This also
requires the committment of the clinical community
to the role of diagnostics in clinical practise of
rehabilitation medicine.
Keynote Speakers
2012|5
Curriculum Vitae
Keynote Speaker
Prof. B.R. Bloem
Healthcare new style:
ad
ifferent role for
healthcare professionals
and patients
The world around us is changing. Healthcare is no
exception to this phenomenon. The role of both
health care professionals and that of patients will
change due to social changes such as individualism,
globalization and technology. In my presentation I will
address these new roles. Healthcare professionals
need to develop from omnipotent ‘Gods’ into a coach
or a guide, who supports the patient in making the
right decisions. Moreover, healthcare professionals
have to specialize on a limited number of disorders
and integrated care should be provided during the
entire disease process of patients.
The new role of the healthcare professionals has
resulted in the development of ParkinsonNet. In
my presentation I will elaborate on the creation of
ParkinsonNet, the current state of affairs, and on
some important developments for the near future.
I will also discuss the important role, played by the
rehabilitation specialists within the ParkinsonNet.
Patients will change from passive objects into active
subjects, who make a significant contribution to
maintaining both their own good health and in the
225
Bas Bloem is a consultant neurologist at the
Department of Neurology, Radboud University
Nijmegen Medical Centre, the Netherlands. He
received his MD degree (with honour) at Leiden
University Medical Centre in 1993. In 1994, he
obtained his PhD degree in Leiden, based on a
thesis entitled ‘Postural reflexes in Parkinson’s
disease’. He was trained as a neurologist between
1994 and 2000, also at Leiden University Medical
Centre. He received additional training as a
movement disorders specialist during fellowships
at ‘The Parkinson's Institute’, Sunneyvale,
California (with Dr. J.W. Langston), and at the
Institute of Neurology, Queen Square, London
(with Prof. N.P. Quinn and Prof. J.C. Rothwell). In
2002, he founded and became Medical Director
of the Parkinson Centre Nijmegen (ParC), which
was recognised from 2005 onwards as centre
of excellence for Parkinson’s disease. Together
with Dr. Marten Munneke, he also developed
ParkinsonNet, an innovative healthcare concept
that now consists of 64 professional networks for
Parkinson patients covering all of the Netherlands
(www.parkinsonnet.nl). In September 2008, he
was appointed as Professor of Neurology, with
movement disorders as special area of interest.
He is currently President of the International
Society for Gait and Postural Research, and is
on the editorial board for several national and
international journals. Since 2009, he is member of
the European Section Executive Committee of the
Movement Disorder Society. In 2009, he also joined
the board of ZonMw (The Netherlands Organisation
for Health Research and Development). He
currently has two main research interests: cerebral
compensatory mechanisms, especially in the
field of gait & balance; and healthcare innovation,
aiming to develop and scientifically evaluate
patient-centred collaborative care. For this latter
purpose, Prof. Bloem co-founded MijnZorgnet
(together with Prof. Jan Kremer), a service
provider that delivers web-based communities for
both patients and health professionals. Prof. Bloem
has published over 350 publications, including
more than 260 peer-reviewed international papers.
recovery from diseases. Modern ICT solutions can
support these new roles, but they can never be an
aim in themselves. At the end of my presentation
I will briefly address the question whether and how
patients with a neurodegenerative disease like
Parkinson in close cooperation with health care
professionals can make use of such modern ICT
applications.
Parallel Session 1
2012|5
1b: Minisymposium
Rehabilitation and virtual environments:
a love affair or just a one night stand?
Chair: A. Mert MD PhD
W. Bles PhD, W.J. Renger MSc, M. Roerdink PhD, M.P. Schijven MD PhD, W. Wertheim MD
Rehabilitation and virtual environments: a love
affair or just a one night stand?
In the last 4,5 years more than 12 000 sessions on
the Computer Assisted Rehabilitation ENvironment
at the Military Rehabilitation Center in Doorn have
been performed. The success rate from the patient’s
perspective is very high, but adherence to several
gaming and virtual reality principles is necessary.
Often this means that the therapist has to ‘fade into
the background’.
A method has been developed of developing a
rehabilitation game. This method that has been applied
to the ‘Body Posture’ game. This game has won the Best
Serious Game 2011 award of the Dutch Game awards.
Principles and intensity of therapy that have worked
well in our setting will be presented. These might
be used as a starting point for future research and
shaping of therapy. Also pitfalls in this type of research
will be discussed. Lastly, how to use this type of
assistive technology as an analysis tool will be shown.
Simulation and serious gaming: seriously?!
The application of digital games as training modality
for medical professionals is on the rise. Often referred
to as ‘serious games’, they form a category of training
tools that provide a challenging simulated environment.
They may be of use to train medical professionals,
resulting in reduced healthcare cost while enhancing
patient safety. Learning through challenging games
occurs faster than imposed learning, with results
more securely mapped in the brain, i.e. leading to
better retention and enhancing deep and sustained
learning. Acceptance of serious gaming, however, is
a process that requires intensive collaboration with
game designers, a change of mindset in health care
educators and robust validation of the embedding of
such technology in teaching healthcare professionals.
This talk provides you with an overview of the current
state-of-the-art in serious gaming for training health
care professionals.
From simulation to transformation: game design
principles and its application in healthcare
Simulation has been around for a long time and
227
is used in many contexts to train professionals in
understanding complex processes, decision making
or performing complex motorskills.
Games are relatively new in entering other contexts
than entertainment, so called serious games. In
this presentation we will look at the similarities and
differences between games and simulation. What are
the advantages of using or making games compared
to simulations?
A vital difference between games and simulations
is their relationship to the real. Simulations aim
at a 1:1 relationship with reality while using virtual
presence. Games aim at 1:x relationship, hence the
term transformation. This puts more importance on
the collaboration between subject matter expert and
designer, but if done right leads to a very different
user experience for the user/patient/client. Using a number of examples of serious games in the
context of healthcare, a number of critical lessons
learned will be presented covering the design process
and collaboration between medical experts and
designers.
Simulator and game induced sickness
The use of serious gaming and simulators in health
care holds a potential problem that needs to be
addressed, since ignoring it will compromise the
potential usefulness of these techniques. With
increasing screen sizes, better graphics, the use
head mounted displays and of motion platforms a
special form of motion sickness, simulator sickness,
can arise. This can lead to nausea, decreased
performance and to aversion to these therapy
forms. In rehabilitation practices where patients
have decreased sensory functioning and suboptimal
integration of sensory input (e.g. after a stroke), this
can be a compounding problem.
Overcoming and preventing simulator sickness is
possible, but adherence to well known principles in
the field of simulation is necessary.
In this presentation the causes of simulator sickness
are addressed, also how to prevent and overcome it.
Parallel Session 1
Moving from the ‘red carpet’ to a treadmill with
visual context to enhance the task-specificity of
intensive, repetitive gait training
General recommendations for effective rehabilitation
indicate that we should start as early as possible
with high-intensity, repetitive and task-specific
practice with feedback on performance. For gait
rehabilitation, treadmill training represents a practice
form that largely complies with these evidence-based
ingredients. However, the task-specificity aspect of
treadmill training can be disputed because it places no
demands on precise foot placement, which is critical
for safe ambulation in ever changing environments.
After all, most falls occur due to inaccurate foot
placement relative to environmental context (e.g.,
obstacles, uneven terrain), resulting in trips, slips and
misplaced steps. A well-suited metaphor for treadmill
walking is a red carpet: the regular, flat walking
surface lacks fall hazards, placing minimal demands
on foot placement precision. In this presentation,
I will discuss the development of an innovative
rehabilitation treadmill with projected visual context,
placing high demands on foot positioning and thereby
enhancing the task-specificity of treadmill training.
Virtual Reality In Rehabilitation, how to get it
operational for daily use.
In recent years a lot of new technology entered
healthcare institutions. One of these new
technologies concerns a virtual reality instrument
to enhance rehabilitation programs in a ‘gaming
environment’.
Since a few years the military rehabilitation center
in the Netherlands is working with a VR-instrument
called CAREN (computer assisted rehabilitation
2012|5
environment). CAREN is a high-end virtual reality
tool providing diagnostic and treatment features.
Embedding these virtual reality instruments in a
medical rehabilitation environment requires quite
some management skills. The treatment with
this novel tool had to be aligned with the existing
treatment protocols in neurological and orthopedic
rehabilitation. Beside that we have to create
commitment and acceptance of this tool by our
therapists.
In my presentation I will focus on how to create a
platform in a healthcare organization to realize a
startup with this new technlogy tool and I will report
on our experiences with doing so.
Programma
Chair: A. Mert MD PhD
1. Rehabilitation and virtual environments: a love
affair or just a one night stand?
A. Mert MD PhD
2. Simulation and serious gaming: seriously?!
M.P. Schijven MD PhD
3. From simulation to transformation: game
design principles and its application in
healthcare
W.J. Renger MSc
4. Simulator and game induced sickness
W. Bles PhD
5. Moving from the ‘red carpet’ to a treadmill with
visual context to enhance the task-specificity
of intensive, repetitive gait training
M. Roerdink PhD
6. Virtual Reality In Rehabilitation, how to get it
operational for daily use.
W. Wertheim MD
1c: Minisymposium
SCI: innovation in sitting, standing and walking
Chair: J.M. Stolwijk-Swüste MD PhD
C. Smit MD, S. van Langeveld PT PhD, H. van de Meent MD PhD, H.A.F.M. Rijken PT, B. Fleerkotte PT,
prof. T.W.J. Janssen PhD
In this mini-symposium innovations in sitting, standing
and walking in spinal cord injury will be presented.
Pressure ulcers still are among the most prevalent
and serious complications in people with a spinal cord
injury (SCI). Electrical Stimulation-induced muscle
activation of the gluteal and hamstring muscles induced
228
significant acute reductions in interface pressure
of the ischial tuberosities in SCI. Pressure relief
movements improved (sub)cutaneous oxygenation
and mean blood flow, while ES-induced contractions
increased peak BF but not oxygenation. ES-induced
contractions might be a promising additional method
to reduce risk of pressure ulcers in SCI.
Parallel Session 1
In a special project in 2011, persons with tetraplegia C5
and C6 admitted to rehabilitation center De Hoogstraat
were given the opportunity to explore the use of an
iPad. Soon it became clear that the use of an iPad
can contribute to the independence of persons with
tetraplegia in communication, mobility, and self-care
activities. The rehabilitation technology department
and a software company developed applications and
devices for the iPad and Smartphone to serve as an
environmental control unit in the rehabilitation center
and at home. Compared to conventional systems for
environmental control at one’s home the iPad is easier
in use and price affordable.
Traumatic spinal cord injury is a serious disorder in
which early prediction of ambulation is important
to counsel patients and to plan rehabilitation.
A reliable, validated prediction rule to assess a
patient’s chances of walking independently after
such injury was developed. This prediction rule,
including age and four neurological tests, can give an
early prognosis of an individual’s ability to walk after
traumatic spinal cord injury, which can be used to set
rehabilitation goals and might improve the ability to
stratify patients in interventional trials.
Experiences from the past that led to the purchase
of Lokomat and implementation of robot-assisted
treadmill training with the Lokomat.
A study focussing on the gait training of chronic
SCI subjects with LOPES with Assisted-As-Needed
support of the hip flexion ( and thereby step height)
during swing. Results of the study and experiences of
the subjects will be presented.
The results of the first Dutch study into the effects
of robot-assisted treadmill training (RATT) using the
Lokomat will be discussed. In a randomized controlled
trial with patients with stroke and a non-randomized
trial with patients with incomplete spinal injury it
229
2012|5
was shown that RATT resulted in improvements in
walking ability, but that results on group level were
not clearly different from conventional gait training.
A large variability in progression among patients was
clear, and it remained unclear how this variability
could be explained.
Many questions about, for example, optimal training
parameters, specific effects for different groups
of patients, individual responses, and the costeffectiveness of robot-assisted treadmill training
need to be answered. This can only be done in a
multicenter study and in this mini-symposium the
setup of such a collaborative effort will be discussed.
Programme
Chair: J.M. Stolwijk-Swüste MD PhD
1. Effect of electrostimulation of gluteal and
hamstring muscles on sitting pressure, blood
flow and oxygenation
C. Smit MD
2. Implementing the use of an iPad as a
multifunctional tool to gain independence in
functional activities
S. van Langeveld PT PhD
3. To walk or not to walk: a prediction rule for
walking after SCI
H. van de Meent MD PhD
4. Experiences in implementation of robot
assisted treadmill training with the Lokomat
H.A.F.M. Rijken PT
5. Experiences with robot assisted treadmill
training with the LOPES
B. Fleerkotte PT
6. Effects of robot assisted treadmill walking:
where to walk to from here?
Prof. T.W.J. Janssen PhD
7. Discussion of robot assisted treadmill training
research in the future
J.M. Stolwijk-Swüste MD PhD
Parallel Session 1
2012|5
1d: Workshop
Problems and pitfalls in the vocational training of
specialists are there to be solved
Chair: H. Hacking MD
A. van Kuijk MD PhD, C. den Rooyen MSc
On behalf of the Concilium VRA
Medical education must be multidimensional and
impart competence beyond Medical Expert to
effectively be responsible to society and meet the
needs of the patients in the 21th century.
In 2009 the KNMG adopted the framework for
medical education called the CANMEDS framework
for physician competence. The CANMEDS framework
consists of 7 roles each identified by a set of
competencies. Competencies are a complex set of
behaviours built on the components of knowledge,
skills, attitudes, and competence as personal ability.
In 2011 this framework has been integrated into
standards of training (‘Beter’) as well as in legislation
(kaderbesluit CCMS) .
In clinical practice, however, Implementation can
be hindered by resistance to change amongst both
program directors, faculty staff, and residents.
Frequently mentioned underlying concepts of
opposition are the conceptual concern that
standardized competencies may never be able to
capture important aspects of the medical profession,
faculty overload, lack of competence, lack of
resources, or simple lack of interest. These different
concepts ask for different implementation strategies.
Successful implementation of the CANMEDS roles and
the educational programme ‘BETER’ in to teaching
practice requires an opposition-tailored strategy
involving intra- and interprofessional cooperation.
In this highly interactive workshop we try to help
program directors and faculty staff by providing
231
Programme
1.
2.
3.
4.
Introduction
Hub Hacking
Resistance to change: the puzzle
Corry den Rooyen
Change-management: an example
Annette van Kuijk
The puzzle & change management:
do-it-your-self
Corry den Rooyen & Annette van Kuijk
5. The puzzle & change management: lessons
learned
Hub Hacking
6. Manage educational change: Plan-do-check act
Annette van Kuijk & Corry den Rooyen
7. Evaluation and closing
Hub Hacking
Maximum 30 participants
a framework to analyse resistance to change and
group dynamics. Participants will be challenged to
analyse their own group of colleagues (either staff or
residents). The more you understand people's needs,
the better you will be able to manage educational
change. Subsequently, we will provide a framework
to plan, implement, and manage educational change
in your own organization. Including an introduction in
quality instruments, especially what and how to use
these in small groups.
Parallel Session 1
2012|5
1e: Minisymposium
Evaluation, prediction and treatment of walking ability in
children with spina bifida
Presentation of the first multidisciplinary guideline
Chair: B. Ivanyi MD PhD
H.J.G. van den Berg-Emons PhD, J.F. de Groot PhD, M.J. Nederhand MD PhD, M.A.G.C. Schoenmakers PhD,
J.A. van der Sluijs MD PhD
Substantial progress in the treatment of walking
ability in children with spina bifida (SB) has been
reached by developments in orthesiology and
its evaluation using computerized gait-analysis
techniques, developments in neurosurgery and
orthopedic surgery techniques, and specific training
programs. Between 80 and 90% of children with
lumbosacral SB become community ambulators
during childhood. Nevertheless they remain at risk of
a sedentary life, and to make walking possible they
need a combination of active lifestyle, physiotherapy,
orthotic management and surgical treatment. An
optimal tuning of such a multidisciplinary treatment
is essential, but to date multidisciplinary guidelines,
which when implemented properly have shown to
improve the quality of patient care, were missing.
The first multidisciplinary evidence based guideline
on evaluation, prediction and treatment of walking
ability in children with SB is being established in the
Netherlands. At the minisymposium the main aspects
of the guideline will be presented by the authors.
The main topics concern the outcome measures and
prognostic factors of walking ability in children with
SB and the recommended conservative and surgical
treatment to enhance their walking ability. The
conclusions and recommendations for best practice
will be discussed and illustrated with clinical cases,
also to solicit inputs from the audience.
232
Speakers
B. Ivanyi MD PhD, Department of Rehabilitation
Medicine, Academic Medical Center, University of
Amsterdam, the Netherlands
H.J.G. van den Berg-Emons PhD, Department
of Rehabilitation Medicine and Physical Therapy,
Erasmus MC Rotterdam, the Netherlands
J.F. de Groot PhD, Researchgroup Lifestyle
and Health, HU University of Applied Sciences,
Utrecht, the Netherlands
M.J. Nederhand MD PhD, Roessingh Centre for
Rehabilitation, Enschede, the Netherlands
M.A.G.C. Schoenmakers PhD, Pediatric Physical
Therapy and Exercise Physiology, University
Medical Center, Utrecht, the Netherlands
J.A. van der Sluijs MD PhD, Department of
orthopedics, VU medical centre, Amsterdam, the
Netherlands
Parallel Session 1
2012|5
1f: Minisymposium
‘It’s my life!’ Innovation of care for young adults with
childhood onset disabilities
Chair: M.E. Roebroeck PhD
W.M.A. van der Slot MD, M.S.G. Floothuis OT, E. Kruijver, C.G.B. Maathuis MD PhD, A. Grootoonk, S.R. Hilberink MSc
On behalf of TransitieNet, national network to innovate transition and lifespan care
In their transition to adulthood, young people with
childhood onset disabilities may experience problems
to manage their own life and take responsibility for
their health. Since 2007 Dutch rehabilitation centers
cooperate in the national network TransitieNet to
innovate care for young people (16-25 years). The
centers implement young adult teams and ageappropriate interventions, aiming to improve the
young people’s autonomy in several life areas. So far,
eight interventions focusing on different topics are
developed for young people aged 16-25 years. Also
interventions for youth and parents are available.
We evaluate the feasibility and effectiveness of the
interventions in multi-center studies.
In this minisymposium clinicians from several
rehabilitation centers will share their experiences
with young adult teams and age-appropriate
interventions addressing several life areas. We will
particularly focus on the goals and methods of a
young adult team, and on interventions to improve
work participation, emerging romantic relationships
and sexuality and skills for growing up (Groei-wijzer,
for youth and their parents). Couples of presenters
will share their experiences with developing an
intervention and implementing it in clinical practice.
They will address the following interventions:
TraJect: At Work?! - an intervention to improve work
participation of young adults with disabilities. Key
principles are the convergence of rehabilitation and
vocational services in one program and its just-intime availability, when the young person is looking
for a job.
Friendships, romantic relationships and sexuality
- a group program to enhance the young adult’s
self-confidence and social skills. Exchanging
experiences about intimacy and sexuality with agemates appeared to be highly valued by young people
participating in this intervention.
The Dutch version of Skills for Growing Up (Groeiwijzer), an intervention for youth with disabilities and
their parents to encourage a child’s development
towards independence and autonomy. Implementing
the Groei-wijzer seemed to increase the focus on
autonomy and participation within rehabilitation care.
With the use of practical examples and discussion
on feasibility and preliminary effectiveness of
the interventions we encourage interaction with
participants of the symposium.
Programme
Chair: M.E. Roebroeck PhD, Erasmus MC
1. Goals and methods of a young adult team
Wilma van der Slot MD, Rijndam Rehabilitation center
2. Intervention: friendships, romantic relationships and sexuality
Egbert Kruijver, Sophia Rehabilitation
Sander Hilberink MSc, Erasmus MC
3. TraJect: At Work?! - an intervention to improve work participation
Monique Floothuis OT, Erasmus MC
Marij Roebroeck PhD, Erasmus MC
4. Skills for Growing Up, the Dutch version: Groei-wijzer
Karel Maathuis MD PhD, UMC Groningen
Anneke Grootoonk, Centre for Rehabilitation, Beatrixoord
233
Parallel Session 1
2012|5
1g: Workshop
Rehabiltation Medicine: Rehab is fun!
Chair: G.M. Rommers MD PhD
M. Tepper MD, R. Dahmen MD, W.G.M. Bakx MD, Prof. F. Nollet MD PhD
Only for medical students
Rehabilitation medicine is all about function and
participation. In this workshop we present patient
cases with a variety of diagnoses well known to
rehabilitation medicine. We present cases about
stroke, spinal cord, amputation and orthotics devices
to speed up the mobilisation process. To learn about
cognitive limitations in everyday life and how to deal
with it.
234
Share the expertise and challenges ahead together
with experienced staff to learn what rehabilitation
medicine is all about! We will highlight the pleasure
of everyday practise and what to learn from it for
medical students. Information about clerkships
and training posts will be available and specialist
registrars tell you all about: rehab is fun!
Parallel Session 2
2012|5
2b: Workshop
Effective exercises in rehabilitation medicine:
how does it work?
Chair: P.C.T. van Aanholt MD
R. Dekker MD PhD, F. Hettinga PhD
On behalf of the Werkgroep VRA Bewegen en Sport (WVBS, National project group VRA physical activity and sports)
It is well known that an active lifestyle is important for
a healthy life. A lot of diseases are cured or at least
have a less significant impact by an active lifestyle.
The intention of the workshop is to promote the need
of an active lifestyle for everybody and more specific
for our patients and for people with a disability.
We want to advocate the need of expertise of Exercise
Physiology for Rehabilitation Physicians. We also show
why knowledge of Exercise Physiology is of great
importance to make the right Rehabilitation Program
and to give an adequate advise for an active lifestyle.
We show that the aim of the treatment should guide
the selection of type of training program, which is
specific for each individual.
We will have an active workshop. All participants will
have to exercise physical activities with a different
energy level. That is why it is advised to wear
sportswear.
235
Programme
1. Opening
Peter van Aanholt
2. An active lifestyle is important for everybody
including patients and people with a disability
Rienk Dekker
3. The knowledge of exercise physiology is
neccesary in rehabilitation medicine
Floor Hettinga
4. Active workshop
Members of WVBS
5. Evaluation active workshop and it’s
implications in the rehabilitation program
Peter van Aanholt
Parallel Session 2
2012|5
2c: Minisymposium
From innovation to implementation in paediatric
rehabilitation: playfulness and flow
Chair: Prof. A.C.H. Geurts MD PhD
Prof. M.W.G. Nijhuis-van der Sanden PhD, A. Houwink PT PhD, P.B.M. Aarts OT PhD, Y.A. Geerdink OT MSc,
J.C. van Munster MD
‘Time on task’ is the most important predictor for
the effectiveness of exercise training. Therefore for
children, both a playful presentation and a generation
of a positive ‘flow’ are crucial. This minisymposium
presents two state of the art, playful training
interventions for children with writing disabilities
(‘Juf-in-a-Box’) and children with unilateral spastic
cerebral palsy (‘the Pirate concept’).
Juf-in-a-Box
Between 10 to 33% of children in primary education
have problems with handwriting, which is one of the
most common reasons for primary school children
to be referred to paediatric physical or occupational
therapy. Handwriting problems can be related to
motor disorders e.g. DCD), or to cognitive and/or
behavioural disorders (e.g. ADHD or Autism Spectrum
Disorders). In addition, an inappropriate didactical
approach is also a possible cause of handwriting
problems. In the KNGF Evidence Statement Motor
Handwriting Problems in Children, evidence is
presented that the amount of training is essential for
the development of quality and speed in handwriting
Programme
Chair: Prof. A.C.H. Geurts MD PhD
1. Theoretical background of motor writing
disorders in children
Prof. M.W.G. Nijhuis-van der Sanden PhD
2. Development and preliminary results of
Juf-in-a-Box
A. Houwink PT PhD
3. The current state of the implementation of the
Pirate concept (LIPIC)
P.B.M. Aarts OT PhD
4. Assessing individual change while
implementing a CIMT concept: opportunities
and barriers
Y.A. Geerdink OT MSc
5. The role of the rehabilitation physician in the
implementation of an intervention
J.C. van Munster MD
236
(Overvelde et al., 2011; www.kngfrichtlijnen.nl). To
increase the amount of practice, ‘Juf-in-a-Box’ was
developed. Juf-in-a-Box, a serious computer game on
an interactive tablet, provides writing exercises with
increasingly difficult levels presented so that motor
skill learning is facilitated. The series of exercises
are presented in a playful and educational way using
challenging feedback. The effectiveness of the Juf
has recently been tested in a first pilot study. In the
first part of this mini-symposium, Ria Nijhuis-Van der
Sanden will present the theoretical background and
Annemieke Houwink will present the development
and first results of Juf-in-a-Box.
The Pirate
concept
The appreciation of an intervention in paediatric
rehabilitation is often related to the provision
of family-centred services, which are focused
on improvement of a child’s daily-life activities.
Furthermore, playfulness and flow are important
for children to enjoy the intervention and stay
motivated. These are key aspects of the evidencebased intervention: ‘modified constraint-induced
movement therapy in the Pirate group’. After
extensive studies on the effects of the Pirate
concept, a project has now started to implement
this intervention in 12 other rehabilitation centres in
the Netherlands (Landelijke Implementatie Piraten
Concept; LIPIC). In the second part of this minisymposium, Pauline Aarts will present the current
state of the Pirate concept and LIPIC. Another
important aspect of nation-wide implementation is to
use one standard measurement protocol in order to
evaluate all interventions and to form one database.
These outcome measures should be reliable and
valid, and useable for both diagnostic and evaluative
purposes. Composing such an assessment battery
is challenging, and the choices made and the
proposal to set up a collective database for LIPIC
are discussed by Yvonne Geerdink. Finally, Judith
van Munster will discuss the role of the rehabilitation
physician in selecting children for an appropriate
upper-limb intervention such as the Pirate concept.
Parallel Session 2
2012|5
Identifying the main problems by examination and
assessment are needed to determine the focus of an
intervention, i.e. on upper-limb function, capacity,
motor planning or neurocognitive problems such as
developmental disregard.
References
1. Overvelde A, Van Bommel-Rutgers I, Bosga-Stork I, Van
Cauteren M, Halfwerk B, Smits-Engelsman B, Nijhuis-Van
der Sanden MWG. KNGF: Evidence Statement Motorische
schrijfproblemen bij kinderen. Suppl Ned Tijdschr Fysiother.
2011;121(2):1-65; https://www.kngfrichtlijnen.nl/657/
Evidence-Statements.htm
2. Overvelde A, Van Bommel-Rutgers I, Bosga-Stork I, Van
Cauteren M, Halfwerk B, Smits-Engelsman B, Nijhuis-Van
der Sanden MWG.KNGF Evidence Statement Motor handwriting problems in children (Flowchart and Summary).
https://www.kngfrichtlijnen.nl/654/KNGF-Guidelines-inEnglish.htm
2d: Workshop
Changes in educational program VRA for residents in PM&R
Chair: M. Tepper MD
R. Dahmen MD, H. Arwert MD, M. van Beugen MD, L. Kruisheer MD, D. Jägers MD
On behalf of the Educational Board VRA
Educational programme ‘BETER’ describes the
competencies of a Medical Specialist in Physical and
Rehabilitation Medicine according to the CANMEDS. In
the current educational programme of the VRA most
courses are dedicated to specific themes or diagnoses.
In 2014 a new four year course will be introduced;
focusing on the themes Communication and
Management and Clinical Reasoning. Each year will
have its own subjects related to these themes as
the course intensity and complexity increases with
each passing year. Education in smaller groups is
more effective and beneficial to the attitude of active
learning. In the near future e-learning will play a
more prominent role.
237
In an interactive workshop we will introduce the VRA
2014 educational programme. A guest speaker will
introduce the concept of e-learning and there will be
room to exchange experiences. The consequences
for the role of course coordinator and organizing
committee will also be discussed.
Participants
Course coordinators, trainers, members of VRA
Concilium and VRA Kerngroep.
Learning
goals
• Information about changes in educational
programme VRA 2014
• Knowledge about active learning and e-learning.
Parallel Session 2
2012|5
2e: Minisymposium
Physician Assistants in rehabilitation: from innovation to
implementation
Chair: J.F. Braam MPA
W.H. van Unen MPA, J.P.M. Berkvens MD, A.M. ter Steeg MD MHA, B.F. Weitenberg MPA
At present the Dutch healthcare system is changing
in several areas. One of the new developments is
task reallocation. The master physician assistant
(MPA) is a relative new health care professional. In
the Netherlands, approximately 800 PAs currently
work within all medical specialties. Nearly 30 PAs are
deployed in physical and rehabilitation medicine. This
number steadily increases. Does the PA empower
chances for rehabilitation medicine, both in the
short and long term? Given the central congress
theme 'Innovation' the speakers will reveal what
opportunities the deployment of PAs in rehabilitation
medicine entail.
After a short introduction Wijnand van Unen will kick
off by exposing the position of PAs from a broader
perspective. He will first inform you about the
position of PA’s in Northern America and Europe,
followed by a special focus on PA’s in the Netherlands
and developments in the Dutch health care system.
Furthermore he will show to you opportunities in task
reallocation and display the current status of Dutch
health care legislation.
Contents of the Dutch PA medical training programme
will be highlighted by Josephine Berkvens.
She will provide an insight into the Dutch training
programme and curriculum leading to competent
PAs. Subsequently she will pay attention to the
allowance for the clinical educators and employers
238
of health care institutions, offered by the Dutch
government and designed to financially compensate
the loss of working hours caused by the PA’s
internships during their medical training. The last part of this minisymposium focuses on the
process of implementation and collaboration between
rehabilitation specialists and PAs. Physician assistant
Berber Weitenberg and rehabilitation specialist Anne
Marie ter Steeg will keynote this process from a PA
and medical specialist perspective, as well as from
a medical manager point of view. They will highlight
the advantages and disadvantages of deployment
of PAs, and set out conditions needed to enable
PAs to perform at their best possible level within
Programme
Chair: J.F. Braam MPA, Isala klinieken
1. The Physician Assistant: friend or foe?
W.H. van Unen MPA, Nederlandse Associatie
Physician Assistants (NAPA)
2. Educating competent Physician Assistants
J.P.M. Berkvens MD, Academie
Gezondheidszorg Utrecht
3. Physician Assistants in rehabilitation,
valuable?
A.M. ter Steeg MD MHA, Sophia Revalidatie
B.F. Weitenberg MPA, Sophia Revalidatie
Parallel Session 2
2012|5
2f: Workshop
Clinical assessment of walking energy cost and fitness in
children and adolescents with cerebral palsy or other motor
impairments: application in pediatric rehabilitation
Chair: A. Dallmeijer PhD
A. Balemans MSc, E. Bolster MPPT, A. Buizer MD PhD
Time
Summary
schedule
Chair: A. Dallmeijer PhD
1. Background exercise physiology (20 min)
2. Test protocol and procedures (20 min)
3. Interpretation of test results (20 min)
4. 3 clinical case presentations (30 min + 15 min
discussion)
Presenters
Annet Dallmeijer PhD, human movement scientist1
Astrid Balemans MSc, human movement scientist1
Eline Bolster PT, pediatric physical therapist1
Annemieke Buizer MD PhD, pediatric physiatrist1
1
Department of Rehabilitation Medicine,
VU Medical Centre, Amsterdam
Learning
goals
To provide pediatric physiatrists with a basic
knowledge of clinical exercise testing principles
for assessing energy cost of walking (walking
economy) and fitness in children and adolescents
with mobility limitations, and its clinical application
in rehabilitation practice. Clinical cases will be
presented and discussed in order to illustrate the
application.
Target
Assessment of walking energy cost and fitness is
becoming increasingly important in the treatment
of mobility limitations in children and adolescents
with child-onset disabilities. Common complaints
in these patient groups include reduced walking
distance and early fatigue during daily life activities.
These complaints may be associated with an
increased walking energy cost or a reduced fitness
level. Appropriate assessment of these outcomes
are therefore essential for clinical decision
making. This workshop provides a background in
exercise physiology that is required to understand
and interpret test results. Test protocols, test
interpretation and clinical cases will be presented
and discussed with the audience.
Annet Dallmeijer is human movement scientist
and associate professor focusing on research
in pediatric rehabilitation medicine.
Astrid Balemans is a human movement scientist,
currently finalizing her PhD work on fitness and
physical activity in children with cerebral palsy
(Learn 2 Move). She is specialized in lab-based
exercise testing of children with CP.
Eline Bolster is pediatric physical therapist,
research assistant and laboratory worker of
the exercise physiology lab.
audience
Pediatric physiatrists who are involved in the
treatment of mobility limitations in (ambulant)
children and adolescents with CP or other motor
impairments.
Annemieke Buizer is pediatric physiatrist,
specialized in treatment of mobility problems
in children with cerebral palsy
239
Parallel Session 3
2012|5
3b: Minisymposium
Rehabilitation Robotics: a promise for the near future?
Chair: Prof. J.S. Rietman MD PhD
E. van Asseldonk PhD, J.H. Buurke PT PhD, A. Stienen PhD, G. Prange PhD, A. Kottink PhD
The incidence of people suffering from a stroke in the
Netherlands is 1.6 per 1000 inhabitants. Because of
demographic changes (aging) the expectance is that
this will increase with 50% in 2025.
One of the consequences of a disturbed generation
of neural commands in the sensorimotor cortex
is impaired motor function of the upper and lower
extremities. Intensive and task-specific treatment,
consisting of active, highly repetitive movements,
is regarded one of the most effective approaches
in neural rehabilitation. Recent development in
robot-mediated rehabilitation has revealed the great
potential of robotic devices for delivering repetitive
training, thus facilitating a high frequency and/
or duration of task-specific training during subacute and chronic phases of stroke rehabilitation.
Motivation can be increased through combination
with virtual reality game environments. While there
is growing evidence that such technologies are
beneficial to patients’ recovery of functional and
motor outcome, the uptake of these technologies has
been slow.
The objective of this symposium is to present an
overview of recent developments and state of the
art regarding rehabilitation robotics, combining both
240
technical and clinical perspectives. This will involve
the route from neurological knowledge of recovery
processes to technological applications necessary
for the development and integration of innovative
robotic technologies to implementation of these
technologies in rehabilitation.
Programme
Chair: Prof. Hans Rietman MD PhD
1. Introduction
Hans Rietman MD PhD
2. Robotic developments Lower Extremity
(e.g. LOPES)
Edwin van Asseldonk PhD
3. Robotics lower extremities; from basic science
to admission in healthcare
Jaap Buurke PT PhD
4. Robotic developments Upper Extremity
Arno Stienen PhD
5. Robotics for the upper extremities; from
basic science to application in Rehabilitation
Gerdienke Prange PhD
6. The ROBAR study; implementation and
acceptation in care
Anke Kottink PhD
Parallel Session 3
2012|5
3c: Minisymposium
RCT’s and alternative study designs in rehabilitation
medicine; from design to implementation and all the bumps
on the way
Chair: Prof. H.J. Stam MD PhD
S. Bus PhD, prof. G. Kwakkel PT PhD, prof. F. Nollet MD PhD, R. Selles PhD
Organizers: Sicco Bus, PhD, AMC Amsterdam & Ruud Selles, PhD, Erasmus MC Rotterdam.
Randomized controlled trials (RCTs) represent the
study design with the highest level of evidence to
determine the effectiveness of an intervention.
The design is therefore the state of the art in
different fields of medicine and allied health
sciences, including rehabilitation medicine and
physical therapy. However, RCTs can be difficult to
setup, mostly require large numbers of patients,
often encounter many ‘bumps on the way’ during
their execution, and implementation of results
is challenging. Despite of this, many RCTs are
conducted, or have been completed, in the field
of rehabilitation medicine in the Netherlands. In
this mini-symposium, some of the state-of-the-art
trials in the field will be presented, with a focus
on the challenges that the project groups faced in
setting-up, and executing the trial. Solutions to these
challenges and possible alternative study designs,
such as cluster randomized trials and propensitymatching in observational studies, will be discussed.
The
learning goals are to gain insight in:
1. How to design a randomized controlled trial.
2. Solutions for difficult-to-conduct trials in
3. The pro’s and con’s of controlled study designs.
4. Alternative study designs for effectiveness
research and when they may apply.
5. The design and main findings of some of the
state-of-the art trials in the Netherlands.
Programme
Chair: Prof. Henk J. Stam MD PhD
1. Introduction: Challenges in RCT’s
Henk Stam MD PhD, Erasmus MC, Rotterdam, the Netherlands
2. The effects of physical training versus cognitive behavioural therapy on fatigue, daily functioning, and
quality of life in patients with neuromuscular diseases (FACTS-2-NMD trial)
Frans Nollet MD PhD, AMC, Amsterdam, the Netherlands
3. Randomized clinical trials: A difficult design or difficult to organize?
Gert Kwakkel PT PhD, VUmc, Amsterdam, the Netherlands
4. Multicenter RCT on the effectiveness of custom footwear in preventing foot ulcer recurrence in diabetes
(DIAFOS trial)
Sicco Bus PhD, AMC, Amsterdam, the Netherlands
5. Observational study designs for efficacy studies in rehabilitation
Ruud Selles PhD, Erasmus MC, Rotterdam, the Netherlands
6. Panel discussion with audience participation
241
Parallel Session 3
2012|5
3d: Minisymposium
Wheeled mobility: an ergonomics perspective
Chair: Prof. L.H.V. van der Woude PhD
S. de Groot PhD, R.J.K. Vegter MSc, M.G.M. Kloosterman MSc, F. Hettinga PhD, L.J.M. Valent PhD
Since more than 30yrs manual wheelchair propulsion
is subject of study in the Netherlands. Optimization
of performance and functioning in daily life and
sports has been the key ergonomics focus point.
Social range of action and freedom of mobility of the
wheelchair-user combination in this context is the
central outcome. This implies an accurate balance
between stress, strain and capacity (of the upper
body), which should lead to the prevention of overuse
injuries, as well as prevent an inactive lifestyle.
Indeed ‘exercise is medicine’, and a physically active
lifestyle is suggested to be key to well-being and
health, while supporting participation. Optimal
quality wheelchairs (or assistive technology for that
matter), wheelchair fitting as well as individual work
capacity and skill are key to that.
The current state of the art will be presented
by a group of (young) researchers, currently
active in research on wheeled mobility, work that
is exemplified in 6 short yet, complementary
presentations and a combined discussion.
Objectives
The attendees will appreciate, learn and understand:
• The importance of an ergonomics perspective
on wheeled mobility (and assistive technology in
general) and in rehabilitation practice in general.
• The mechanisms and outcomes as well as
measurement of physiological strain and work
capacity in wheelchair arm work.
• The mechanisms and measurement of upper body
overuse, strain and its long term consequences.
• The mechanisms of physical inactivity in
wheelchair use and its health consequences.
• The preventive role of an active lifestyle with
optimal conditions of wheelchair mechanics,
wheelchair-user interface and wheelchair work
capacity in the context of these long term health
problems and quality of life.
Sonja de Groot PhD is a human movement scientist and received her PhD for her thesis entitled ‘Manual
wheelchair propulsion: biophysical aspects of learning’. She works at Reade, center for rehabilitation &
rheumatology as a senior researcher and is also affiliated to the Center for Human Movement Sciences,
University of Groningen, UMCG (www.scionn.nl).
Riemer J.K. Vegter MSc (1981; http://www.rug.nl/staff/R.J.K.Vegter), lecturer/PhD student at UMCG/RUG,
Center for Human Movement Sciences, starting 2009;focused on motor learning processes underlying
manual wheelchair skill acquisition (http://cirrie.buffalo.edu/encyclopedia/en/article/191/).
Marieke G.M. Kloosterman MSc (1983), human movement scientist, RUG (2009). PhD researcher at
Roessingh Research and Development, Enschede, investigating the differences in shoulder load, efficiency
of propulsion and activities of daily living between hand-rim and power assisted wheelchair propulsion.
Florentina Hettinga PhD, assistant professor, Center for Human Movement Sciences, UMCG/RUG,
specializing in the field of sports and handicap. She is also in the board of the Dutch association of
human movement sciences (VVBN).
Linda J.M. Valent PhD (1971:www.heliomare.nl/Site/Research-Development), Rehabilitation center
Heliomare Wijk aan Zee, received her PhD in Human Movement Sciences, VU University Amsterdam
(2009). Member of the NVDG working group (zitten zonder zorgen, Initiator of ‘The Handbike Battle’.
Prof. Lucas H.V. van der Woude PhD (1954; www.rug.nl/staff/l.h.v.van.der.woude); Chair of this symposium
242
Parallel Session 3
2012|5
Programme
1. WHEEL-I: the development of a wheelchair propulsion lab for rehabilitation and sports
Sonja de Groot PhD, Rehabilitation Center Reade, Amsterdam, Center for Human Movement Sciences,
UMCG/RUG, Groningen (15min)
2. Motor learning in handrim wheelchair propulsion
Riemer Vegter MSc, Center for Human Movement Sciences, UMCG/RUG, Groningen (15min)
3. Power assist wheelchairs: the good alternative?
Marieke Kloosterman MSc, Roessingh Research & Development, Enschede (15min)
4. Handcycling sports & performance
Floor Hettinga PhD, Center for Human Movement Sciences, UMCG, Groningen (15min)
5. Staying fit in a wheelchair
Linda Valen PhD, Rehabilitation Center Heliomare, Wijk aan Zee (15min)
6. Ergonomics of sports wheelchairs
Prof. Lucas van der Woude PhD, Center for Human Movement Sciences, UMCG/RUG, Groningen (15min)
3e: Workshop
Introduction of IFMS in a medical staff of rehabilitation
physicians
Chair: A. Kap MD
E. van Loon MD, E. Turlings MSc, N. van Vemde MA
On behalf of the VRA Quality Committee
Individual functioning medical specialists (IFMS) is a
method to improve the individual professionalism of
medical specialists.
have a constructive but critical dialogue with your
colleagues? Personal experiences are shared on
working with the IFMS.
This workshop will give you theoretical background
about several methods. Practical information is
given on questions such as: which aspects are
necessary for a good feedback conversation; how to
The workshop is led by Elma Turlings and Nathalie
van Vemde, experienced trainers on this subject
at Q-Academy and consultants at Q-Consult,
bedrijfskundige adviseurs in Arnhem.
243
Parallel Session 3
2012|5
3f: Minisymposium
Lifespan expectations for individuals with cerebral palsy
Chair: A.J. Dallmeijer PhD
D.W. Smits PhD, S.S. Tan PhD, R.C. Vos PhD
Growth curves empirically model the evolution of
an outcome variable over time. Using growth curves
in clinical practice has gained attention in many
developed countries. As part of the longitudinal
PERRIN+ study, developmental trajectories were
determined for gross motor function, daily activities
and social participation based on 424 individuals
with cerebral palsy (CP) recruited in the Netherlands.
The study is the first to cover toddlers, children,
adolescents and young adults with CP. By means
of an interactive discussion, we will discuss (1) the
value of developmental trajectories in the context
of lifespan expectations for the treatment of CP and
(2) the applications of developmental trajectories in
daily practice. As developmental trajectories support
individuals with CP, their families and professionals in
setting realistic lifespan expectations at an early age,
this course encourages the use of growth curves in
the treatment of CP.
Dirk-Wouter Smits is an educational scientist
and a physical therapist. He received his PhD in
2011, Utrecht University Medical Center. Since
2005, he has been working as a researcher in
paediatric rehabilitation, in particular in the Dutch
longitudinal PERRIN study (www.perrin.nl). DirkWouter is affiliated with the Centre of Excellence
for Rehabilitation Medicine in Rehabilitation
Centre De Hoogstraat, Utrecht.
Siok Swan Tan is a health-economist at the
institute for Medical Technology Assessment
(Erasmus University Rotterdam). She received
her PhD in 2009 at Erasmus University
Rotterdam. Current studies include amongst
others methodological aspects of costing studies
in economic evaluations and European projects
within the framework programs of the European
Commission Since January 2011, Siok Swan is
involved in the PERRIN Plus study (www.perrin.nl)
at the Department of Rehabilitation Medicine and
Physical Therapy (Erasmus MC University Medical
Center).
Rimke Vos works as a postdoc researcher at the
department of Rehabilitation Medicine at the
VU University Medical Center (Amsterdam) and
as research coordinator at the HagaHospital
(The Hague). She studied Public Health
(Movement Science) at Maastricht University
and receive her PhD in 2011 at Leiden Univercity
Medical Center. Since January 2011, Rimke is
involved in the PERRIN Plus study (www.perrin.
nl) at the department of Rehabilitation Medicine
(VU Medical Center).
244
Free Papers Session 1
2012|5
Free Papers
Thursday afternoon
13.15 -15.15 Parallel session 1
Chair: M. Andela MD, scientific committee
1.
Does case management improve quality of ALS care in the Netherlands?
H.W.J. Creemers
Page 246
2.
Recovery of Motor Imagery Ability (MIA) in stroke patients. W. Feenstra
Page 246
3.
The influence of balance support on the metabolic cost of walking in stroke patients during
overground and treadmill walking. T. IJmker
Page 247
4.
Selective activity of flexor and extensor wrist muscles is reduced in post-stroke patients.
I. Kouwijzer Page 248
5.
Effects of circuit training as alternative to usual physiotherapy after stroke: randomised
controlled trial. G. Kwakkel
6.
Functional gait training using an instrumented treadmill with visual context improves gait
adaptability and associated attentional demands in the chronic phase after stroke: a proof of
concept. M.W. van Ooijen Page 249
7.
Course of mood over time and its predictors following moderate to severe traumatic brain injury:
a prospective cohort study. L. Valk-Kleibeuker Page 250
8.
A longitudinal study of locus of control and healthrelated quality of life after traumatic
brain injury. J.E. Wielenga-Boiten
245
Page 249
Page 251
1. Does
case management improve quality of
ALS
care in the
2012|5
Netherlands?
H.W.J. Creemers MSc1, J.H. Veldink MD PhD2, K. Schipper PhD3, prof. F. Nollet MD PhD1,
prof. L.H. van den Berg MD PhD2, A. Beelen PhD1
3
1
2
Department of Rehabilitation, Academic Medical Center Amsterdam, Netherlands ALS Center, the Netherlands
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht,
Netherlands ALS Center, the Netherlands
Department of Medical Humanities, EMGO+ Institute, VU Medical Center, Amsterdam, the Netherlands
Introduction
There is no evidence about the effectiveness of case
management (CM) as an adjunct to usual care in ALS
patients and their caregivers.
Objective
Does CM improve ALS patient’s quality of life, caregiver
burden and perceived quality of ALS care (QoC)?
Patients
Patients with Amyotrophic Lateral Sclerosis (ALS)
and their most important informal caregiver.
Methods
In a cluster-randomized controlled trial with a mixed
methods approach, throughout 12 months ALS
patients and their caregivers received CM plus usual
care or usual care only. Primary outcome measure
was the ALS Assessment Questionnaire-40 items,
domain Emotional Functioning (ALSAQ-40 EF).
Secondary outcome measures were the Caregiver
Strain Index (CSI) and QoC (rating score, range
0 to 10=best possible). In a sequential qualitative
study we gathered data on experiences with case
management from the viewpoint of participants and
their consultants in rehabilitation medicine.
2. Recovery
of
Motor Imagery Ability (MIA)
Results
We found no effect of CM on outcome measures.
Semi-structured interviews revealed three recurrent
themes: offering emotional support, professional
expertise in ALS care and providing practical
support. Higher needs for case management
appeared to be associated with a limited social
network, dissatisfaction with the ALS team, not
daring to ask for help, a rapid disease course, the
timing of the case management period in the disease
course and a limited empowerment of participants.
Discussion and Conclusions
Our case management intervention showed no effect,
but individual ALS patients and caregivers valued
aspects of case management positively.
Clinical message
Case management has no added value to Dutch
ALS care but aspects of case management may be
valuable assets to ALS care in individual situations.
H.W.J. Creemers
[email protected]
in stroke patients
W. Feenstra MD1, S.J. de Vries MSc2, A.M. Boonstra MD PhD3, M. Tepper MD1, prof. E. Otten MSc PhD2
Center for rehabilitation, University Hospital Groningen, the Netherlands
Department of Human Movement Sciences, University of Groningen, the Netherlands
3
Center for rehabilitation, Revalidatie Friesland Beetsterzwaag, the Netherlands
1
2
Introduction
Studies show that training through motor imagery
(mental practice) can be a good addition to physical
therapy in stroke patients (Lui, 2004; Page, 2007).
Yet it is not clear which patients benefit from mental
practice and which don’t.
246
Objective
The main objective of the study is to gain more
insight in the MIA of stroke patients.
Patients
Stroke patients with diminished arm-hand function
(and relatively good cognitive function), direct post
onset, and a control group of healthy volunteers.
Methods
3, 6 en 16 weeks post stroke the MIA (Parsons’
mental rotation task) and the arm-hand function
(Fugl-Meyer score and Utrechtse arm-hand test)
of 24 stroke patients were assessed, together with
a control group of sex, age and hand dominance
matched healthy volunteers.
Clinical message
Since a great part of the stroke patients is able to
motor image, mental practice can be used in addition
to physical training.
If you want to use mental practice in your early
rehabilitation program, be aware that 25% of the
stroke patients isn’t able to motor image.
Results
75% of the patients is able to motor image 3 weeks
after stroke. Of the patients who weren’t able to motor
image, in 60% their MIA still recovered after 6 weeks.
The other 40% didn’t recover, also not after 16 weeks.
There was no correlation between the recovery of
motor imagery and the recovery arm-hand function.
References
Liu KP, Chan CC, Lee TM, Hui-Chan CW. Mental
imagery for promoting relearning for people after
stroke: a randomized controlled trial. Arch Phys Med
Rehabil 2004; 85: 1403–1408.
Discussion and conclusions
75% of the stroke patients is able to motor image
3 weeks after stroke, 6 weeks after stroke this is
92%. There is no correlation between motor imagery
ability and arm-hand function and it’s recovery.
3. The
2012|5
Page SJ, Levine P, Leonard AC. Mental practice in
chronic stroke: results of a randomized, placebocontrolled trial. Stroke 2007; 38(4):1293-1297.
W. Feenstra
[email protected]
influence of balance support on the metabolic cost of walking in stroke patients during
overground and treadmill walking
T. IJmker MSc1,2, A. Jarbandhan MSc2, D. Rijntjes1, C.J.C. Lamoth PhD3, H. Houdijk PhD1,2
3
1
2
Heliomare Research & Development, Rehabilitation Center Heliomare, Wijk aan Zee, the Netherlands
MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, the Netherlands
Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen,
the Netherlands
Introduction
Stroke patients often suffer from highly increased
energy costs of walking1. Previous research
suggests that balance control could be an important
contributing factor to this increase2-3.
Objective
To investigate the influence of balance support on
energy cost during treadmill and overground walking in
stroke patients with varying degrees of walking ability.
Patients
Twenty-four stroke patients participated (mean age
50.3 years; 7 females). Twelve relied on a walking aid
in daily life (Dependent walkers), and twelve did not
(Independent walkers).
Methods
All subjects completed four 5-minute walking trials
at preferred speed: (1)supported overground walking
with a cane, (2)unsupported overground walking,
(3)supported treadmill walking using one handrail,
247
and (4)unsupported treadmill walking. Energy cost
(J/kg/m) was calculated from oxygen consumption
recorded using respirometry.
Results
On the treadmill, handrail support resulted in a
significant decrease in energy cost of on average
16% (14% (0,52J/kg/m) for independent and
19% (1,50J/kg/m) for dependent walkers). During
overground walking dependent walkers showed a
significant decrease in energy cost of 8% due to
support, whereas independent walkers showed a
slight but significant increase (6%) in energy cost.
Discussion and conclusion
Results indicate that for stroke patients a significant
part of the energy cost of walking is related to
balance control. This part appears to be larger in
subjects with lower walking ability.
Clinical message
Impaired balance control should not be overlooked as
contributing factor to the increased cost of walking
after stroke. Providing balance support or balance
training could be considered to improve gait economy
in stroke survivors.
2012|5
References
1. Detrembleur C, Gait Posture. 2003;18(2):47-55.
2. Donelan JM, J Biomech. 2004;37(6):827-835.
3. Houdijk H, Gait Posture. 2010;32:321-326.
T. IJmker
[email protected]
4. Selective
activity of flexor and extensor wrist muscles is reduced in post-stroke patients
I. Kouwijzer MD1,2, J.M. van der Krogt MD1,2, A. Klomp MSc2,3, C.G.M. Meskers MD PhD2,
prof. J.H. Arendzen MD PhD2, J.H. de Groot PhD2,3
Rijnlands Revalidatiecentrum, Leiden, the Netherlands
Leiden University Medical Center, the Netherlands
3
TU Delft, the Netherlands
1
2
Introduction
Loss of selective muscle activation after stroke
contributes to poor arm function but is difficult to
quantify. The objective of this study was to quantify
selective activity of flexor and extensor wrist
muscles in post-stroke patients.
Methods
31 Patients in the chronic phase after stroke and
14 matched healthy controls exerted a flexion and
extension torque onto a haptic wrist manipulator.
EMG of the flexor and the extensor carpi radialis
muscles was stratified for equal flexion and
extension torques. The Activation Ratio per muscle
was determined, i.e. ratio of the difference of EMG
activity during flexion and extension over summed
EMG activity. A ratio close to one indicates selective
activation while a ratio close to zero indicates
indifferent activation.
Results
Control subjects could exert higher (p<0.001) flexion
and extension torques (25.42 Nm and 14.32 Nm)
248
compared to post-stroke subjects (14.45 Nm and
6.69 Nm). The Activation Ratio’s for flexor and
extensor muscle were significantly lower (p<0.001) in
post-stroke subjects (ARflex: 0.72 – 0.54, ARext: 0.79 – 0.64).
Activation Ratio’s allow for muscle specific
determination of selective activity which is
advantageous in case of diverging muscle features. In
post-stroke patients the loss of selective activity has
to be accounted for when explaining and intervening
on loss of function.
Clinical message
Quantification of muscle specific selective activation
in post stroke hemiparesis allows for assessment
of contribution of the muscle to co-contraction and
functional loss and evaluation of therapeutic options.
I.Kouwijzer
[email protected]
2012|5
5. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised
controlled trial
Prof. G. Kwakkel PhD1,2, L. E.G. Wevers MSc1, prof. E. Lindeman MD PhD1, I.G.L. van de Port PhD1
Rudolf Magnus Institute of Neuroscience and Centre of Excellence for Rehabilitation Medicine, University Medical Centre
Utrecht and Rehabilitation Centre De Hoogstraat, Utrecht, the Netherlands
2
Research Institute MOVE, Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, the Netherlands
1
Objective
To analyse the effect of task oriented circuit training
(CCT) compared with usual physiotherapy in terms of
self reported walking competency for patients with
stroke discharged from a rehabilitation centre to
their own home.
Patients
Patients with mild to moderate stroke who were
able to walk a minimum of 10 m without physical
assistance and discharged from inpatient
rehabilitation to the community.
Methods
Patients were randomly allocated to CCT or usual
physiotherapy, after stratification by rehabilitation
centre (n=9), with an online randomisation procedure.
Patients in the intervention group received circuit
training in 90 minute sessions twice a week for 12
weeks with a follow-up to 24 weeks. The primary
outcome was the mobility domain of the stroke
impact scale.
Results
126 patients were included in the CCT and 124 in
the usual care group, with data from 125 and 117,
respectively, available for analysis. One patient from
the circuit training group and seven from the control
group dropped out. CCT was a safe intervention,
and no serious adverse events were reported. There
were no significant differences between groups for
the stroke impact scale mobility domain at 12 weeks.
CCT was associated with significantly higher scores
in terms of gait speed walking distance, and modified
stairs test. There were no significant differences
between groups at follow-up.
CCT can safely replace usual physiotherapy and
is equally effective as usual face-to-face care for
improving mobility in patients with mild to moderate
stroke discharged from a rehabilitation centre to the
community.
G. Kwakkel
[email protected]
6. Functional gait training using an instrumented treadmill with visual context improves gait
adaptability and associated attentional demands in the chronic phase after stroke: a proof of concept
M.W. van Ooijen MSc1,2, J.H.M. Heeren MD3,4, Prof. A.C.H. Geurts MD PhD3,4,5, Prof. T.W.J. Janssen PhD1,2,
P.J. Beek PhD1, V. Weerdesteyn PT PhD3,4,5, M. Roerdink PhD1
3
4
5
1
2
MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, the Netherlands
Amsterdam Rehabilitation Research Center | Reade, Amsterdam, the Netherlands
Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation,
the Netherlands
Sint Maartenskliniek, Centre for Rehabilitation, Nijmegen, the Netherlands
Sint Maartenskliniek Research, Development & Education, Nijmegen, the Netherlands
Introduction
After stroke, the ability to make step adjustments
during walking, i.e. gait adaptability, is often reduced,
which contributes to increased risk of falling. The
C-Mill is an instrumented treadmill with visual
context, specifically designed to train this aspect of
walking ability.
249
Objective
This proof-of-concept study aimed to examine the
effect of C-Mill training on gait adaptability.
Patients
Sixteen community-dwelling persons in the chronic
phase after stroke (54±11 yrs; time after stroke: 17±11
months).
Methods
Participants underwent 10 1-hr C-Mill training
sessions in 5-6 weeks. Pre and post intervention,
instrumented obstacle-avoidance tests with and
without a concurrent cognitive auditory Stroop
task were conducted to examine the effect of C-Mill
training on gait adaptability (i.e. obstacle-avoidance
success rates) and associated attentional demands
(Stroop performance success rates).
Results
Obstacle-avoidance success rates improved
after C-Mill training from 48±4% (Mean±SE) pre
intervention to 70±5% post intervention (p<0.001).
In addition, improved obstacle-avoidance was
accompanied by decreased attentional demands;
Stroop performance success rates during obstacle
avoidance improved from 77±4% pre intervention to
85±4% post intervention (p = 0.012), while Stroop
performance success rates during the control
7. Course of mood over time and its
injury : a prospective cohort study
2012|5
conditions sitting and walking did not improve after
C-Mill training (p<0.05).
C-Mill therapy fully complies with the general
recommendation that gait training should comprise
task-specific, repetitive, intensive gait training with
feedback on performance. The results of this study
indicate that C-Mill training is promising for improving
gait adaptability and associated attentional demands.
Clinical message
Obstacle avoidance and its attentional demands
improve after C-Mill training in stroke patients.
Acknowledgement: This project was funded by the
Dutch Brain Society, grant 2010(1)-25
M.W. van Ooijen
[email protected]
predictors following moderate to severe traumatic brain
L. Valk-Kleibeuker MD BSc1, M.H. Heijenbrok-Kal PhD1,2, G.M. Ribbers, MD PhD1,2
Rijndam Rehabilitation Center and Department of Rehabilitation Medicine and Physical Therapy Erasmus MC, the Netherlands
Rotterdam Neurorehabilitation Research (RoNeRes), the Netherlands
1
2
Introduction
Psychiatric disorders frequently complicate recovery
and rehabilitation from TBI. The most frequently
diagnosed psychiatric disorder after TBI is depression.
Objective
To evaluate the course of mood and identify its
determinants for up to 3 years following moderate to
severe traumatic brain injury.
Patients
Patients hospitalized with moderate to severe
traumatic brain injury.
Methods
Mood was assessed using the Wimbledon Self Report
Scale (WSRS), motor and cognitive outcome with
the Functional Independence Measure (FIM) and
Functional Assessment Measure (FAM), respectively,
at 3, 6, 12, 18, 24 and 36 months post-injury. We
performed repeated measurements analyses to
determine the course of mood over time and its
determinants.
250
Results
113 patients were included, aged 33 years (SD 13.1),
26% had moderate and 74% severe TBI, 73% were
men. Mood score did not change until 2 years after
TBI, after which the mood score significantly improved
(µd=-1.3; p<0.016). The mean FIM score improved
significantly until 18 months (µd=1.9; p<0.019) and the
FAM score until 12 months (µd=2.7; p<0.000) after TBI,
after which both remained stable. In a multivariable
model, concurrent FAM score and discharge destination
were independent predictors of mood scores in
addition to time. Higher FAM scores were related to
better mood scores (β=-0.29, p<0.000). Patients who
were discharged home had significantly better mood
scores than patients that were treated in an inpatient
rehabilitation centre or nursing home (β=1.27; p<0.094).
Conclusions and Clinical message
Mood starts to improve 2 years after TBI, when
motor and cognitive outcome have stabilized. Mood is
affected more by cognitive than motor outcome.
L. Valk-Kleibeuker
[email protected]
8. A
2012|5
longitudinal study of locus of control and health-related quality of life after traumatic
brain injury
J.E. Wielenga-Boiten MD1, M.H. Heijenbrok-Kal PhD1,2, G.M. Ribbers, MD PhD1,2
Rijndam Rehabilitation Center and Department of Rehabilitation Medicine and Physical Therapy Erasmus MC, the Netherlands
1
2
Introduction
Moderating factors on long-term recovery after
traumatic brain injury (TBI), such as locus of control
(LOC) beliefs, are largely unknown.
Objective
To evaluate changes in LOC in the chronic phase after
traumatic brain injury and to determine its effect on
health-related quality of life (HR-QoL).
Patients
Patients with moderate to severe TBI (Glasgow Coma
Scale 3-12).
Methods
LOC and HR-QoL were measured at 12, 18, 24
and 36 months post-injury with respectively the
Multidimensional Health Locus of Control Scale
(MHLCS) and the Sickness Impact Profile-68
(SIP-68). The MHLCS has 3 domains: internal control
(LOC-internal), depending on the physician (LOCphysician) and attributed to chance (LOC-chance).
Linear mixed model analyses were performed.
Results
In total, 113 patients (aged 33 years (SD 13), 73%
male), of which 26% with moderate and 74%
with severe TBI, were included. At 36 months
post-injury, LOC-internal (µd= -1.10, p<0.036) and
LOC-chance (µd= -1.35, p<0.012) were significantly
251
lower compared to 12 months post-injury. The LOCphysician and HR-QoL did not change significantly
in the chronic phase post-injury. LOC-chance was
an independent predictor of HR-QoL (β=0.17,
p-value=0.006), adjusted for patient characteristics,
functional and cognitive outcome.
LOC-internal and LOC-chance decline during the
chronic phase after TBI. TBI patients with a high
external LOC-chance experience more health-related
burden on the long term.
Clinical message
This study shows that a high external LOC-chance
negatively affects HR-QoL; therefore training
programs focussing on improving internal LOC should
be integrated in cognitive rehabilitation programs for
TBI patients.
J.E. Wielenga-Boiten
[email protected]
2012|5
Free Papers
Friday morning
8.30 - 10.30 Parallel session 2
Chair: J.H. de Groot PhD, scientific committee
1.
Trajectories in wheelchair exercise capacity after spinal cord injury.
C.F. van Koppenhagen
2.
The effect of robot-assisted gait training on cardiopulmonary fitness in motor incomplete spinal
cord injury: a training study. F. Hoekstra Page 254
3.
Health related quality of life, body functions and activities; satisfied boys, worrying parents.
S.L.S. van Houwen-Opstal
Page 254
4.
Electrical activation of paralyzed muscles increases ‘resting’ energy expenditure in individuals
with spinal cord injuries. T.W.J. Janssen
Page 255
5.
Cognitive mechanisms of change in multidisciplinary treatment of patients with chronic wide
spread pain: a prospective cohort study. A. de Rooij
Page 256
6.
Percutaneous nerve stimulation in severe neuropathic pain patients due to spinal cord injury:
a pilot study. J.M. Stolwijk-Swuste Page 256
7.
Implementation of Acceptance & Commitment Therapy (ACT) in Dutch pain rehabilitation.
H.R. Trompetter Page 257
8.
Fatigue resistance of the knee extensor muscles in patients with post-polio syndrome.
E.L. Voorn
252
Page 253
Page 258
1. Trajectories
2012|5
in wheelchair exercise capacity after spinal cord injury
C.F. van Koppenhagen MD1, S. de Groot PhD2,6, T. Hoekstra MSc3, M.W.M. Post PhD1,
F.W.A. van Asbeck MD PhD1, N.M.A.J. Zusterzeel MD4, prof. E. Lindeman MD PhD5,
prof. L.H.V. van der Woude PhD6
3
4
5
6
1
2
Rehabilitation Centre De Hoogstraat, Utrecht, the Netherlands
Reade Amsterdam, the Netherlands
VU University Amsterdam, the Netherlands
Adelante Rehabilitation Hoensbroek, the Netherlands
University Medical Center Utrecht, the Netherlands
University Medical Center Groningen, the Netherlands
Introduction
A spinal cord injury (SCI) potentially leads to a
debilitative cycle of exercise capacity with long-term
health consequences. Heterogeneity in the course of
exercise capacity after SCI, influenced by different
determinants, is suggested.
Objective
Identifying different trajectories and their
determinants in the course of exercise capacity in
the period between start of active SCI rehabilitation
and five years after discharge.
Patients
Prospective cohort study of 130 persons in 8
rehabilitation centres, aged 18-65, and wheelchairdependent.
Methods
Measurements at the start of active inpatient
rehabilitation, three months later, at discharge of
inpatient rehabilitation, one year, and five years after
discharge. Main outcome measurement: Exercise
capacity: Peak Oxygen Uptake (VO2peak (l.min-1)),
Peak Power Output (POpeak (W)).
Results
Using Latent Class Growth Mixture Modelling, four
different trajectories in the course of POpeak were
found: (1) high progressive scores, (2) progressive
scores during inpatient rehabilitation with deteriorating
figures after discharge, (3) low progressive scores,
(4) low inpatient scores with strong progressive scores
after discharge. VO2peak showed similar trajectories.
Logistic regression between high and low progressive
trajectory revealed that older age, female gender,
tetraplegic lesion and low functional status were
associated with low progressive trajectory.
Wheelchair exercise capacity after SCI shows a
positive trend and can be described in distinct
trajectories dependent on personal, lesion and
functional characteristics.
Clinical message
Conducting a peak wheelchair exercise test in SCI
follow up care might help to identify persons at risk
for a debilitative cycle of exercise capacity with longterm health consequences.
C.F. van Koppenhagen
[email protected]
253
2. The
2012|5
effect of robot-assisted gait training on cardiopulmonary fitness in motor incomplete
spinal cord injury : a training study
F. Hoekstra MSc1,2, J.M. Stolwijk-Swüste MD PhD1, M.P.M. van Nunen MSc1,2, H.L. Gerrits PhD2,
prof. T.W.J. Janssen PhD1,2
MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam,
the Netherlands
1
2
Introduction
Robot-assisted gait training (RAGT) is a unique
exercise modality for people with an incomplete
spinal cord injury (iSCI). Little is documented about
the cardiovascular effects of RAGT in this population.
Objectives
To investigate the effect of a period of RAGT
on cardiopulmonary fitness in subjects with an
iSCI. Secondary goals were to evaluate exercise
intensity and to study changes in metabolic cost of
standardized RAGT.
Patients
Ten subjects with a motor iSCI (ASIA-C and ASIA-D).
Methods
Twenty-four sessions of RAGT on a lokomat were
completed within 10 to 16 weeks. A graded arm crank
exercise test was performed before and after the
training programme. Oxygen consumption (VO2) and
heart rate (HR) were measured during a training
session at the start and at the end.
Results
Submaximal HR during arm crank exercise test
was significantly lower at post-test compared to
pre-test. Most subjects exercised at low intensity
(<3 metabolic equivalents) during robotic walking. At
the end of the training period, subjects reached lower
VO2 (p=0.03) and HR (p=0.06) when performing
standardized RAGT compared to the start.
In spite of the low exercise intensity of the training
programme, a period of RAGT had a positive effect
on submaximal exercise performance reflecting an
improvement in cardiovascular efficiency. Possible
mechanisms contributing to the higher robotic
walking economy are more appropriate muscle
activation or peripheral changes.
Clinical message
RAGT can be used as an additional form of lowintensity exercise in iSCI because of potential health
benefits associated with this exercise modality.
F. Hoekstra
[email protected]
3. Health
related quality of life, bodyfunctions and activities; satisfied boys, worrying parents
S.L.S. Houwen MD, M. Jansen MSc, N. van Alfen PhD, I.J.M. de Groot PhD
St Radboud University, Nijmegen, the Netherlands
Introduction
DMD is the most common progressive muscular
disorder in childhood. HRQoL is expected to be
negatively influenced by the progression. Knowledge
of the different composing factors of HRQoL and
its relationship with disease severity is rare. This
knowledge helps to support the boys.
Objectives
(1) To examine composing factors of HRQoL in boys
254
with DMD who are either ambulant or non-ambulant,
or are losing their manual abilities, (2) to investigate
the relationship between HRQoL, bodily functions
and activities and (3) to compare perceptions of boys
with their parents.
Methods
Ten HRQOL domains were assessed in 41 boys with
DMD and their parents, using the KIDSCREEN-52
questionnaire. The data were compared with
healthy age-matched controls group. We examined
the relation with MRC, Vignos and Brooke scales,
endurance test, MFM and PEDI.
Results
Nineteen participants were ambulant, while twentytwo patients were wheelchair-confined. Five
participants had decreased manual abilities. Boys
with DMD perceived only their physical abilities as
lower compared to healthy controls. The parents
scored much lower than the boys on the domains
‘Self Perception’, ‘Moods and Emotions’ and
4. Electrical activation of paralyzed
individuals with spinal cord injuries
2012|5
‘Bullying’. There were no significant correlations
between HRQoL, bodily functions and activity level.
Conclusion
The composing factors of HRQoL are not influenced
except for the physical abilities by DMD progression.
Parents, however, have a different view concerning
HRQoL of their sons, mainly on the psychosocial
domains. This needs attention in the DMD
management.
S.L.S. Houwen-van Opstal
[email protected]
muscles increases ‘resting’ energy expenditure in
Prof. T.W.J. Janssen PhD1, A. Vink MSc2, W. Harmsen MSc2, C.A.J. Smit MD3, J. Stolwijk MD PhD3,
S. de Groot PhD1
Faculty of Human Movement Sciences, VU University Amsterdam, the Netherlands
3
Reade, revalidatie en reumatologie, Amsterdam, the Netherlands
1
2
Introduction
Obesity is a major problem in wheelchair users with
spinal cord injuries (SCI), probably even more than
in the general population due to reduced activity
and resting metabolic rate. Increasing the metabolic
rate by electrically activating the paralyzed leg
and gluteal muscles while sitting might assist in
combating the development of obesity.
Objective
To evaluate if electrical activation of the paralyzed
leg muscles results in a marked increase of energy
expenditure and how duty cycle and amount of
activated muscle mass affect this increase.
Methods
Nine men with SCI (40±15 yrs; ASIA A/B) received 4
different 10-min protocols while sitting still. Current
amplitude (35-120 mA) was individually set to induce
muscle contractions at comfortable levels. The
amount of muscle mass (gluteus and hamstring vs
gluteus, hamstring, quadriceps and calf) and duty
cycle (1s-4s vs 1s-8s) varied among protocols. Energy
expenditure was calculated from oxygen uptake.
255
Results
Energy expenditure increased (p<0.05) from rest
(5.10±0.76 kJ/min) in all protocols, with the largest
increase (+51%) with more muscles activated and
shorter rest (7.69±2.28 kJ/min). Two hours of daily
stimulation with this protocol can be estimated to
counteract the yearly 1.8-kg increase in body mass
found in individuals with SCI (De Groot et al., J Rehab
Med 2010).
Conclusion
Electrical activation of paralyzed muscles can
markedly increase energy expenditure in individuals
with SCI while sitting in rest, with larger increases
when activating more muscle mass and a shorter
duty cycle.
Clinical message.
Electrical activation of paralyzed muscles could be
helpful for weight management in SCI.
T.W.J. Janssen
[email protected]
5. Cognitive mechanisms of change in multidisciplinary
spread pain: a prospective cohort study
2012|5
treatment of patients with chronic wide
A. de Rooij MSc1, M.R. de Boer PhD2, 3, M. van der Leeden PhD1,4, L.D. Roorda PT MD PhD1,
M.P.M. Steultjens PhD5, J. Dekker PhD1, 4, 6
3
4
5
6
1
2
Amsterdam Rehabilitation Research Center | Reade, the Netherlands
VU University, Department of Health Sciences, Amsterdam, the Netherlands
UMCG, Department of Health Sciences, Groningen, the Netherlands
VU University Medical Centre, Department of Rehabilitation Medicine and EMGO Institute, Amsterdam, the Netherlands
Glasgow Caledonian University, School of Health, Glasgow, Scotland UK
VU University Medical Centre, Department of Psychiatry and EMGO Institute, Amsterdam, the Netherlands
Introduction
Cognitive mechanisms of change in the
multidisciplinary treatment of patients with chronic
widespread pain (CWP) are only partially understood.
Objectives
To evaluate the contribution of improvement in
negative emotional cognitions, active cognitive
coping, and control and chronicity beliefs to the
outcome of the multidisciplinary treatment in CWP.
Patients
120 CWP patients, who completed a multidisciplinary
pain management treatment.
Methods
Data were used from baseline, 6 months and 18
months follow-up of a prospective cohort study.
Longitudinal relationships were analyzed between
changes in cognitions and outcome. Outcome
domains included: depression, interference of pain in
daily life, pain, and global perceived effect.
6. Percutaneous
Results
Improvements in negative emotional cognitions
were associated with improvements in all outcome
domains, in particular with improvement in
depression and interference of pain. Improvements
in active cognitive coping were associated with
improvements in interference of pain. Improvements
in control and chronicity beliefs were associated with
improvements in depression and pain.
Cognitive mechanisms of change during multi
disciplinary treatment in CWP include improvement in
negative emotional cognitions, active cognitive coping,
and control and chronic timeline beliefs. Improvement
in negative emotional cognitions was most
consistently related to the outcome of treatment.
Replication of this study is needed. Subsequently,
these mechanisms of change should be tested in
randomized control trials for their effectiveness.
A. de Rooij
[email protected]
nerve stimulation in severe neuropathic pain patients due to spinal cord injury :
a pilot study
J.M. Stolwijk-Swüste MD PhD1, D.J. Kopsky MD1,2, F.W.L. Ettema PT1, M. van der Leeden PhD1,3,
prof. J. Dekker PhD1,3
Institute for Neuropathic Pain, Soest, the Netherlands
3
VU University Medical Center, Dept. of Rehabilitation Medicine and psychiatry, EMGO Institute, the Netherlands
1
2
Introduction
Prevalence of pain in patients with spinal cord
injury (SCI) is 65–85%, and neuropathic pain mainly
continues or even worsens over time irrespective
of treatment. Thus, new treatment approaches are
needed. Percutaneous (Electrical) Nerve Stimulation
256
(P(E)NS) could be an interesting non-pharmacological
approach.
Objective
To evaluate the feasibility and effect of P(E)NS in SCI
patients with chronic neuropathic pain.
Methods
In 18 weeks 12 P(E)NS treatments were scheduled.
Assessment with questionnaires was performed at
baseline (T0), after 8 (T8), 18 (T18) weeks and 12
weeks follow-up (T30). Feasibility was evaluated and
pre-test/post-test comparison was made on pain and
quality of life scales.
Results
From 26 screened patients 17 were included. Minor side
effects: 4.2%, 2 dropouts, returned questionnaires:
88.2%, and given scheduled treatments: 94.1%.
Pain score on the Week Pain intensity Diary
changed from 6.5 (SD:1.7) at baseline to 5.4 at T8
significantly, though no significance on T18 and T30.
Pain reduction of ≥50% directly after treatment was
reported in 46.9%. Most of the patients with pain
7. Implementation
of
2012|5
reduction of 15% or more at T8 (N=7) had sustainable
effects at T18 and T30. No significant changes were
seen on quality of life scales.
Discussion
The study design is feasible for a larger study. Clear
difference can be made after 8 P(E)NS treatments
between responders and non-responders.
Clinical message
P(E)NS is feasible in SCI patients with neuropathic
pain and might have effect for a selected group. From
clinical experience after 3 test sessions, responders
could be identified.
J.M. Stolwijk-Swüste
[email protected]
Acceptance & Commitment Therapy (ACT)
in
Dutch
pain rehabilitation
H.R. Trompetter MSc1,2, P.H.T.G. Heuts MD PhD3, prof. E.T. Bohlmeijer PhD2,
prof. M.M. Vollenbroek-Hutten PhD1,4, prof. K.M.G. Schreurs PhD1,2,5
3
4
5
1
2
Roessingh Research and Development, Enschede, the Netherlands
Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
Adelante Rehabilitation Centre, Hoensbroek, the Netherlands
Faculty of Electrical Engineering, Mathematics & Informatics, University of Twente, Enschede, the Netherlands
Roessingh Rehabilitation Centre, Enschede, the Netherlands
Introduction
Acceptance & Commitment Therapy (ACT) is
effective in treatment of chronic pain by teaching
patients acceptance of inevitable pain experiences.
Objective
We developed an ACT course for multidisciplinary pain
teams which was implemented systematically in nine
Dutch rehabilitation centers. The implementation pro
cess of ACT in Dutch pain rehabilitation was evaluated.
Patients
Chronic pain patients with heterogenic diagnoses
who receive multidisciplinary pain treatment.
Methods
160 professionals from nine rehabilitation institutes
participated. During a 1-year period, they received
a workshop, supervision and intervision in working
with ACT. We measured professionals’ attitudes and
feelings of self-efficacy towards working with ACT at
the start (T0), half way (6 months; T1) and at the end
of the implementation trajectory (1 year; T2). Also
competencies in working with ACT were measured by
257
self-assessment (T0; T1; T2), by video-recordings of
professionals (T2; N = 27) and by assessing patients’
experiences of treatment.
Results
Preliminary results show that at start of the
implementation professionals hold positive attitudes
towards ACT, the ability of their teams to implement
ACT and the written self help book for patients. Results
on competency in working with ACT will be presented.
Much can be learned from systematic implementation
and monitoring of implementation processes in
health care services.
Clinical message
A focus on acceptance in rehabilitation of chronic pain
offers a solution to the inherent paradox of chronic
pain. Systematic implementation of new forms of
treatment ensures quality and uniformity of treatment.
H.R. Trompetter
[email protected]
8. Fatigue
2012|5
resistance of the knee extensor muscles in patients with post-polio syndrome
E.L. Voorn MSc1,2, A. Beelen PhD1, H.L. Gerrits PhD2, A. de Haan PhD2, prof. F. Nollet MD PhD1
Department of Rehabilitation, Academic Medical Center, Amsterdam, the Netherlands
MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands
1
2
Introduction
Abnormal muscle fatigability is one of the key
symptoms of post-polio syndrome (PPS). The few
studies that objectively compared muscle fatigue in
PPS with healthy controls show contradictory results.
Objective
To compare fatigue resistance of the knee extensor
muscles between patients with PPS and healthy
subjects.
Patients
38 patients with PPS (12 men) and 19 age-matched
controls (7 men) participated.
Methods
Fatigue resistance of the knee extensor muscles
was assessed using isometric contractions on a
dynamometer evoked by electrical stimulation
(during 5 min), leading to an initial torque level
of 30-40% of maximal voluntary torque (MVT).
Peak torque of each contraction was expressed
as a percentage of the first contraction. Fatigue
resistance was defined as the percentage torque that
remained at the end of the fatigue protocol.
258
Results
MVT was higher in healthy subjects compared to PPS
(179±34 versus 106±42 Nm; p = 0.000). Relative
initial torque of the fatigue protocol was similar
in both groups (30.8±5.6 versus 33.4±9.3% MVT;
p = 0.300). Fatigue resistance did not differ between
patients with PPS and healthy subjects (50.6±10.5%
vs 52.2±11.9%; p = 0.780).
Our findings do not support the hypothesis that
fatigue resistance of the quadriceps muscle in
patients with PPS is reduced. Therefore, muscle
fatigability in PPS is most likely the result of muscle
weakness that requires individuals to work at higher
relative intensities, inducing early fatigue.
Clinical message
Symptoms of abnormal muscle fatigability in PPS can
not be explained by an increased intrinsic fatigability
of muscle fibres.
E.L. Voorn
[email protected]
2012|5
Free Papers
Friday afternoon
13.15 - 15.15 Parallel session 3
Chair: J.H. de Groot PhD, scientific committee
1.
Perceived usability of therapeutic footwear in diabetic patients with neuropathy and
prior foot ulceration. M.J.L. Arts
Page 260
2.
School performance of children with Obstetric Brachial Plexus Palsy. L. Corsel
Page 260
3.
Walking in an unstable environment: The response of people with a transitibial
amputation to balance perturbations during gait. L. Hak
Page 261
4.
Safety and efficacy of the osseointegrated prosthesis for lower limb amputees:
Preliminary results of the first 24 patients in the Netherlands. H. van de Meent
Page 262
5.
Body structures and physical complaints in Upper Limb Reduction Deficiency:
a 24 year follow up study. S.G. Postema
Page 263
6.
Intermanual Transfer in Upper-Limb Myoelectric Prosthetic Training. S. Romkema
Page 263
7.
Birth prevalence and possible risk factors for congenital limb defects in the
Northern Netherlands. E. Vasluian
Page 264
8.
Prognostic factors in the causation of recurrent plantar ulceration in patients with
diabetes. R. Waaijman
Page 265
259
Parallel Session 3
1. Perceived
2012|5
usability of therapeutic footwear in diabetic patients with neuropathy and prior
foot ulceration
M.L.J. Arts MSc1, M. de Haart MD PhD1*, J.P.J Bakker MD PhD2, H.G.A. Hacking MD3, S.A. Bus PhD1,
prof. F. Nollet MD PhD1
3
*
1
2
Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Department of Rehabilitation, Medical Center Alkmaar, Alkmaar, the Netherlands
Department of Rehabilitation, St. Antonius Hospital, Nieuwegein, the Netherlands
Presenting author
Introduction
To be effective in ulcer prevention, prescribed
orthopaedic footwear needs to be worn by the
patient. Perception of footwear usability may play an
important role here.
Objective
To determine perceived usability of orthopaedic
footwear in diabetic patients at high risk for foot
ulceration and to associate this with patient and
footwear characteristics and with footwear use.
Patients
153 diabetic patients with neuropathy, prior plantar
foot ulceration, and prescribed orthopaedic footwear.
Methods
Patient perception of footwear usability was
assessed with the Questionnaire of Usability
Evaluation. Usability included appearance, comfort,
weight, durability, stability, maintenance, and ease of
use, each assessed with visual analogue scales (VAS,
10 = best outcome). Individual priorities and actual
use of footwear were evaluated. Associations were
analyzed with Mann-Whitney U tests (p<0.05).
2. School
performance of children with
Results
Median VAS scores ranged from 6.5 to 9.1 for all
domains. Comfort was identified as highest priority,
by 33% of patients. Younger patients and higher
educated patients were less satisfied with footwear
appearance (p<0.01). A high shaft support was less
appreciated (p=0.02). Low perceived benefit of
footwear use was associated with less footwear
use (p<0.001). Large inter-individual differences in
outcomes were found.
Despite individual differences, perceived usability
was rated as quite positive. Low footwear use with
those who perceived the least benefit of footwear use
emphasizes the need to educate high-risk patients
about footwear value in ulcer protection.
Clinical message
Insight in patient’s considerations and priorities of
footwear usability is important to direct prescription
practice and to improve wearing behaviour.
M.L.J. Arts
[email protected]
Obstetric Brachial Plexus Palsy
L. Corsel MD1, N. Haga MD1,2, M.S. van Wijlen-Hempel MD PhD3, M.H. van Doorn MD4,
H. Beckerman PhD4, Y.J.M. Janssen-Potten PhD5,6
3
4
5
6
1
2
Adelante Zorggroep, Hoensbroek, the Netherlands
Atrium Medical Centre, Heerlen, the Netherlands
Leiden University Medical Center, Leiden, the Netherlands
Dept Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
Maastricht University, Research School Caphri, Maastricht, the Netherlands
Introduction
Little is known about the functioning of children with
Obstetric Brachial Plexus Palsy (OBPP). Information
about their cognitive functioning or school
performance is lacking.
260
Objective
To determine whether in the population of children
with OBPP the frequency of learning difficulties is
higher compared to the general population.
Parallel Session 3
Patients
The cohort study included 469 children with OBPP
aged 8-12 years, known to specialised OBPP-teams
throughout the Netherlands (OBPP-group).
Methods
Parents received a questionnaire regarding medical
history, motor functioning and school performance.
The latter was operationalised as a financial
allowance for children with impairments and learning
difficulties (LGF). The frequency of LGF in the
OBPP-group was compared to that in the general
population. Possible causes for learning difficulties
were studied, i.e. neonatal asphyxia, forcedhandedness and writing difficulties.
Result
233(49.7%) questionnaires were returned. In the
OBPP-group 19% received LGF, in the general
population 5.8%. The need for LGF in children with
3. Walking
in an unstable environment:
The
2012|5
total OBPP (n=34) was 50%, compared to 11.4%
in children with upper OBPP(n=158). Children with
asphyxia(n=42) received LGF in 28.8% of cases versus
16.2% in children without asphyxia(n=158). In 23.1%
of right sided OBPP cases(n=108) LGF was provided
versus 12.3% in left sided OBPP children(n=81).
In children with OBPP, problems in school
performance occur more often than in the general
population, which seems to be related to severity of
the OBPP, asphyxia, forced handedness, and writing
difficulties, necessitating further research.
Clinical message
Be aware of the occurrence of learning difficulties
and cognitive dysfunctioning in children with OBPP.
L. Corsel
[email protected]
response of people with a transitibial amputation to
balance perturbations during gait
L. Hak MSc1, J.H. van Dieën PhD1, P. van der Wurff PhD2, M.R. Prins BSc1,2, A. Mert Col. MD PhD2,
P.J. Beek PhD1, H. Houdijk PhD1,3
3
1
2
Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, the Netherlands
Center for Augmented Motor Learning and Training, National Military Rehabilitation Centre Aardenburg, Doorn,
the Netherlands
Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands
Introduction
It is frequently suggested that people with gait
impairments, like lower limb amputees, walk slower
than able-bodied people to decrease the probability
of falling[1]. However, able-bodied subjects do not
change walking speed when they are perturbed.
Instead, they increase step frequency and step width,
and decrease step length, which increases backward
and sideward margins of stability (MoS)[2].
Objective
The objective of this study was to investigate the
differences in response to balance perturbations
during gait between transtibial amputees and ablebodied people.
Subjects
9 transtibial amputees (age 35.7 +/- 11.6) and 8 age
matched controls (age 38.2 +/- 11.4) participated.
261
Methods
Subjects performed two four-minute walking trials
on a self-paced treadmill of the Computer Assisted
Rehabilitation ENvironment (CAREN) system. In
one trial, they walked unperturbed. In the other
trial, quasi-random medio-lateral translations of the
walking surface were imposed.
Results
In general, amputees walked slower and with smaller
backward MoS than healthy controls. In response
to the perturbation, similar to healthy controls,
amputees did not change walking speed, but
decreased step length and increased step frequency,
step width, and their backward and sideward MoS.
Amputees walked overall slower than healthy
controls, but they did not further slowdown in
response to the perturbation. Just as the healthy
controls they increased their MoS, and therefore
Parallel Session 3
decreased the risk on making a backward and
sideward fall[3, 4].
2012|5
2. Hak L, Houdijk H, Steenbrink F, Mert A, van der Wurff
P, Beek PJ, van Dieen JH. Speeding up or slowing
down?: Gait adaptations to preserve gait stability in
Clinical message
Based on this study, it is questionable whether a lower
walking speed in amputees reflects a strategy to
decrease the risk of falling, or serves other purposes.
response to balance perturbations. Gait Posture 2012,
doi:10.1016/j.gaitpost.2012.03.005.
3. Hof AL, Gazendam MG, Sinke WE. The condition for
dynamic stability. J Biomech 2005;38:1-8.
4. Pai YC, Patton J. Center of mass velocity-position predic
References
tions for balance control. J Biomech 1997;30:347-54.
1. Dingwell JB, Marin LC. Kinematic variability and local
dynamic stability of upper body motions when walking
at different speeds. J Biomech 2006;39:444-52.
4. Safety
L. Hak
[email protected]
and efficacy of the osseointegrated prosthesis for lower limb amputees:
results of the first
24
patients in the
Netherlands
Preliminary
H. van de Meent PhD, B. Palm MSc, J.P.M. Frölke PhD
Centre of Evidence Based Practise, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
Introduction
An osseointegrated prosthesis is an alternative
for socket prosthesis for amputees with chronic,
disabling stump problems.
Objective
To evaluate the safety and efficacy of
osseointegrated prosthesis compared to conventional
prosthesis.
Patients
Twenty four lower limb amputees (one bilateral),
mean age 46.5 yrs (range 23-67 yrs) mean time of
amputation 16.4 yrs (range 2-45 yrs).
Methods
In a prospective case control study safety was
evaluated in the 12 months post surgery with respect
to (un)expected adverse events. Efficacy was
assessed by quality of life, six minutes walking test,
timed get up and go test and oxygen consumption.
Results
Two patients had soft tissue infection that needed
surgical cleaning. Seven patients had mild infections
262
of the stoma (peri-implantantitis) that needed
antibiotics. Eleven patients had stoma pain, eight
patients complained of aching stump muscles and
two patients had aching hip joints. Three patients had
a change of the transcutaneous adaptor because of
breaking of the safety weakpoint caused by a fall with
the prosthesis. The 6 minutes walking test improved
29%, energy consumption improved 31%, prosthetic
use score improved 41% and Timed get up and go
test improved 44%. All pre-post changes were
statistically significant.
Although peri-implantitis is a frequent adverse event,
the infections are mild and easily cured by cleaning
and antibiotics. Stoma pain and aching muscles are
transient and tolerated since patients experience a
huge improvement of comfort and function.
Clinical message
The osseointegrated prosthesis is a safe alternative
for amputees with chronic, disabling stump problems.
H. van de Meent
[email protected]
Parallel Session 3
5. Body structures
follow up study
and physical complaints in
Upper Limb Reduction Deficiency:
a
24
2012|5
year
S.G. Postema BSc1,2, Prof. C.K. van der Sluis MD PhD1, K. Waldenlöv BSc3, L.M. Norling Hermansson PhD2,4
3
4
1
2
University Medical Center Groningen, Department of Rehabilitation Medicine, the Netherlands
Department of Rehabilitation Research, Department of Prosthetics and Orthotics, University Hospital Örebro, Sweden
Limb Deficiency and Arm Prosthesis Centre, Department of pediatrics, Örebro University Hospital, Örebro, Sweden
Department of Rehabilitation Research, University Hospital Örebro, Örebro, Sweden
Introduction
The development of spinal deviations, other upper body
structures and physical complaints is unclear in children
with upper limb reduction deficiency (ULRD). Little is
known about the effects of prosthesis use on these.
Objective
To describe upper body structures of persons with
unilateral ULRD and the development of these
structures over time, to examine the presence of
physical complaints in this population, and to study
the effect of prosthesis use on body structures and
physical complaints.
Patients
Twenty-eight persons (age 8-18 years at inclusion)
with ULRD and 62 matched controls.
Methods
A prospective cohort study with a follow-up period of
24 years was conducted. Patients underwent measure
ments of upper-arm, trunk and spine and answered
study-specific and validated questionnaires (Brief Pain
Inventory, QuickDash) at baseline and follow-up.
6. Intermanual Transfer
in
Results
Within-subject differences in structures of the arm and
trunk were shown in patients, but not in controls, both
at baseline and follow-up. Spinal deviations, without
structural scoliosis, were greater in patients, compared
to controls. Differences in rate of physical complaints
and effects of prosthesis use could not be detected.
The structural within-person difference between
body-halves may explain the findings of spinal
deviations. The rates of physical complaints were
remarkably low, compared to earlier studies. This
might be due to differences between persons
with ULRD and upper limb amputations, level of
deficiency, prosthetic use or age.
Clinical message
Persons with ULRD have consistent differences in
upper body structures. Deviations of the spine do not
proceed to clinically relevant scoliosis.
S.G. Postema
[email protected]
Upper-Limb Myoelectric Prosthetic Training
S. Romkema MSc1, R.M. Bongers MSc PhD2, prof. C.K. van der Sluis MD PhD1
2
1
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen,
the Netherlands
Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen,
the Netherlands
Introduction
Myoelectric upper-limb prosthetic training should
start within the first month after amputation for
the best results. To start training directly after an
arm or a hand amputation intermanual transfer can
be used. Intermanual transfer implies that motor
skills learned at one side of the body, transfer to
the other side. This suggests that by practising the
263
unaffected arm, between amputation and prosthetic
fitting, the affected arm will also improve. Practising
the unaffected arm is possible using a prosthetic
simulator, a myoelectric prosthesis for a sound arm.
Objective
The aim was to determine whether intermanual transfer
effects could be detected after training with a simulator.
Parallel Session 3
Patients
Able-bodied persons participated in the experiment.
Methods
Able-bodied right-handed participants (N=48,
mean age: 24.6y) were randomly assigned to an
experimental or a control group. The experimental
group performed a five-day training program with
a simulator. To determine the improvement in
skill, a test was administered before, immediately
after, and six days after training. The control group
only executed the tests. The training program was
performed with one (‘unaffected’) arm; tests were
performed with the other (‘affected’) arm. Movement
times, the time from the beginning until completion
of the task, were recorded.
7. Birth prevalence
Netherlands
2012|5
Results
The movement time decreased significantly more
(p<.05) in the experimental group compared to
the control group, indicating faster handling of the
prosthesis.
Intermanual transfer was present after training with
a myoelectric prosthetic simulator.
Clinical Message
These results demonstrate the possible benefit of
starting early with training in rehabilitation of upperlimb amputees.
S. Romkema
[email protected]
and possible risk factors for congenital limb defects in the
Northern
E. Vasluian MSc1, prof. C.K. van der Sluis MD PhD1, H.A. Reinders-Messelink MSc PhD1,
A.J. van Essen MD PhD2, P.U. Dijkstra PhD1, H.E.K. de Walle PhD3
2
3
1
the Netherlands
Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
EUROCAT Registration of Congenital Anomalies, Department of Genetics, University Medical Centre Groningen, University
of Groningen, Groningen, the Netherlands
Introduction
Reported birth prevalences of congenital limb
defects (CLD) vary largely between countries.
Smoking, alcohol, chronic diseases, obesity, not
taking folic acid supplements are controversial
possible risk factors affecting limb development.
Objective
To describe the epidemiology of CLD in the northern
Netherlands and identify potential risk factors.
Methods
In a population-based epidemiological study we
investigated the prevalence of CLD for the period
1981-2010. Additionally, in a case-control study we
searched for possible risk factors associated with
CLD like maternal smoking, alcohol consumption,
chronic diseases, maternal weight, folic acid
supplementation before and during pregnancy,
maternal age, education level, and fertility problems.
Data on cases with CLD in the northern Netherlands
were collected by EUROCAT. Logistic regression was
used to analyze risk factors.
264
Results
The birth prevalence of all limb defects for the period
1981-2010 was 21.3 per 10,000 births. There was an
overall decrease in isolated limb defects (p=0.023)
during 1992-2010, specifically in syndactyly (p<0.01).
Of 1061 children with CLD, 54.9% were males, 51.1%
had isolated defects, 14.8% had multiple congenital
defects, and 34.1% had a recognized syndrome. The
upper/lower limb ratio was 2:1, and the left/right side
ratio was 1.2:1. Commonly associated anomalies were
of cardiovascular and musculoskeletal origin (20.2%
and 14.7%, respectively). We did not find a significant
association with the risk factors we studied.
The birth prevalence of limb defects and of
syndactyly in particular, has dropped in time in the
northern Netherlands. We found no association of
CLD with smoking, alcohol consumption, obesity or
multivitamin/folic acid supplementation.
E. Vasluian
[email protected]
Parallel Session 3
8. Prognostic
2012|5
factors in the causation of recurrent plantar ulceration in patients with diabetes
R. Waaijman MSc1, M. de Haart MD PhD1, M.L.J. Arts MSc1, D. Wever MD2, A. Verlouw MD3,
prof. F. Nollet MD PhD1, S.A. Bus PhD1,4
3
4
1
2
Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Department of Rehabilitation, Medisch Spectrum Twente, Enschede, the Netherlands
Department of Rehabilitation, Maxima Medical Centre, Veldhoven, the Netherlands
Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
Introduction
Orthopaedic footwear is often prescribed to prevent
diabetic foot ulceration, but ulcer recurrence
rates are high. Many factors may contribute to
this outcome, but have not been assessed in an
integrated fashion in a prospective study design.
Objective
To assess the determinants of plantar foot ulcer
recurrence in diabetic patients.
Patients
171 diabetic patients with peripheral neuropathy, a
history of plantar foot ulceration, and prescribed
orthopaedic footwear.
Methods
Patients were followed for 18 months or until plantar
ulceration. Demographic and disease-related factors,
footwear adherence and daily step count, and dynamic
barefoot peak pressures were assessed once. Every
3 months, in-shoe plantar pressures and presence of
foot ulcers and minor lesions (blister, callus, redness)
were assessed. Univariate logistic regression was used
to assess determinants of ulceration.
Results
71 patients reulcerated. Significant predictors were:
type of footwear (0.49), variance in number of daily
265
steps (0.98), cumulative months of prior ulceration
(1.03), presence of minor foot lesions (8.19), barefoot
peak pressure (1.11), severity of foot deformity
(1.78), and foot amputation (2.26). Non-significant
predictors were: gender, age, education level,
diabetes type and duration, HbA1c, BMI, daily step
count, footwear adherence, in-shoe peak pressure,
and peripheral arterial disease.
Discussion
This study shows which risk factors should be care
fully screened for in diabetic patients at high risk for
ulceration. Some factors are alterable, others are not.
Clinical Message
To prevent ulcer recurrence, patients should be urged
not to walk barefoot at any time, limit extremes in
their activity, and check their feet for minor lesions.
R. Waaijman
[email protected]
Posters Thursday
2012|5
Thursday
11.10 – 11.35
1.
Osseointegrated Prosthetic Fitting: first experiences with the Swedish method
in the Netherlands. J.H. Arendzen
Page 268
2.
Musculoskeletal complaints of conservatory students: preliminary results of a
cross-sectional study in 8 Dutch conservatories. V.A.E. Baadjou
Page 268
3.
Robot-assisted treadmill training in spinal cord injury: a pilot study on bowel, bladder
and sexual function. N.E. Bouma-Kollerie
Page 269
4.
Dynamic assessment: useful for assessing learning potential in patients with ABI?
Preliminary results of an ongoing study. H. Boosman
Page 270
5.
Cognitive complaints after Out-Of-Hospital Cardiac arrest. L.W. Boyce
Page 270
6.
Muscle fatigue during repetitive voluntary maximal contractions; a comparison between
children with cerebral palsy, typical developing children and young adults. M.M. Eken
Page 271
7.
Effectiveness of booster mCIMT-BiT for children and adolescents with unilateral
upperlimb paresis: preliminary results. Y. Geerdink Page 272
8.
Feasibility of a home-based training programme in adolescents and young adults
with cerebral palsy. L.E. Haffmans
Page 272
9.
Absolute and relative flexor tendon excursions in zone II and V of the hand measured
by ultrasound. S.G. Heemskerk, E. Pirard
Page 273
266
Posters Thursday
2012|5
10.
High prevalence of hand and wrist impairments in juvenile idiopathic arthritis (JIA).
A.F. Hoeksma
Page 274
11.
Assessment of upper-limb capacity, performance and developmental disregard with the
VOAA-DDD-R in children with unilateral spastic cerebral palsy. A. Houwink Page 274
12.
Changes in fitness, wellbeing and rehabilitation goals during a process-guided cardiac
rehabilitation program. N. Huizenga
Page 275
13.
Learning to live and move with chronic neuropathic pain in diabetes. I.M. Kanera Page 276
14.
Promoting gain versus preventing loss in chronic pain: does it matter what patients
focus on? H.P.J. Kindermans
Page 276
15.
Knee joint stabilization therapy in patients with osteoarthritis of the knee: a randomized,
controlled trial. J. Knoop
Page 277
16.
Long-term functioning of caregivers of survivors of a cardiac arrest. V.R.M. Moulaert Page 278
17.
Feasibility of an early intervention service for survivors of a cardiac arrest:
a process evaluation. V.R.M. Moulaert
Page 278
18.
Transfer of motor learning in (robotic) task-oriented armhand training after stroke.
R.J.M. Lemmens
Page 279
267
Posters Thursday
1. Osseointegrated Prosthetic Fitting:
Netherlands
first experiences with the
Swedish
2012|5
method in the
Prof. J.H. Arendzen MD PhD, P.D.S. Dijkstra MD PhD orthopedic surgeon
LUMC, Leiden University Medical Center, Leiden, the Netherlands
Around 1990 Dr. R Brånemark, an orthopedic surgeon
in Gothenburg in Sweden started experiments to fix
an exoskeletal prosthesis to the residual femur bone.
Earlier surgical attempts to fix a cemented implant
showed poor results. The Swedish procedure was
called osseointegration because a titanium fixture
was placed in the bone cavity that –under the right
conditions- integrated into the cortical bone.
rehabilitation program they started in 1999 the
Osseintegrated Prostheses for the Rehabilitation of
Amputees (OPRA) study. More than 100 patients have
been treated with osseointegration, about half have
been included in the OPRA study and the functional
use has been improved up to 95%. Patient selection,
surgical technique and a well-conducted rehabilitation
program seem to be the key factors for the success.
Based on the Swedish experiences we started Leiden
in 2011 with the first selection of eligible patients
and operations followed since September 2011.
On 4 patients the two stage operation procedure
has been completed and 2 have completed their
rehabilitation program.
The procedure, the rehabilitation program and
the preliminary results of our first patients will be
explained in this case report.
In the first 9 years a number of complications
occurred, in particular infections and non-fixture
resulting in a successful prosthetic use of 64%.
After improving the surgical techniques and the
J.H. Arendzen
[email protected]
2. Musculoskeletal complaints of conservatory
sectional study in 8 Dutch conservatories
students: preliminary results of a cross-
V.A.E. Baadjou MSc1,2, S.M.D. Huysmans2, J.A.M.C.F. Verbunt MD PhD1,2,3,
M.D.F. van Eijsden-Besseling MD PhD1,2,3, Prof. R.J.E.M. Smeets, MD PhD1,2,3
Adelante centre of expertise in rehabilitation and audiology, Hoensbroek, the Netherlands
Maastricht University, FHML, Caphri, Department of Rehabilitation Medicine, Maastricht, the Netherlands
3
Maastricht University Medical Centre, Maastricht, the Netherlands
1
2
Introduction
A large number of conservatory students develop
playing-related physical complaints. Physical
complaints can be a serious threat to the quality
of performance as well as to the musician’s quality
of life.
Objective
To study the prevalence of physical complaints in
conservatory students.
Population
1406 third and fourth year students from 8 Dutch
conservatories.
268
Methods
Cross-sectional survey by a questionnaire per e-mail.
Measurements: a.o. existence and characteristics of
physical complaints (DMQ), quality of life (SF-36), and
disability (DASH).
Results
At week 2 of a total survey duration of 4 weeks,
response rate is around 10%. Preliminary results
show a mean age of 24.3 years. 65.6% is female
and 34.5% male. Categories of instruments played
are string instruments (35.7%), wind instruments
(22.6%), voice (17.9%), keyboard instruments
(16.7%), and others (7.2%). 82.1% rated their general
Posters Thursday
health minimally as good. For upper extremities,
more than 65% reported having ever experienced
pain or discomfort and around 40% reported
complaints in the past 7 days; mean pain VAS score
was 5.93 (SD 2.08). 44% experienced mild, moderate
or severe disability playing their musical instrument
because of pain in arm, hand or shoulder.
Preliminary results show a high prevalence of upper
extremity pain and disabilities related to playing a
musical instrument. Final results of this survey will
be presented at the congress.
3. Robot-assisted
2012|5
Clinical message
Prevalence rate of disabling physical complaints in
conservatory students is high. It is recommended
to develop and implement effective prevention
programs and provide effective treatment once pain
has developed.
V.A.E. Baadjou
[email protected]
treadmill training in spinal cord injury : a pilot study on bowel, bladder and
sexual function
N.E. Bouma MSc MD1, J.M. Stolwijk-Swüste PhD MD1, M. van Nunen MSc1,2, K.H. Gerrits PhD1,2,
T.W.J. Janssen PhD1,2
MOVE Research Institute Amsterdam, Faculty of Human Movement Science, VU University, the Netherlands
1
2
Introduction
In Spinal Cord Injury (SCI) problems with bowel,
bladder and sexual function have a negative effect
on quality of life. During robot-assisted treadmill
training (RATT) patients reported a positive influence
on these functions.
Objective
To explore the effect of RATT on bowel, bladder and
sexual function in patients with SCI.
Methods
Fourteen patients were included, ASIA B, C and D,
6 patients <1y and 8 patients ≥2y post-injury. RATT
was administered twice a week for 30-45 minutes,
combined with conventional physical therapy twice
a week 30 minutes for 12 weeks. Self-reported
questionnaires and VAS-score on satisfaction with
bowel, bladder and sexual function were filled out
before (T0) and after completion (T1).
Results
VAS scores on all 3 functions improved, but only
significantly in bowel function in patients with SCI
≥2y (53,13 (SE 5,52) to 66,75 (SE 4,89), p=0,031).
There were no significant differences in frequency of
obstipation, faecal incontinence or laxation methods.
In bladder function VAS scores on T0 resp T1 were
69,00 (SE 10,41) and 76,88 (SE 7,96) for SCI≥2y. In
sexual function VAS scores on T0 resp T1 were 50,75
(SE 10,61) to 52,63 (SE 10,40) for SCI ≥2y. Regarding
bladder and sexual function no differences were found.
Conclusions
This pilot study showed an increase in satisfaction on
bowel, bladder and sexual function, with bowel function
being significantly improved. Future research with
more responsive outcome measures, a larger group
of patients and controls should be conducted to gain
more insight in the effect of RATT on these functions.
N.E. Bouma-Kollerie
[email protected]
269
Posters Thursday
4. Dynamic assessment: useful for assessing
Preliminary results of an ongoing study
learning potential in patients with
2012|5
ABI?
H. Boosman MSc1, J.M.A. Visser-Meily MD PhD1, S. Nassime BSc2, C.M. van Heugten PhD2
2
1
Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center
Utrecht and De Hoogstraat, Utrecht, the Netherlands
Maastricht University, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience and
Maastricht University, Department of Neuropsychology and Psychopharmacology, Maastricht, the Netherlands
Introduction
During rehabilitation, it is not only important to
objectify and quantify impairments but also to
determine whether a patient has the potential
to learn and improve. Learning potential can be
determined with a dynamic assessment (DA). The
aim of DA is to determine the extent to which
performance improves in response to guidance. The
dynamic Wisconsin Card Sorting Test (dWCST) is a
frequently used DA but rarely used in patients with
acquired brain injury (ABI).
These preliminary results suggest that ABI patients
can have a different degree of cognitive learning
potential. Additional research should determine
whether cognitive learning potential is associated
with motor learning potential or with rehabilitation
outcome.
Objective
Evaluate the use of the dWCST in ABI patients.
Patients
ABI patients in inpatient rehabilitation.
Methods
Three consecutive administrations of the WCST in a
pretest-training-posttest design. The WCST measures
executive functioning. The pre-test and post-test
followed standard WCST procedures. During the
training additional instructions and feedback were
given. Cognitive learning potential was evaluated by
comparing pre- and post-test performance.
5. Cognitive
complaints after
Results
To date, the dWCST was administered to 33 patients.
Sixteen patients showed continuously adequate
performance. Thirteen patients were good learners
(impaired pre-test, adequate post-test) and two
patients were poor learners (impaired pre- and
post-test). Furthermore, two patients had adequate
performance at pre-test but demonstrated a
decrease in performance post-test with many
perseverative errors (≥1.5SD) only at post-test.
Clinical message
It is important to look beyond a patient’s actual
performance and focus on a patient’s potential
performance.
H. Boosman
[email protected]
Out-Of-Hospital Cardiac
arrest
L.W. Boyce MA, P.H. Goossens MD PhD
Rijnlands Rehabilitation Centre, Rotterdam, the Netherlands
Introduction
Every year 16.000 people experience an Out-ofHospital Cardiac Arrest (OHCA). Up to 40 percent
of the patients experience cognitive complaints. In
daily practice, little attention is paid to mild cognitive
complaints.
Patients
Survivors of OHCA, > 16 year, admitted to the
Rijnlands Rehabilitation Centre for outdoor patient
cardiac rehabilitation between August 2011 and April
2012.
Methods
Within a month after leaving the hospital, cognitive
impairments were assessed. Cognitive complaints
were defined as CFQ > 32, IQCODE > 3.6 or MMSE < 28.
Objectives
How many OHCA survivors experience cognitive
complaints?
270
Posters Thursday
Also participation, QoL and perceived health were
assessed. Spouses strain was measured with CSI.
Results
Of 42 OHCA patients (85.7% male, 14.3% female,
aged 15-77 years) 10 reported cognitive complaints.
50 % of the complaints were classified as mild, 50 %
as severe. 11 spouses experienced high strain (CSI > 7)
cognitive problems we found (24 %) is lower than
found in literature (40 %) since only patients
eligible for outdoor patient cardiac rehabilitation
were included. Knowledge of cognitive complaints
after OHCA provides the opportunity to tailor the
rehabilitation process with respect to both cognitive
and cardiac rehabilitation.
L.W. Boyce
[email protected]
Comprehensibly, the percentages experienced
6. Muscle
2012|5
fatigue during repetitive voluntary maximal contractions; a comparison between
children with cerebral palsy, typical developing children and young adults
M.M. Eken MSc1,2,3, A.J. Dallmeijer, PhD1,2, H. Houdijk PhD2,3,4, C.A.M. Doorenbosch PhD1,2
3
4
1
2
Dept Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
Research Institute Move VU University Amsterdam, the Netherlands
Rehabilitation Center Heliomare, Wijk aan Zee, the Netherlands
Faculty of Human Movement Sciences, VU University, Amsterdam, the Netherlands
Introduction
Children with cerebral palsy (CP) show better muscle
fatigue resistance compared to typical developing
(TD) peers. This surprising finding might be explained
by lower maximal muscle strength in CP children.
Objective
The purpose of this study is to investigate muscle
fatigability in three groups of subjects with different
maximal strength levels: children with CP, age
matched TD children and young adults (YA).
Patients
Seven children with spastic CP (GMFCS I [n=2] II
[n=5]; 9±2years), 9 TD children (10±2years) and 10
YA (22±3years) participated in this study.
Methods
Subjects performed a fatiguing protocol consisting of
35 maximal isokinetic knee flexions and extensions
on an isokinetic dynamometer. Muscle fatigability was
described as the rate of decline between the highest
and lowest peak extension and flexion torque relative
to the maximal torque. In addition, muscle activation
(EMG) was measured over the series of contractions.
271
Results
Maximal peak torque and decline in peak torque of
extensors and flexors were significantly larger in YA
than in both CP and TD. Decline in median frequency
was larger in YA than in CP (vastus lateralis,
semitendinosus, biceps femoris) and TD (biceps
femoris).
The noticeably larger decline of peak torque and EMG
median frequency over 35 maximal contractions
in YA confirmed that higher muscle fatigability
coincides with higher peak strength levels. Stronger
muscles may have different metabolic properties that
can explain differences in fatigue resistance.
Clinical message
Lower strength levels in children (with CP) may
explain the better fatigue resistance.
M.M. Eken
[email protected]
Posters Thursday
7. Effectiveness of booster mCIMT-BiT
paresis: preliminary results
2012|5
for children and adolescents with unilateral upperlimb
Y. Geerdink MSc1, P. Aarts PhD1, Prof. A. Geurts MD PhD2
Sint Maartenskliniek, Department of Pediatric Rehabilitation, Nijmegen, the Netherlands
Radboud University Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation,
Nijmegen, the Netherlands
1
2
Introduction
For older children with unilateral upper extremity
(UE) paresis who cope with problems performing
bimanual daily activities, intensive UE training during
several weeks may be no option when the school
program prevails.
Objective
We conducted a pilot study to evaluate whether a oneweek booster session of 15 hours modified constraint
induced movement therapy (mCIMT) combined
with 25 hours bimanual training (BiT) is effective in
older children with unilateral Cerebral Palsy (CP) or
Obstetric Plexus Brachial Lesion (OPBL).
Patients
Fourteen subjects, mean age 11.3 (8.2-17.5) years,
participated. All had received some form of UEtraining
before. Twelve subjects had unilateral CP (MACS I:n=3,
MACS II:n=8, MACS III:n=1) and two had OPBL.
Methods
Participants were measured at baseline, one
week and four months post intervention. Primary
outcomes were ABILHAND-Kids, COPM and
Box-and-Block test. We used t-tests to compare
8. Feasibility of
erebral palsy
c
post-intervention results with baseline. Pre-post
intervention effect sizes were calculated (Cohen’s
d-value).
Results
There were significant improvements on all outcome
measures. Effect sizes were medium for Box-andBlock test (affected hand d=0.47), large for COPMperformance (d=3.52), COPM-satisfaction (d=4.18)
and ABILHAND-Kids (d=0.84).
Preliminary results of this study indicate that a oneweek booster session of 40 hours mCIMT-BiT can have
beneficial effects on both qualitative and quantitative
aspects of affected UE use in older children with
unilateral CP or OPBL. Whether or not these results
are retained after four months is not yet known.
Clinical message
Older children and parents are highly satisfied with
improved hand use after one week of intensive UE
therapy.
Y. Geerdink
[email protected]
a home-based training programme in adolescents and young adults with
L.E. Haffmans MD1, J. van Meeteren MD PhD2, J. Slaman MSc2, R.M.C.M. Brenner MD1,
H.J.G. van den Berg-Emons PhD2
Sophia Rehabilitation, The Hague, the Netherlands
Erasmus Medical Centre, Rotterdam, the Netherlands
1
2
Introduction
It is important to improve physical fitness in people
with CP, since this may improve functioning, health,
and quality of life. Compliance in centre-based
training (CBT) programmes is often reduced due to
transport and time investment problems. A partly
home-based training (HBT) programme might be a
feasible alternative.
272
Objective
Aim of this study was to investigate the feasibility of
HBT as part of the intervention ‘Active lifestyle and
sport stimulation’.
Patients
Seventeen participants with spastic CP, gross motor
function classification system I-III, 16-24 years.
Posters Thursday
Methods
Participants followed a 12 week training programme
(aerobic capacity and muscle strength), once/week
at home and once/week in a rehabilitation-centre.
Frequency, duration and intensity were recorded
with heartrate-monitors. Statistical analysis was
performed with paired t-tests. (p<0.05)
Results
Frequencies in HBT (mean 7 sessions, SD 6 sessions)
and CBT (mean 8 sessions, SD 2 sessions) were
comparable (p=0.22). Eighteen percent of the
participants only performed CBT.
Duration of HBT (mean 35m4s, SD 23m50s) was
shorter (p<0.05) than CBT (mean 55m30s, SD 18m9s).
Intensity of HBT (40-60% heart rate reserve (HRR)
9. Absolute
2012|5
mean 7m32s, SD 9m16s; >60% HRR mean 3m4s,
SD 4m13s) was lower (p<0.05) than CBT (40-60%
HRR mean 17m57s, SD 5m5s; >60% HRR mean
17m43s, SD 12m1s).
HBT seems less feasible in this population than CBT.
Not all participants performed HBT and duration and
intensity were low.
Clinical message
CBT might be preferred above HBT.
L.E. Haffmans
[email protected]
and relative flexor tendon excursions in zone
II
and
V
of the hand measured by
ultrasound
S.G. Heemskerk MD1, E. Pirard MD1, J.W. Korstanje MSc PhD2, H. Arwert MD1, R.W. Selles MD PhD2
Sophia Rehabiliation Centre, The Hague, the Netherlands
Department of Rehabilitation Medicine and department of Plastic and Reconstructive Surgery, Erasmus MC Rotterdam,
the Netherlands
1
2
Introduction
Adjacent fingers in tendon mobilization protocols have
a large influence on tendon excursion in zone V, both
absolute and relative to the moving surrounding tissue.
Objective
We hypothesized that absolute displacement of the
flexor digitorum profundus (FDP) in zone II and V are
comparable but that relative displacements differ
due to different anatomy.
in zone V for the active four-finger-, passive fourfinger-, modified Kleinert- and a modified Kleinert
protocol with the other fingers in flexion. Excursions
differed significantly between zone II en V. In
contrast to zone V, in zone II, it was not possible to
view and measure a surrounding tissue moving partly
in the same direction as the tendon.
Patients
Ten healthy participants.
Absolute FDP tendon excursion measured in zone II
was not comparable to zone V. In contrast to zone
V, in zone II, relative displacement of the long finger
FDP tendon excursions could not be measured.
Methods
Long finger FDP tendon excursion and surrounding
tissue movement were measured in zone II and V
during four mobilization protocols with an iU22.
Speckle tracking image analyses was performed to
measure the tendon excursions.
Clinical message
This method can measure tendon excursion in zone
II and V, but the excursion in both zones are not
comparable. Relative displacement in zone II seems
to be less important than in zone V due to different
anatomy.
Results
The mean absolute excursions were 4.3, 3.3, 4.2
and 4.6mm in zone II and 10.3, 7.8, 4.4 and 7.0mm
S.G. Heemskerk
[email protected]
273
Posters Thursday
10. High
prevalence of hand and wrist impairments in juvenile idiopathic arthritis
2012|5
(JIA)
A.F. Hoeksma MD PhD1, G.W. Zinger MD1, M.A.J. van Rossum MD PhD2,3, K.M. Dolman MD PhD2,5,
prof. J. Dekker MSc PhD1,4, L.D. Roorda MD PhD1
3
4
5
1
2
Jan van Breemen Research Institute Reade, the Netherlands
Dept of Rheumatology Emma Childrens’ Hospital AMC, the Netherlands
Dept of Rehabilitation Medicine VU University Medical Centre, the Netherlands
Dept of Pediatrics St Lucas Andreas Hospital5, Amsterdam, the Netherlands
Introduction
Juvenile Idiopathic Arthritis (JIA) is the most
frequent form of arthritis in children. In all subtypes
of JIA the hand and wrist can be affected. This may
lead to serious impairments and deformities. General
problems of hand and wrist are described in 80% in
JIA without further specification of the impairments.
Methods
All children were included, who were diagnosed
between 2003 and 2008 for JIA at the Jan van
Breemen Institute and Emma Childrens’ Hospital
AMC, Amsterdam, and who have been treated in
these clinics since then. During control visits at the
outpatient clinic, assessment of complaints was
performed, together with a standardized physical
examination of the hand and wrist.
inclusion criteria, of which 121 (80%) were assessed:
mean disease duration 2.6 year, 72% female, mean
age 13.7 years. The prevalence of any hand and wrist
complaint was 56% and 49%, respectively. In only
15% and 28% of the children there were signs of
active arthritis in hand and wrist joints respectively,
and in 3% stenosing tenosynovitis. The prevalence
of any hand or wrist impairment was 40%. Most
frequent impairments were: limited range of motion
of wrist (22%), PIP (18%), and MCP joints (8%). Only
2 children showed Boutonniere deformities. Four
children showed diminished grip force in both hands.
Conclusions
In 121 children with JIA (80% of the total cohort), there
was a high prevalence of hand and wrist impairments,
also without the presence of active clinical arthritis.
A.F. Hoeksma
[email protected]
Results
Between 2006 and 2010, 152 children met the
11. Assessment of upper-limb capacity, performance and developmental
VOAA-DDD-R in children with unilateral spastic cerebral palsy
disregard with the
A. Houwink PhD1, Y.A. Geerdink MSc2, Prof. B. Steenbergen PhD3, Prof. A.C.H. Geurts MD PhD1,
P.B.M. Aarts PhD2
2
3
1
Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation,
the Netherlands
Sint Maartenskliniek, Department of Pediatric Rehabilitation, the Netherlands
Radboud University Nijmegen, Behavioural Science Institute, Nijmegen, the Netherlands
Introduction
Children with unilateral spastic cerebral palsy
(CP) not only experience limitations in upperlimb capacity, they often underuse their affected
limb in daily life (limited performance) given their
individual capacity. This discrepancy is also termed
‘developmental disregard’. The revised VideoObservation Aarts and Aarts module Determine
Developmental Disregard (VOAA-DDD-R) assesses
developmental disregard, unilateral capacity, and
274
unilateral performance during bimanual activities.
Objective
To investigate the validity and reliability of the
VOAA-DDD-R.
Patients
Twenty-five children with unilateral spastic CP (2.5-8
years) and 46 age and gender matched typically
developing children (TDC).
Posters Thursday
Methods
Upper-limb capacity and performance were assessed
by measuring the frequency of grasping, holding
and releasing during two tasks in which bimanual
activity was demanded or stimulated. Developmental
disregard was defined as the difference in overall
duration of affected upper-limb use between
both tasks. Construct validity was determined
by comparing the children with CP to the TDC.
Intra-rater, inter-rater, and test-retest reliability
were determined using the intraclass correlation
coefficient (ICC), standard error of measurement
(SEM), and smallest detectable difference (SDD).
Results
Children with CP (mean age 4.7±1.6, range 2.7-8 years)
scored lower on capacity (p=0.052) and performance
12. Changes in fitness,
ehabilitation program
r
2012|5
(p<0.05), and higher on developmental disregard than
TDC (p<0.05). The ICCs (0.79-1.00) indicated good
reliability. Absolute agreement was high, SEMs ranged
from 4.5%-6.8%, and SDDs ranged from 12.5%-19.0%.
Conclusion
The VOAA-DDD-R is a reliable and valid tool to
assess upper-limb capacity, performance, and
developmental disregard in children with CP.
Clinical message
The VOAA-DDD-R can be used to assess upper-limb
disability in order to design an individually-tailored
rehabilitation program.
A. Houwink
[email protected]
wellbeing and rehabilitation goals during a process-guided cardiac
N. Huizenga BSc1, J.A. Haisma MD PhD2, A.J. Funke Küpper MD PhD2, J.J. van Dixhoorn MD PhD2
VU Medical Center Amsterdam, the Netherlands
Kennemer Gasthuis Haarlem, the Netherlands
1
2
Introduction
Rehabilitation reduces morbidity and mortality
following a cardiac event. However, its effect on
wellbeing or rehabilitation goals is less known. We
showed that a process-guided program (duration of
rehabilitation can be adjusted at an intermediate
evaluation) reduced the duration of rehabilitation
for some patients. However, its effect on outcome is
unknown for a large population.
Objective
To investigate changes in fitness, wellbeing and
attained rehabilitation goals following a processguided cardiac rehabilitation program.
Patients
All 3754 patients referred by the cardiologist
between December 1999 and December 2011.
Methods
The program included information sessions, fitness
and relaxation exercises. The duration was determined
at an intermediate systematic evaluation. Before,
during and after the program, we determined fitness
(Watts during 20 minute interval exercise), wellbeing
(MPVH) and rehabilitation goals (attained or not).
275
Results
Approximately 50% of the patients could stop the
program at the intermediate evaluation. Overall,
significant changes were found for fitness (1087
to 1275 Watts), wellbeing (27 to 31 points) and
subjective invalidity (25 to 22 points). Approximately
60% of the patients reported attained rehabilitation
goals.
A process-guided approach reduced the duration
of rehabilitation for many patients, while overall
positive changes in outcome were maintained.
To allow more patients to benefit from cardiac
rehabilitation with currently limited means, we need
to find ways to further tailor the program to patients’
actual needs.
Clinical message
Process-guided cardiac rehabilitation is associated
with positive changes in fitness, wellbeing and
rehabilitation goals. An intermediate evaluation may
reduce the duration of rehabilitation.
N. Huizenga
[email protected]
Posters Thursday
13. Learning
2012|5
to live and move with chronic neuropathic pain in diabetes
I.M. Kanera MSc1, J. M. Ruijgrok MD PhD1,2, H.P.J. Kindermans PhD1, J.A. Verbunt MD PhD1,2,3,
prof. R.J.E.M. Smeets MD PhD1,2,3
3
1
2
Department of Rehabilitation Medicine, CAPHRI, Maastricht University, the Netherlands
Department of Rehabilitation Medicine, Maastricht University Medical Centre (MUMC),
the Netherlands
Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
Introduction
Diabetic peripheral neuropathic pain (DPNP) is
associated with high levels of depression and anxiety
and has a significant impact on patients’ quality of life.
Importantly, due to the interference of neuropathic
pain with physical activity and/or exercise, DPNP
might exacerbate diabetes outcomes. In patients
with non-specific pain, anxiety and fears are known
to contribute to experienced limitations in daily life
functioning. Yet, only limited evidence is available
on the experiences and perceptions of living with
DPNP. Whether anxiety influences daily functioning
of patients with DPNP or other aspects of living with
diabetes is currently unclear. As a consequence,
the aim of the present study is to generate deeper
understanding of the role of psychological and
behavioral factors in the relationship between DPNP
and participation in daily life.
Methods
A qualitative methodology was used: semi structured
focus group interviews. Inclusion criteria: Pain
Severity Index (PSI) ≥5 and Pain Disability Index
(PDI) ≥29. All interviews are video-recorded and
14. Promoting gain
grounded theory approach is used for the data
analysis.
Results
Three focus group interviews with patients with
DPNP (N = 12; M: F = 2:1) were conducted. Mean
age was 65.3 (SD = 10.3). Mean level of pain (PSI):
6.5 (SD = 1.2). Mean level of disability (PDI): 45.25
(SD = 8.7). Specific fears (fear of hypoglycemia,
physical injuries, further decline, physical exhaustion
and more pain, and social fears), cognitions (pain
beliefs, locus of control), attention (e.g. distraction)
and negative emotions could be identified.
A complex set of psychological factors are identified
having possible influence on physical activity.
Different kinds of irrational but also rational fears
as well as specific cognitions were mentioned. By
addressing the full range of psychological factors,
participation in daily life can possibly be ameliorated.
I.M. Kanera
[email protected]
versus preventing loss in chronic pain: does it matter what patients focus on?
H. Kindermans PhD1, M. Hanssen MSc2, prof. M. Peters PhD2, J. Verbunt PhD1,2,4, prof. R. Smeets PhD1,3,4
3
4
1
2
Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
Department of Rehabilitation Medicine, Maastricht University Medical Centre (MUMC+), the Netherlands
Introduction
Increasing evidence suggests that goal processes
play an important role in living with chronic pain.
Regulatory focus theory differentiates between two
distinct goal orientations. A promotion focus involves
eagerness to attain advancement, a focus on obtaining
gains and a strategy of ‘making good things happen’.
A prevention focus entails vigilance to assure safety,
a focus on preventing loss and a strategy of ‘keeping
276
bad things from happening’. A novel theoretical
model is proposed in which promotion, in contrast
with prevention, regulatory focus is expected to be
associated with better outcomes in chronic pain.
Objective
The objective of the present study was to determine
associations between regulatory focus and, wellbeing and disability in chronic pain.
Posters Thursday
Patients
Participants with chronic musculoskeletal pain were
recruited from the general population. N = 247 – 249
for current correlational analyses.
Methods
A cross-sectional questionnaire study was conducted
including the following online questionnaires:
Regulatory Focus Questionnaire (promotion
and prevention subscale), the Well-Being
Questionnaire-12, and the Pain Disability Index.
Results
Preliminary Pearson correlational analyses
demonstrated a positive relationship between
promotion focus and well-being (r = .42, p < .001) and a
15. Knee
2012|5
negative relationship with disability (r = -25, p < .001).
No significant associations were found for prevention.
Final results will be presented on the poster.
Promotion, but not prevention focus, was related with
higher levels of well-being and lower levels of disability.
Clinical message
Though preliminary, results indicate that chronic pain
patients might benefit from increasing promotion
focus as part of treatment.
H.P.J. Kindermans
[email protected]
joint stabilization therapy in patients with osteoarthritis of the knee: a randomized,
controlled trial
J. Knoop MSc1, prof. J. Dekker PhD1,2, M. van der Leeden PhD1,2, prof. W.F. Lems MD PhD1,2,
L.D. Roorda MD PT PhD1,*, prof. M.P.M. Steultjens PhD3
3
*
1
2
Reade, centre for rehabilitation and rheumatology, Amsterdam, the Netherlands
VUmc, Amsterdam, the Netherlands
Glasgow Caledonian University, Glasgow, UK
Presenting author
Objective
To evaluate the effectiveness of a newly developed
exercise program which initially focused on knee
joint stabilization, before starting with muscle
strengthening exercises and training of daily
activities in patients with knee osteoarthritis
(OA) and instability of the knee joint, compared to
muscle strengthening exercises and training of daily
activities only.
Methods
A single-blinded, randomized, controlled trial
involving 159 knee OA patients with instability of the
knee joint, who were randomly assigned over two
treatment groups. Both groups received a supervised
exercise program for 12 weeks, consisting of muscle
strengthening exercises and training of daily activities,
but only in the experimental group exercises initially
focused on knee joint stabilization. Outcome measures
included self-reported activity limitations (primary
outcome; WOMAC physical function), self-reported
pain severity (NRS) and knee instability.
277
Results
Both treatment groups demonstrated large, clinically
relevant, reductions (~30-40%) in activity limitations,
pain and knee instability, which were sustained at
38-weeks follow-up. No differences in effectiveness
between experimental and control treatment were
found on self-reported activity limitations (B (95% CI)
= -0.1 (-2.6 - 2.5)) or any other outcome measure,
except for a higher global perceived effect in the
experimental group (87% vs 73%, p=.04).
Conclusions
Both interventions were effective in reducing activity
limitations and pain and in restoring knee stability,
emphasizing the dominant role of muscle function
in knee stabilization. Against this background, initial
knee joint stabilization training, before starting
muscle strengthening exercises and training of daily
activities, did not show an additional effect in knee
OA patients with knee instability.
J. Knoop
[email protected]
Posters Thursday
16. Long-term
2012|5
functioning of caregivers of survivors of a cardiac arrest
V.R.M. Moulaert MD*
* Presenting: J. van het Wout-Hofland
Introduction
A cardiac arrest is a stressful event that does not
only affect the survivors, but also their caregivers.
However, little is known about the consequences for
the caregivers.
of posttraumatic stress and 40% experienced
severe fatigue. A high level of caregiver strain was
reported in 14% and 15% had a reduced quality of
life. Caregivers who had witnessed the resuscitation
experienced significantly more posttraumatic stress.
Objective
To determine the level of functioning of caregivers of
survivors of a cardiac arrest two years after the event.
Even two years after the cardiac arrest emotional
problems, posttraumatic stress and fatigue
were common in the caregivers. Caregivers who
witnessed the resuscitation reported a higher level
of posttraumatic stress. Seeing the resuscitation
apparently results in more emotional problems which
remain present for a long time.
Methods
A longitudinal cohort study including 57 caregivers
of cardiac arrest survivors. Participants received
a questionnaire at home two years after the event.
Outcome measures were emotional functioning
(anxiety/ depression) (HADS), posttraumatic stress
(Impact of Event Scale), caregiver strain (Caregiver
Strain Index) and quality of life (SF-36).
Results
Two years after the cardiac arrest 19% of the
caregivers scored high on anxiety and 11% had signs
of depression. Almost 30% scored high on symptoms
17. Feasibility
Clinical message
A cardiac arrest has a high impact on the caregivers
of the survivors. It is important to pay attention to the
well-being of the caregivers, even in the long term and
especially when caregivers witnessed the resuscitation.
V.R.M. Moulaert
[email protected]
of an early intervention service for survivors of a cardiac arrest: a process
evaluation
V.R.M. Moulaert MD
Introduction
Survivors of a cardiac arrest are at risk for hypoxic
brain injury, which can result in cognitive and emotional
problems. At this moment there is no regular follow-up
care for these kinds of problems. We designed an early
intervention service called ‘Stand still…, and move on’.
This intervention is provided by specialized nurses and
consists of 1) screening for cognitive and emotional
problems, 2) provision of information and support,
3) promotion of self-management strategies and
4) referral to further specialised care if indicated.
Objective
To assess the feasibility of the new intervention for
survivors of a cardiac arrest and their caregivers.
278
Methods
Registration forms, evaluation forms and semistructured interviews were used to collect data on
the performance of the intervention according to
protocol, patients’ adherence and opinion about the
intervention from the nurses (n=75), patients (n=58)
and caregivers (n=50).
Results
Most aspects of the intervention have been
performed according to protocol. However, the
start of the intervention was later than intended
(on average after 2½ months, instead of 1 month),
and self-management strategies were often not
addressed. The adherence of the participants was
Posters Thursday
sufficient. The intervention was positively evaluated
by nurses, patients and partners.
The early intervention service seems to be feasible
and acceptable according to nurses, patients
and caregivers. Next, the effectiveness of this
intervention needs to be determined.
18. Transfer
2012|5
Clinical message
The new early intervention service is a feasible and
promising programme for survivors of a cardiac
arrest and their caregivers.
V.R.M. Moulaert
[email protected]
of motor learning in (robotic) task-oriented arm-hand training after stroke
R. Lemmens MSc1,2, A. Timmermans PhD1,2, prof. R. Smeets MD PhD1,2,3, H. Seelen PhD1,2
Maastricht University, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht, the Netherlands
3
Maastricht University Medical Centre, Department of Rehabilitation Medicine, Maastricht, the Netherlands
1
2
Introduction
Impaired arm-hand performance after stroke
severely affects patients’ everyday life activities.
Technology-supported rehabilitation is a promising
tool for improving arm-hand performance in
stroke patients. Besides the task-specific learning
process, the ability to transfer acquired arm-hand
performance from trained skills to untrained skills
and situations is very important. The aim of this
study was to examine to what extent transfer of
arm-hand skilled performance occurred after taskoriented (technology-supported) training.
Methods
Twenty-two chronic stroke patients participated in
a single-blind, randomized controlled trial. The use
of technology (Haptic Master) during task-oriented
training (2x30min/day, 4 days/week, 8 weeks) was
the only difference between the intervention group
(HMG) and control group (CG). The Motor Activity
Log (MAL), consisting of an amount of use scale
(AOU) and quality of use scale (QOU), was used to
determine improvement on untrained tasks.
Results
Transfer of motor learning occurred in both groups.
The HMG improved on 29% (AOU) and 38% (QOU)
of the untrained tasks, reported by the MAL. The
CG improved on 29% (AOU) and 50% (QOU) of the
untrained tasks. The mean improvement in score for
279
untrained tasks was 67% (AOU) and 45% (QOU) for
the HMG and 62% (AOU) and 41% (QOU) for the CG.
No significant differences between groups were found.
Conclusions
Transfer of motor learning occurred in both groups.
This may be attributable to the task-oriented training
approach, applied in both groups.
Clinical Message
Task-oriented arm-hand training may enhance motor
learning in chronic stroke patients, thereby improving
their performance during everyday life activities.
R.J.M. Lemmens
[email protected]
Posters Friday
2012|5
Friday
11.45 – 12.10
19.
‘Nebula’: the concept of playful learning. A.A. van Kuijk
Page 282
20.
Tarsal coalitions in seven dancers: presentation, treatment and outcome.
A.E. van Loon-Felter
Page 282
21.
Process evaluation of the treatment program ‘Oncological spinal cord injury’:
Experiences and needs of patients and experts. L.H. van Orsouw
Page 283
22.
Goal Attainment Scaling in outpatient rehabilitation of mobility after stroke.
D.I. van Riet-Paap
Page 284
23.
Blended learning in residency training in PM&R: fashion or value? G.M. Rommers
Page 285
24.
Sexual functioning before and after multidisciplinary pain rehabilitation in patients
with chronic musculoskeletal pain. J.L. Swaan Page 285
25.
Measures and procedures utilized to determine the added value of microprocessorcontrolled prosthetic knee joints: a systematic review. P.J.R. Theeven
Page 286
26.
Learning curves of Southampton Hand Assessment Procedure tasks in novice
prosthetic users. E. Vasluian
Page 287
280
Posters Friday
2012|5
27.
The psychometric qualities of the PHODA-Youth for adolescents with chronic
musculoskeletal pain. J.A. Verbunt
Page 287
28.
The difference in physical functioning between relatively active and passive patients
with Chronic Fatigue Syndrome. D.C.W.M. Vos-Vromans
Page 288
29.
Cognitive and emotional problems in patients surgically treated for a cerebral meningioma.
S. van der Vossen
Page 289
30.
Adherence to wearing prescribed custom-made footwear in diabetic patients with a
history of plantar ulceration. R. Waaijman
Page 290
31.
Complications following traumatic spinal cord injury during the acute phase.
K.C.M. van Weert
Page 290
32.
School absence in adolescents with nonspecific chronic pain and/or fatigue.
T. Westendorp
Page 291
33.
Akathisia, a rare cause of psychomotor agitation in patients with traumatic brain injury:
a case report and review of the literature. J.E. Wielenga-Boiten
Page 292
281
Posters Friday
19. ‘Nebula’:
2012|5
the concept of playful learning
A. van Kuijk MD PhD1, E. Albers PT1, K. Peeters ST1, N. Kerkhof PT 1, L. van Gemert OT 1, L. de Koning1,
Bart van Goch2
Librazorggroep, Rehabilitation Center Blixembosch, Eindhoven, the Netherlands
Nyoyn B.V., Eindhoven, the Netherlands
1
2
Introduction
Play is an activity that is voluntary, intrinsically
motivated, and fundamentally exciting. Play
incorporates free will and choices. It can be
instrumented for learning. By inviting children into
activities in which physical activity is inherent to
play, training can be optimized.
Aim
Our goal was to create an interactive engaging
environment aimed at getting children involved.
By turning the environment into a playful tool, we
wanted to create an interesting and user-friendly
means of treatment.
Methods
Nyoyn designed an interactive wall that can be
fully integrated within its environment. The wall
combines interactive technology and softwarecontrolled content. By touching the wall the user’s
body will ignite LED lights and sound effects. A
multidisciplinary project team developed a variety
of games to invite children to playfully practice. Pilot
therapy sessions were performed to see if children
would spontaneously interact with the wall.
20. Tarsal
Results
We will present the process from creation to
implementation. The interactive wall did invite
children to be curious, interact, and explore on
basis of free will. Nebula has been successfully
implemented in speech and language therapy as
well as in therapy settings strengthening body
movements and motor skills.
Conclusion
Nebula invites children to touch, feel, and interact. It
has been used successfully in speech and language
therapy, as well as in therapy settings strengthening
body movement and motor skills, giving children
affected by these problems greater independence
and mobility at training sessions. Currently, feedback
parameters on the patients’ performance are
developed in order to study treatment progress and
effectiveness.
A. van Kuijk
[email protected]
coalitions in seven dancers: presentation, treatment and outcome
A.E. van Loon-Felter MD1,2, A.B.M. Rietveld MD1
1
Medical Centre for Dancers and Musicians, The Hague, the Netherlands
AIOS Rehabilitation at Sophia Revalidatie, The Hague, the Netherlands
2
Introduction
A tarsal coalition is a fusion between two or more
bones of the tarsus. The prevalence of tarsal
coalitions in the general population is estimated at
1-3%.
Clinical report
We describe seven dancers diagnosed with tarsal
coalitions between 2008 and 2011. The presenting
complaints were ankle pain, a sense of instability,
a painfree foot deformity, and specific dance
movement problems. Physical examination revealed
282
a stiff subtalar joint with the modified heel tip test.
Three patients with a calcaneo-navicular coalition
were treated successfully by operative coalition
resection. Four patients with a talo-calcaneal
coalition were treated conservatively with amongst
others an UCBL-orthosis for ADL. Three of these 4
dancers were able to continue their dancing career
with only minor limitations.
In these seven consecutive cases, tarsal coalitions in
dancers are described, but it is also useful information
Posters Friday
for the clinic of the general rehabilitation doctor.
In conclusion, six out of seven dancers with a tarsal
coalition were able to continue their dancing career.
Treatment depends on the type and extent of the
coalition: in calcaneo-navicular coalitions early
resection of the ‘bar’ is the treatment of choice.
In our opinion the only option for talo-calcaneal
coalitions in dancers is conservative treatment.
21. Process
evaluation of the treatment program
2012|5
Clinical message
The modified heel tip test confirms restricted
subtalar movement in tarsal coalitions. When tarsal
coalitions occur, it does not necessarily mean a
dancing career is over. Treatment depends on the
type and extent of the coalition.
A.E. van Loon-Felter
[email protected]
‘Oncological
spinal cord injury’:
Experiences
and needs of patients and experts
L.H. van Orsouw MPA
Reade, centre for rehabilitation and rheumatology, Amsterdam, the Netherlands
Introduction
In the Netherlands 2.5 to 6% of all cancer patients
develop a spinal cord injury (SCI) due to metastatic
cancer with a median survival of six months. Reade
provides an inpatient program of six weeks for
these patients to enable them to return home as
quickly as possible and optimize the quality of life
with their family. Purpose of this study is to explore
experiences and needs of patients and experts to
improve the inpatient treatment program.
insufficient knowlegde of experts was experienced
with specific physical oncological problems, (3)
experts experienced a lack of aftercare. Emotional
and existential themes: (1) Patients were satisfied
with psychological counselling, (2) experts
experienced difficulties talking about emotional
and existential themes, (3) patients were in need of
spiritual counselling and family counselling.
Logistical factors: (1) insufficient agreements were
experienced with suppliers of aids and care.
Methods
Process evaluation with semi-structured interviews
with patients and experts. Topics of interview:
Process and content of treatment; emotional and
existential themes; logistical factors. Data-analysis:
Interviews were transcribed, coded and analysed by
multiple researchers.
Conclusions
Adjustment of the treatment program should be
realized in order to provide a program that meets the
needs of the individual patient. Therefore a common
view on oncological rehabilitation has to be established
and experts should be trained to deal with the physical
and emotional aspects of the oncological SCI patients.
Results
6 patients and 11 experts were interviewed. Process
and content: (1) Patients and experts had different
expectations of the treatment program, (2)
L.H. van Orsouw
[email protected]
283
Posters Friday
22. Goal Attainment Scaling
2012|5
in outpatient rehabilitation of mobility after stroke
D.I. van Riet Paap MD1,2, J. Vloothuis MD1,3, C.A. van Bennekom MD PhD2, L. Heijnen MD PhD1,
A. Beelen PhD1,4
3
4
1
2
Merem Rehabilitation centre De Trappenberg, Huizen, the Netherlands
Heliomare Rehabilitation, Research and Development, Wijk aan Zee and Spaarne Hospital Hoofddorp, the Netherlands
Amsterdam Rehabilitation Research Center | Reade, Centre for Rehabilitation and Rheumatology, Amsterdam,
the Netherlands
Department of Rehabilitation, Academic Medical Center, University of Amsterdam, the Netherlands
Introduction
In stroke rehabilitation, improving mobility is an
important treatment goal which is usually evaluated
with walking tests. These capacity tests may not
capture improvements in more complex walking
activities (walking stairs/uneven surfaces/slopes).
Goal attainment scaling (GAS) may be an alternative
outcome measure.
Objective
To evaluate whether GAS can be used in
outpatient stroke rehabilitation and to compare its
responsiveness with standard measures used in
rehabilitation of mobility.
Patients
Two groups were included: 16 outpatient rehabilitation
post-acute stroke patients and 15 chronic stroke
patients with drop foot participating an efficacy study
of peroneal electrical stimulation treatment.
Methods
GAS of three individual goals was set and compared
with changes in the 6-min-walking-test (6MWT) and
the Rivermead Mobility Index (RMI, only in postacute patients). Patients were classified responders/
nonresponders based on the minimal detectable
change on these tests.
284
Results
Preliminary results in 11 post-acute stroke patients
showed that of 33 selected goals, 21 (7 subjects)
were achieved at the predicted level or higher. These
subjects also responded on standard measures. GAS
scores differed significantly between responders on
6MWT (n=3) and nonresponders (n=8; P=.03) and
between responders on RMI (n=6) and nonresponders
(n=5; P<0.001).
Of 44 selected goals set by 15 participants of the
efficacy study, 20 were achieved (11 subjects). All
patients were non-responders on 6MWT. Most goals
represented walking stairs or uneven/sloping ground.
This preliminary study suggests that GAS is
a responsive and useful outcome measure for
evaluating mobility, specifically more complex
walking activities.
Clinical message
GAS may be a valuable asset to standard measures
for evaluation of treatment goals for community
ambulation in stroke patients.
D.I. van Riet-Paap
[email protected]
Posters Friday
23. Blended
learning in
Residency Training
in
PM&R:
2012|5
fashion or value?
G.M. Rommers MD PhD1, M. Tepper MD1, R. Dahmen MD2, prof. J. Cohen-Schotanus MSc PhD3,
prof. K. Postema MD PhD1
Department of Rehabilitation Medicine, University Medical Center Groningen, the Netherlands
Amsterdam Rehabilitation Reseach Center | Reade, Amsterdam, the Netherlands
3
Institute for Medical Education, Faculty of Medical Sciences, University of Groningen, the Netherlands
1
2
Introduction
Blended learning offers new possibilities for
additional education before entering formal courses
in the national training scheme for residents in
PM&R. During the Orthotic Shoe Prescription course
blended learning is introduced.
Objective
Blended learning for registrars give better pre and post
test course results than normal course enrolment.
Subjects
All participating 2-4th year residents are enrolled in
the study.
Methods
All 80 registrars are given access to an e-learning
environment 4 weeks before the start of the course.
Group A has access to standard material and an
e-learning module containing extra information about
anatomy, kinematics and shoe prescription. Group
B has access to the same standard study material:
reader and study book only.
Test procedure with MC questions: test 1 (anatomy
and kinematics only): 1 week before course; test 2
(about general knowledge): start of course, test 3
(about general knowledge): 1 week after course.
24. Sexual
Results
(scale 0-10)
Test 1
N
Avg score
Sd
Range
Group A
26
5,4
0,14
3-9
Group B
28
5,6
0,15
4-8
Group A
38
3,8
0,21
0-8
Group B
39
3,4
0,19
0-7
Group A
28
5,4
0,14
3-8
Group B
20
5,3
0,12
3-8
Test 2
Test 3
Blended learning offers possibilities for extra
in-depth education before start of the course.
However, this study shows no group differences.
Although all participants had access to the e-learning
environment almost one third of the residents
did not enter. Furthermore, testing shows limited
improvement of knowledge of the course content.
G.M. Rommers
[email protected]
functioning before and after multidisciplinary pain rehabilitation in patients with
chronic musculoskeletal pain
J.L. Swaan MD
Rijndam Rehabilitation Center, Rotterdam, the Netherlands
Introduction
There is a high prevalence of sexual difficulties in
patients with chronic pain. The few scientific studies
on this topic showed an effect on libido, orgasm, pain
at coitus and erectile function. From previous studies
we know that patients consider sexual difficulties an
important issue.
285
Objective
To examine the prevalence of sexual difficulties and
the correlation between reported pain intensity,
fatigue and emotionality. To examine the effects
of multidisciplinary pain rehabilitation on sexual
functioning in relation to pain intensity, fatigue and
emotionality.
Posters Friday
positive correlation between sexual functioning ,
experienced level of pain disability (PDI) and average
pain intensity. Sexual functioning, pain intensity, and
fatigue improved significantly after treatment.
Patients
769 patients with chronic musculoskeletal pain
referred to a rehabilitation physician.
Methods
For those patients who participated in
multidisciplinary pain rehabilitation we compared
pre- and post treatment measurements. Sexual
difficulties were assessed with the Pain Disability
Index (PDI). Correlations between sexual functioning,
scores on the PDI in total, the RAND-36 and a Dutch
pain questionnaire were examined.
Results
Patients referred to a rehabilitation physician (N=769)
reported a high level of sexual dysfunction. Patients
who completed questionnaires at pre and post
treatment (N=60) there was a statistically significant
25. Measures
2012|5
Without sexual functioning being a specific treatment
goal, it improves after multidisciplinary pain
rehabilitation. With pain reduction and improvement
of physical functioning, sexual functioning seems to
improve as well.
Clinical message
Focus on the usual goals in pain rehabilitation and pay
specific attention to sexual difficulties when necessary.
J.L. Swaan
[email protected]
and procedures utilized to determine the added value of microprocessor-
controlled prosthetic knee joints: a systematic review
P.J.R. Theeven MSc1,2, B. Hemmen MD PhD1, prof. P.R.G. Brink MD PhD3, H.A.M. Seelen PhD1,2,
prof. R.J.E.M. Smeets MD PhD1,2
Adelante, Centre of Expertise in Rehabilitation and Audiology, the Netherlands
Maastricht University, research school CAPHRI, dept. of Rehabilitation Medicine, the Netherlands
3
Maastricht University Medical Centre+, dept. of Traumatology, the Netherlands
1
2
Objective
Investigating how the effects of using a
microprocessor-controlled prosthetic knee joint
(MPK), in comparison with a mechanically controlled
prosthetic knee joint, have been determined thus far.
Methods
A systematic literature search was performed in 6
databases, i.e. PubMed, CINAHL, Cochrane Library,
Embase, Medline and PsychInfo. The search strategy
used was ‘prosthe* AND knee AND (amput* OR
disarticulation) AND (microprocessor OR active OR
electronic* OR magnetorheologic* OR intelligent OR
variable-damping OR computerized)’.
Selection of articles
Papers identified were independently screened by two
researchers. Papers were included when they focused
on persons with a transfemoral amputation or knee
disarticulation, and when persons’ performance using
a mechanically controlled knee joint was contrasted
to persons’ performance using an MPK.
286
Evaluation of articles and results
Outcome measures that have been utilized in the
studies identified were extracted and categorized
according to the ICF framework. Also, a descriptive
analysis regarding all studies was performed. 31
studies and 64 outcome measures were identified.
The majority (70%) of the outcome measures
that described the effects of an MPK on persons’
actual performance with the prosthesis covered ICF
function level. Only 27% of the measures on persons’
actual performance investigated how an MPK may
affect performance in daily life. Research also
predominantly focused on young and active persons.
Conclusion
Scientifically valid evidence regarding the performance
of persons with an MPK in everyday life is limited.
Research should specifically focus on ICF activity and
participation level to increase our understanding of the
possible functional added value of MPKs.
P.J.R. Theeven
[email protected]
Posters Friday
2012|5
26. Learning curves of Southampton Hand Assessment Procedure tasks in novice prosthetic users
E. Vasluian MSc1, R.M. Bongers MSc PhD2, H.A. Reinders-Messelink MSc PhD1, P.U. Dijkstra PhD1,
J.G.M. Burgerhof MSc3, prof. C.K. van der Sluis MD PhD1
2
3
1
the Netherlands
Center of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen,
the Netherlands
Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Introduction
Southampton Hand Assessment Procedure (SHAP) is
a standardized procedure to assess the functionality
of normal, injured or prosthetic hands. Improvements
in functionality assessed with SHAP can not be
distinguished from testing effects (learning).
Objective
To evaluate learning curves of the SHAP tasks in
novice prosthetic users.
Methods
In a longitudinal study, 24 healthy participants
(mean age 21.8, 45.8% men) completed eight
measurement sessions during five consecutive days
using a myoelectric prosthetic simulator. Participants
performed one measurement session on the first and
fifth day, and two sessions on the days in between.
Data were analyzed using a multilevel analysis.
Results
Participants differed in the time needed to execute
the first attempt and the time gained in consecutive
27. The psychometric
musculoskeletal pain
qualities of the
PHODA-Youth
attempts. Difficult tasks varied and required longer
time. Female or participants who performed with the
left hand needed on average more time to perform
the tasks, but no difference in learning curves was
seen between male and female participants. Every
new day participants were slower in the first session.
SHAP tasks, hand, gender, sessions, interaction of the
tasks and sessions, and a ‘new day effect’ contributed
significantly (P<0.01) to the prediction of learning
curves. A clear learning effect occurred in all tasks.
The study showed a strong learning effect of SHAP
in novice prosthetic users, which has to be taken into
account when conducting a reliability study.
Clinical message
SHAP scores in prosthetic hands, acquired in one
session, should be interpreted with caution. They
may be distorted by the learning effect of the SHAP.
E. Vasluian
[email protected]
for adolescents with chronic
J.A. Verbunt MD PhD1,3,4, M. Goossens PhD1,2, A. Nijhuis MSc3, M. Vikstroem MSc2
3
4
1
2
Department of Clinical Psychological Science, EPP, Maastricht University, the Netherlands
Introduction
Behavioral models of chronic musculoskeletal pain
(CMP) predict that dysfuctional assumptions about
the harmfulness of activities may maintain painrelated fear and disability. To assess perceived
harmfulness in adolescents the PHODA (Photographs
Series of Daily Activities)-Youth has been developed.
287
The concept version of the PHODA-youth consisted
of 89 photographs of activities and situations with
subcategories: daily activities, domestic activities,
transport, school/work, sports and leisure time.
Adolescents had to indicate to what extent they
perceive these daily activities to be harmful for them.
Posters Friday
Objective
The aim of this study is to investigate psychometric
properties (internal consistency, test-retest
reliability, construct validity) of the PHODA-Youth in
adolescents with CMP.
Methods
Adolescents with CMP, between 13 and 21, who
appointed a consultant in rehabilitation, were asked
to fill in an electronic version of the PHODA-youth
twice: at entry and four weeks later. In addition
adolescents completed a questionnaire including
criterion variables (catastrophizing, pain intensity,
depression and functioning).
Results
61 adolescents (mean 19 years, 92% female)
participated.
Factor structure analyses revealed three factors:
activities of daily living and household (14 items),
28. The difference in physical
Chronic Fatigue Syndrome
2012|5
intensive physical activities (27 items) and social
activities (11 items).
The Pearson correlation between both PHODA-Y
measurements was .90 (p <.0001).
Regression analysis indicated that PHODA-Y-scores
were significantly associated with the level of
disability and pain catastrophizing.
The PHODA-y consists of 3 factors and its
psychometric properties are adequate
Clinical message
De PHODA-y can be applied in clinical practice to
assess perceived harmfulness in adolescents with
CMP.
J.A. Verbunt
[email protected]
functioning between relatively active and passive patients with
D.C.W.M. Vos-Vromans PT MSc1, I.P.J. Huijnen PT PhD2, A.J.A. Köke, PT PhD3, H.A.M. Seelen PhD2,3,
prof. J.A. Knottnerus MD PhD4, prof. R.J.E.M. Smeets MD PhD2,3
3
4
1
2
Revant, Rehabilitation Centre Breda, the Netherlands
Department of Rehabilitation Medicine, Research School CAPHRI Maastricht University Medical Centre, the Netherlands
Department of General Practice, Research School CAPHRI Maastricht University Medical Centre, the Netherlands
Introduction
Cognitive behavioural therapy (CBT) for patients with
Chronic Fatigue Syndrome (CFS) is often different for
relatively active and passive patients. Evidence to
support the differences between these subgroups is
limited.
Objective
The aim of this study was to evaluate the differences
in actual and perceived physical functioning between
relatively active and passive patients with CFS.
Patients
60 patients with CFS were included.
Methods
This study was part of a multicentre randomized
controlled trial (FatiGo) in which the effectiveness of
two treatment approaches, were compared. Patients
were categorized as relatively active or passive by
their CBT therapist. Physical activity, daily uptime,
288
activity fluctuations, and duration of rest during
daily life, were estimated based on a daily life activity
assessment by an activity monitor. Perceived physical
activity was assessed by using questionnaires.
Results
There were no significant differences in physical activity,
duration of rest and fluctuations in activities during the
day between the subgroups. Relatively active patients
had a significantly higher daily uptime and showed a
significantly lower fluctuation in activities between days.
In addition, passive patients felt more disabled and their
perceived physical functioning level was significantly
lower compared to relatively active patients.
Relatively active and passive patients with CFS
are different regarding their physical functioning,
although significant differences were not found in all
outcomes of the activity monitor.
Posters Friday
Clinical message
In practice the use of both questionnaires and an
activity monitor is warranted to get insight in the
potential difference between actual and perceived
29. Cognitive
2012|5
physical functioning. This information may be helpful
to tailor the treatment of patients with CFS.
D.C.W.M. Vos-Vromans
[email protected]
and emotional problems in patients surgically treated for a cerebral meningioma
S. van der Vossen MD, V.P.M. Schepers MD PhD, J.W. Berkelbach van der Sprenckel MD PhD,
J.M.A. Visser-Meily MD PhD, M.W.M. Post PhD
Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center
Utrecht, the Netherlands and Rehabilitation Center De Hoogstraat, Utrecht, the Netherlands
Introduction
Little is known about possible cognitive and
emotional problems in patients who have been
surgically treated for a cerebral meningioma.
Objective
To determine cognitive complaints and symptoms
of depression or anxiety in patients operated on
a cerebral meningioma, and to establish possible
determinants.
Patients
Patients operated on a cerebral meningioma in the
University Medical Centre Utrecht between 20072009 (n=179).
Methods
Clinical data were retrieved from medical files.
Patients completed a mailed questionnaire. Cognitive
complaints were measured with the Cognitive
Failures Questionnaire (CFQ). Using population
figures, a score above 43.5 was defined as presence
of cognitive complaints. Anxiety and depressive
symptoms were measured with the Hospital Anxiety
and Depression Scale (HADS), and considered
present if the scale score was ≥8.
289
Results
Response rate was 76%. Mean time after operation
was 32.6 months (SD 10.6). 31 patients (23%) showed
cognitive complaints. Country of birth, presence
of depression/burn-out in the medical history and
destination after discharge were related to cognitive
complaints. 39 patients (29%) showed anxiety and
31 patients (23%) showed depressive symptoms.
Presence of depression/burn-out in medical history was
the most important determinant for both subscores.
Scores on CFQ and HADS were strongly related.
Presence of cognitive complaints is only mildly
elevated compared to general population. However,
depressive symptoms are more common. Cognitive
complaints and emotional disturbances strongly
influenced each other.
Clinical message
Assessment of cognitive and emotional problems
is important after surgical treatment for cerebral
meningioma. In case of these problems, individualized
rehabilitative treatment should be initiated.
S. van der Vossen
[email protected]
Posters Friday
30. Adherence
2012|5
to wearing prescribed custom-made footwear in diabetic patients with a history
of plantar ulceration
R. Waaijman MSc1, R. Keukenkamp MSc1, M. de Haart MD PhD1, W.P. Polomski MD2,
prof. F. Nollet MD PhD1, S.A. Bus PhD1,3
Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Department of Rehabilitation, Spaarne Hospital, location Hoofddorp, the Netherlands
3
Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
1
2
Introduction
Prescribed orthopaedic footwear for patient with
diabetes can only be effective in preventing (recurrence
of) foot ulceration when the footwear is worn. Objective
data on footwear adherence is non-existing.
Objective
To objectively assess adherence and to assess
determinants of (non-)adherence.
Patients
107 diabetic patients with peripheral neuropathy,
a history of plantar foot ulceration, and prescribed
orthopaedic footwear.
Methods
Adherence was measured during 7 consecutive days
using a temperature-based monitor worn in the shoe
(lateral shoe border) and a step activity monitor worn
around the ankle. Time away from home was reported
in a diary. Determinants of (non-)adherence were
evaluated in multivariate linear regression analysis.
Results
Footwear adherence was 71% ± 25% (mean ± SD)
31. Complications
overall. At home, footwear adherence was 61 ± 32%.
Away from home, adherence was 87 ± 26%. In
around one third of the patients, adherence was
<60%, with adherence at home being 27% ± 24%. A
lower BMI, more severe foot deformity present, more
variability in step activity over 7 days, and higher
perceived footwear aesthetics were significantly
positively associated with adherence.
Discussion
Adherence is much lower at home than away from
home, particularly in the low-adherence group.
Together with the determinants of (non-)adherence,
this gives clear directions, based on objective data,
for improvement of adherence in these high-risk
patients.
Clinical Message
Many patients show low adherence to prescribed
orthopaedic footwear at home. Patient education and
the provision of special footwear for use at home may
increase adherence and help to prevent foot ulceration.
R. Waaijman
[email protected]
following traumatic spinal cord injury during the acute phase
K.C.M. van Weert MD1,2, E.J. Schouten MD1, J. Hofstede MD2, H.J.G. van den Berg-Emons PhD1,2,3
Libra Zorggroep Rehabilitation Center Leijpark, Tilburg, the Netherlands
Libra Zorggroep Rehabilitation Center Blixembosch, Eindhoven, the Netherlands
3
Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, Rotterdam, the Netherlands
1
2
Introduction
Despite improved acute care management and
greater awareness and recognition of medical
complications after traumatic spinal cord injury (SCI),
many complications still occur in the acute phase. In
order to improve treatment with regard to prevention
of these complications, knowledge on the occurrence
of complications in the acute phase is a prerequisite.
290
Objective
To comprehensively assess the occurrence of medical
complications following traumatic SCI during the
acute phase. In addition, we explored the relationship
with length of hospital stay.
Patients
52 Patients with a new traumatic SCI, treated by a
medical rehabilitation physician.
Posters Friday
Methods
Prospective study from September 2009 to
December 2011 in 3 Dutch trauma hospitals. We
registered the occurrence of medical complications
from the first day after trauma till discharge from the
hospital and length of hospital stay.
Results
30 Patients (57.7%) suffered ≥ 1 medical complication.
Most common were pressure ulcers (32.7%) and
pulmonary complications (28.8%). Patients with 3
or 4 complications had a significantly (p<0.01) longer
hospital stay (59±32 days) than patients with 1 or 2
(33±15 days) or no complications (21±15 days).
32. School
2012|5
Medical complications, and particularly pressure
ulcers and pulmonary complications, still frequently
occur in the acute phase after traumatic SCI. More
complications are associated with longer hospital stay.
Clinical message
Awareness of medical complications and preventive
measures are important in the acute phase after SCI.
K.C.M. van Weert
[email protected]
absence in adolescents with nonspecific chronic pain and/or fatigue
T. Westendorp MSc1,2, J.A. Verbunt MD PhD2,3,4, S.C. Remerie MD PhD1, M. de Craen MSc5,
Prof. R.J.E.M. Smeets MD PhD2,3,4
3
4
5
1
2
Rijndam Rehabilitation Center, Rotterdam, the Netherlands
Trappenberg Rehabilitation Center, Huizen, the Netherlands
Aim
School absenteeism is an urgent matter in adolescents
with chronic pain and/or fatigue. High absence of
school may lead to delay in educational development,
physical inactivity and social deprivation. This leads to
high social economic costs and healthcare use. The aim
of the present study is to study factors associated with
the level of school absence within the context of the ICF
model in adolescents with chronic pain and/or fatigue.
Methods
Data collection was performed in a population of
adolescents with nonspecific pain and/or fatigue
referred for treatment in five rehabilitation centers
in the Netherlands during the period between 2001
and 2005. Factors related to school absenteeism
at baseline were studied with a univariate logistic
regression analysis. School absence, divided into two
categories (normal attendance and absenteeism),
was used as dependent variable. Pain/fatigue
291
intensity, duration of complaint, pain/fatigue history
of family members, anxiety, coping style, life event,
paternal work level and marital state of the parents
were introduced as independent variables. Gender
and age were demographic variables in the model.
Results
172 adolescents (85.5% girls, mean age: 16.2 years)
with nonspecific chronic pain or fatigue participated.
Age and pain/fatigue history within family have a
significant association with school absence (odds
ratio=1.321 and 3.348; p<0.05).
Conclusion
To prevent school absence under adolescents with
chronic pain and/or fatigue age and family pain/
fatigue history should be taken into account.
T. Westendorp
[email protected]
Posters Friday
33. Akathisia,
2012|5
a rare cause of psychomotor agitation in patients with traumatic brain injury :
a case report and review of the literature.
J.E. Wielenga-Boiten MD1, G.M. Ribbers MD PhD1,2
Rijndam Rehabilitation Center and Department of Rehabilitation Medicine and Physical Therapy Erasmus MC,
the Netherlands
2
1
Introduction
We present a case description of akathisia after
traumatic brain injury (TBI) that is not related
to the use of neuroleptics, review earlier case
studies, and discuss the differential diagnosis, its
pathophysiology, treatment and prognosis.
Clinical report
Our patient is a 34-year-old woman with moderate
TBI in whom akathisia developed independent of
the use of neuroleptics. She was first mistakenly
diagnosed as having a delirium and treated as
such. After re-evaluation, the diagnosis delirium
was replaced for akathisia and the symptoms
disappeared completely within 24 hours with the
alpha 2-adrenergic agonist clonidine twice a day
0.025 mg. Only one earlier study has described
post-TBI akathisia unrelated to the use of
neuroleptics. In this case the symptoms resolved
after treatment with bromocriptine. It is less known
that besides antipsychotics, also antiemetics,
antidepressants, and calcium channel blockers
may cause akathisia. Not one hypotheses on its
pathophysiology is completely satisfactory and there
is no evidence based treatment guideline. Several
types of medications have been described such
as beta-adrenergic blockers, dopamine agonists,
benzodiazepines and anticholinergic agents.
Akathisia may cause psychomotor agitation after TBI
and may be misinterpreted as a delirium. Medications
292
that may cause or exacerbate akathisia should be
discontinued. TBI patients preferably should not be
given sedatives. Clonidine and bromocriptine may
serve as medication of first choice.
Clinical message
Not every agitated TBI patient is delirious. Akathisia
should be considered as underlying cause of
psychomotor agitation after TBI. Clonidine and
bromocriptine may serve as medications of first
choice.
Figure 1. Mean values for agitation and workload.
Day 1 = patient’s first day in the rehabilitation center
This figure is a translated and adapted version of
the agitated behavior scale2 including workload
measurement for the nursing. staff.
J.E. Wielenga-Boiten
[email protected]

2012 | 05 - Nederlandse Vereniging van Revalidatieartsen

Transcription

Similar documents

this brochure - Red Bank Veterinary Hospital

Minutes seminar Netherlands Dec 2nd 2010

FERNANDEZ STOHANZL PORTFOLIO 2014.indd

Opera Graphic Design Tempo

grand rapids, mi • van andel arena • sunday, october 16, 2016 • 6:00

Apeldoorn 2007 Report - British Council | Netherlands

Connected

Bending Brakes FAQ - Van Mark Products

Oorsprong, verleden en toekomst van onze huisdieren

wozoco - Mimoa

Examen HAVO Engels (nieuwe stijl en oude stijl)

rehabilitation medicine