achtergrond en onderzoek - Vita

ACHTERGROND EN ONDERZOEK
1 ste editie
| januari 2013
Tanja Ivanovski
edema / oncology physiotherapist
Plezier tijdens oefenen motiveert!
Augmented reality in de oefenzaal?
Volgens de KNGF richtlijn beroerte heeft oefentherapie
als doel het verbeteren van de zitbalans het reiken in zit,
het gaan staan en het kunnen blijven staan een evidentie
op het eerste niveau.
Meerdere malen per dag oefenen wordt geadviseerd.
Het is daarbij van belang om gebruik te kunnen maken
van robottechnologie, exergaming, balanstraining en/of
virtual reality vanwege de noodzakelijke kostenbesparing
in de zorg.
ACHTERGROND EN ONDERZOEK
1 ste editie
| januari 2013
SAMENVATTING
INHOUD
SAMENVATTING
INTRODUCTIE
3
5
1
SERIOUS EXERGAMING
2
HIPPOTHERAPIE
3
FYSIOTHERAPIE & NEURO REVALIDATIE
4
PROPRIOCEPTION
5
SPIEGELNEURONEN
6
MUZIEKTHERAPIE & PSYCHIATRIE
7
FELDENKRAIS & PILATES
8
WHOLE BODY VIBRATION
9
SNOEZELEN
10
E-HEALTH
17
21
29
33
35
37
39
45
47
INDEX MEDISCHE PUBLICATIES
2
9
49
EPILOOG
52
COLOFON
53
inhoud
Therapeutic Motion Simulation (TMS) is een moderne tool voor fysiotherapeuten. TMS is inzetbaar voor neuro revalidatie en het verbeteren van de
kwaliteit van leven van chronisch zieken met ernstige bewegingsstoornissen
zonder dat het saai wordt voor de patiënt. TMS focust op zelfmanagement
van de gebruikers.
De TMS (robot)technologie is veelomvattend omdat het geïnspireerd is
door een aantal bestaande behandelmethoden en -technieken zoals:
•
•
•
•
•
•
•
serious (exer)gaming
fysiotherapie en andere oefenmethoden
hippotherapie
muziektherapie
whole body vibration
snoezelen
e-health
De multidisciplinaire aanpak waarbij uitsluitend gebruik wordt gemaakt
van gevalideerde elementen uit bestaande behandelmethoden is uniek
en kan alleen gerealiseerd worden dankzij de TMS mechatronica die
geavanceerde audio-visuele technologie combineert met low cost robotics
en e-health.
In dit stuk wordt nader ingegaan op het ontstaan van TMS en de daarop­
volgende ontwikkeling. Tevens wordt een aantal gevalideerde methoden
waar TMS gebruik van maakt nader toegelicht.
TMS online wil de kwaliteit van leven en dus de zelfredzaamheid van de
patiënten optimaal stimuleren en streeft er naar om deze technologie ook
bij patiënten thuis te kunnen aanbieden.
samenvatting
3
INTRODUCTIE
Ko Blaas - partiële dwarsleasie
‘Ik voel nu spieren waarvan ik
het bestaan niet meer kende’
Door TMS:
• Betere houding en core stability ▪
• Lopen met rolator verbetert ▪
• Transfers verbetert
• Wervelkolom is soepeler ▪
• Kan zelfstandig uit bed en de deur openen ▪
• Slaapt beter ▪
• Zelf management toegenomen
4
testimonial
Therapeutic Motion Simulation™.
De naam zegt het al; bij TMS gaat het om bewegingssimulatie door middel
van robotfysio, die in een multisensorische - virtuele - omgeving wordt
geplaatst om het realistisch te maken. In eerste instantie was het de
bedoeling om een simulatie paard te bouwen teneinde Hippotherapie
veiliger, goedkoper en dus toegankelijker te maken voor Ernstig Meervoudig
Gehandicapten. Die opzet is geslaagd. De kwaliteit van de bewegingen van
het Vita paard staat buiten kijf volgens ervaren ruiters en ook zonder de
“smell and touch” van het echte paard wordt het Vita paard geassocieerd
met paardrijden. De ritmische beweging van het bekken van de ruiter heeft
net als op een echt paard een ontspannend effect op spasticiteit. Tevens
wordt net als op een echt paard de balans proprioceptief gestimuleerd
wat de sensomotoriek ten goede komt zoals blijkt uit onderzoeken naar
Hippotherapie.
Tijdens een proefperiode bij Stichting Philadelphia te Vierhouten bleek
dat de doelgroep niet alleen goed reageerde op het Vita paard, maar ook
op het Vita rolstoel podium en het Vita loungbed voor liggende patiënten.
Er traden geen contra-indicaties op. Philadelphia schafte de proef­opstelling
aan en bestelde extra platforms voor een andere locatie. In totaal zijn ultimo
2012 >35 systemen in gebruik en blijkt dat TMS veilig en storingsvrij werkt.
De volgende uitdaging die Vita op zich nam was om andere bewegings­
bronnen dan paardrijden te bedenken waarbij men zowel ritmische als
aritmische bewegingen zou kunnen gebruiken, die tenminste dezelfde
effecten als het paardrijden zouden opleveren en bij voorkeur deze effecten
zouden overtreffen.
In deze opzet werd gebruik gemaakt van het gegeven dat de moderne
fysiotherapie evidence based is, dat wil zeggen dat de therapeut protocollen
gebruikt die wetenschappelijk zijn getoetst in clinical trials. Vita ontwikkelt
dus op basis van gevalideerde oefeningen bewegings­choreografieën voor
de beweegplatforms die synchroon aan beeld en geluid deze bewegingen
overbrengen op patiënten die deze bewegingen niet of met moeite zelf­
standig kunnen uitvoeren. Ook deze opzet blijkt aan te slaan. Niet alleen
bij EMG’ers, maar ook bij NAH patiënten zoals bleek in een proef in een
1ste lijn fysiopraktijk.
introductie
5
De redenen dat met TMS dikwijls snel resultaten worden geboekt en
dat patiënten het als prettig ervaren zijn door Vita onderzocht. Uit een
literatuuronderzoek blijkt dat TMS een aantal belangrijke gevalideerde
inzichten en kennis toepast op neurologisch gebied die effect hebben op de
functies, activiteiten en participatie van patiënten. TMS ontleent inspiratie
aan en gebruikt feitelijk elementen uit de onderstaande wetenschappelijke
inzichten en respectievelijke behandelmethoden:
6
Therapeutic Motion Simulation is uniek en wordt gekenmerkt door:
• Serious gaming
•Hippotherapie
• Fysiotherapie & neuro revalidatie
•Propriocepsis
•Spiegelneuronen
•Psychiatrie/psychologie
•Muziektherapie
• Whole Body Vibration
• Feldenkrais & Pilates
•Snoezelen
•E-health
• Beweging te bieden aan mensen die (gedeeltelijk) niet meer kunnen of willen bewegen en zo hun kwaliteit van leven te verbeteren
• De toepassing van lowcost en eenvoudig te bedienen robotfysio
• De synchronisatie van de robot met virtual reality
• Het gebruik van “echte videobeelden” en geen animaties waardoor men zich identificeert met de virtual reality
• De mogelijkheid om persoonlijke beweegprogramma’s samen te stellen
• De combinatie van enerzijds mentale en fysieke ontspanning te bieden en anderzijds fysieke stimulatie op te roepen
• De therapietrouwheid te stimuleren door oefenen (weer) leuk te maken
• Er eindeloos veel mogelijkheden zijn om het oefenen ook leuk te
houden door het aanbieden van nieuwe content
• De kwaliteit van leven door de patient dagelijks te laten bijhouden met behulp van een app en die informatie te linken aan de oefeningen die zijn gedaan
• De mogelijkheid om de huidige lage kostprijs van 5,- per ½ uur te
reduceren.
Door de intensiteit en combinatie van deze elementen te variëren kunnen
beweegprogramma’s worden samengesteld voor bepaalde neurologische
aandoeningen zoals CVA, dwarslaesie, Parkinson, MS, MD, Cerebrale Parese,
autisme, postpolio en dementie.
De betekenis van de voornoemde disciplines voor Therapeutic Motion
Simulation worden hierna toegelicht aan de hand van medische publicaties
op grond waarvan de behaalde resultaten met Therapeutic Motion
Simulation verklaard kunnen worden.
Afhankelijk van de aandoening zal het accent meer op ontspanning of
op stimulatie liggen. Het verdient aanbeveling een fysio- of ergotherapeut
de juiste programmering voor een patiënt te laten bepalen.
Bij het bepalen van de beweegprogramma’s moet ook de uitgangshouding
van de patiënt worden betrokken, omdat er beweegplatforms zijn voor
staande, zittende en liggende patiënten en bij een intake ook de mBBS
of BBS kan worden bepaald.
In het hoofdstuk over fysiotherapie en neuro revalidatie wordt ingegaan
op het gebruik van tools door fysiotherapeuten en KNGF richtlijnen voor
beroerte en Parkinson. Verder wordt de werkwijze van TMS met betrekking
tot zelfmanagement en het meten van de kwaliteit van leven van de
patiënten uiteengezet.
introductie
introductie
7
1
SERIOUS EXERGAMING
Lamoth CJ, Alingh R, Caljouw SR.
Exergaming for elderly: effects of different types of game
feedback on performance of a balance task.
1. Stud Health Technol Inform. 2012;181:103-7.
University Medical Centre Groningen, University of Groningen,
the Netherlands. [email protected]
Esmée – probleemgedrag
‘Esmée is nu opener en
spontaner, alleen maar positief’
Door TMS:
• Stemming beter
• Opener en spontaner
• Loopt rechter op, betere houding
• Betere ademhaling
• Alleen maar positief volgens moeder en oma
8
testimonial
Balance training to improve postural control in elderly can contribute to
the prevention of falls. Video games that require body movements have the
potential to improve balance. However, research about the effects of type
of visual feedback (i.e. the exergame) on the quality of movement and
experienced workout intensity is scarce. In this study twelve healthy older and
younger subjects performed anterior-posterior or mediolateral oscillations on
a wobble board, in three conditions: no feedback, real-time visual feedback,
and real-time visual feedback with a competitive game element. The Elderly
moved slower, less accurately and more irregularly than younger people. Both
feedback conditions ensured a more controlled movement technique on the
wobble-board and increased experienced workout intensity. The participants
enjoyed the attention demanding competitive game element, but this game
did not improve balance performance more than interacting with a game that
incorporated visual feedback. These results show the potential of exergames
with visual feedback to enhance postural control.
PMID: 22954837 [PubMed - indexed for MEDLINE]
serious exergaming
9
10
Sveistrup; licensee BioMed Central Ltd.
Motor rehabilitation using virtual reality
Journal of NeuroEngineering and Rehabilitation 2004, 1:10
Maureen K. Holden, Ph.D.
Virtual Environments for Motor Rehabilitation: Review
Cyberpsychology & Behavior, volume 8, number 3, 2005
ABSTRACT
ABSTRACT
Virtual Reality (VR) provides a unique medium suited to the achievement
of several requirements for effective rehabilitation intervention. Specifically,
therapy can be provided within a functional, purposeful and motivating
context. Many VR applications present opportunities for individuals to
participate in experiences, which are engaging and rewarding. In addition to
the value of the rehabilitation experience for the user, both therapists and
users benefit from the ability to readily grade and document the therapeutic
intervention using various systems. In VR, advanced technologies are used
to produce simulated, interactive and multi-dimensional environments.
Visual interfaces including desktop monitors and head-mounted displays
(HMDs), haptic interfaces, and real-time motion tracking devices are used
to create environments allowing users to interact with images and virtual
objects in real-time through multiple sensory modalities. Opportunities for
object manipulation and body movement through virtual space provide
frameworks that, in varying degrees, are perceived as comparable to similar
opportunities in the real world. This paper reviews current work on motor
rehabilitation using virtual environments and virtual reality and where
possible, compares outcomes with those achieved in real-world applications.
In this paper, the current “state of the art” for virtual reality (VR) applications
in the field of motor rehabilitation is reviewed. The paper begins with a
brief overview of available equipment options.
Next, a discussion of the scientific rationale for use of VR in motor rehabili­
tation is provided. Finally, the major portion of the paper describes the
various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered
include stroke rehabilitation (upper and lower extremity training, spatial
and perceptual-motor training), acquired brain injury, Parkinson’s disease,
orthopedic rehabilitation, balance training, wheelchair mobility and
functional activities of daily living training, and the newly developing field
of tele rehabilitation. Four major findings emerge from these studies:
(1) people with disabilities appear capable of motor learning within virtual
environments; (2) movements learned by people with disabilities in VR
transfer to real world equivalent motor tasks in most cases, and in some
cases even generalize to other untrained tasks; (3) in the few studies (n= 5)
that have compared motor learning in real versus virtual environments,
some advantage for VR training has been found in all cases; and (4) no
occurrences of cyber sickness in impaired populations have been reported
to date in experiments where VR has been used to train motor abilities.
serious exergaming
serious exergaming
11
12
Anat Mirelman, PT, PhD; Paolo Bonato, PhD; Judith E. Deutsch, PT, PhD
Effects of Training With a Robot-Virtual Reality System Compared
With a Robot Alone on the Gait of Individuals After Stroke
Stroke. 2008; 40:169-174
E.D de Bruin, D. Schoene, G. Pichierri, S.T. Smith.
Use of virtual reality technique for the training motor control
in the elderly
Z. Gerontol Geriat 2010 - 43:229-234.
BACKGROUND AND PURPOSE - Training of the lower extremity (LE) using
ABSTRACT
a robot coupled with virtual environments has shown to transfer to
improved overground locomotion. The purpose of this study was to
determine whether the transfer of training of LE movements to locomotion
was greater using a virtual environment coupled with a robot or with the
robot alone.
METHODS - A single, blind, randomized clinical trial was conducted. Eighteen
individuals poststroke participated in a 4-week training protocol. One
group trained with the robot virtual reality (VR) system and the other group
trained with the robot alone. Outcome measures were temporal features of
gait measured in a laboratory setting and the community. Results - Greater
changes in velocity and distance walked were demonstrated for the group
trained with the robotic device coupled with the VR than training with the
robot alone.
Similarly, significantly greater improvements in the distance walked and
number of steps taken in the community were measured for the group that
trained with robot coupled with the VR. These differences were maintained
at 3 months’ follow-up.
CONCLUSIONS - The study is the first to demonstrate that LE training of
individuals with chronic hemiparesis using a robotic device coupled with
VR improved walking ability in the laboratory and the community better
than robot training alone.
Virtual augmented exercise, an emerging technology that can help to
promote physical activity and combine the strength of indoor exercise,
has recently been proposed as having the potential to increase exercise
behavior in older adults. By creating a strong presence in a virtual,
interactive environment, distraction can be taken to greater levels while
maintaining the benefits of indoor exercises which may result in a shift
from negative to positive thoughts about exercise. Recent findings on
young participants show that virtual reality training enhances mood, thus,
increasing enjoyment and energy. For older adults virtual, interactive
environment can influence postural control and fall events by stimulating
the sensory cues that are responsible in maintaining balance and orientation.
However, the potential of virtual reality training has yet to be explored
for older adults. This manuscripot describes the potential of dance pad
training protocols in the elederly and reports on the theoretical rationale
of combining physical game-like exercise with sensory and cognitive
challenges in a virtual environment.
serious exergaming
serious exergaming
13
Dori Rosenberg, MPH, MS1, Colin A. Depp, PhD2,3, Ipsit V. Vahia, MD2,3,
Jennifer Reichstadt, MS3, Barton W. Palmer, PhD2, Jacqueline Kerr, PhD4,
Greg Norman, PhD4, and Dilip V. Jeste, MD2,3
1 Joint Doctoral Program in Clinical Psychology UCSD/SDSU
2 University of California, San Diego, Department of Psychiatry
3 Sam and Rose Stein Institute for Research on Aging, UCSD
4 University of California, San Diego, Department of Family and Preventive Medicine
Exergames for Subsyndromal Depression in Older Adults:
A Pilot Study of a Novel Intervention
Am J Geriatr Psychiatry. 2010 March ; 18(3): 221–226.
ABSTRACT
OBJECTIVES - Subsyndromal depression (SSD) is several times more common
than major depression in older adults, and is associated with significant
negative health outcomes. Physical activity can improve depression, yet
adherence is often poor. We assessed the feasibility, acceptability, and
short-term efficacy and safety of a novel intervention using exergames
(entertaining video games that combine game play with exercise) for SSD
in older adults.
METHODS - Community-dwelling older adults (N = 19, age 63-94) with SSD
participated in a 12- week pilot study (with follow-up at 20 to 24 weeks)
of Nintendo’s Wii Sports, with three 35-minute sessions a week.
RESULTS - 86% of enrolled participants completed the 12-week intervention.
There was a significant improvement in depressive symptoms, mental
health-related quality of life, and cognitive performance, but not physical
health-related quality of life. There were no major adverse events, and
improvement in depression was maintained at follow-up.
CONCLUSIONS - The findings provide preliminary indication of the benefits
of exergames in seniors with SSD. Randomized controlled trials of exergames
for late-life SSD are warranted.
14
serious exergaming
Jessica - verschoven ruggenwervel
‘Mijn rug voelde direct
beter aan!’
Door TMS:
• ▪ Kan weer paardrijden ▪
• ▪ Rug voelt direct beter aan
testimonial
15
2
HIPPOTHERAPIE
2
HE Lechner*,1, S Feldhaus 2, L Gudmundsen2, D Hegemann2, D Michel 2,
GA Zach 2 and H Knecht 1
1 Institute for Clinical Research, Swiss Paraplegic Centre, Nottwil, Switzerland;
2 Swiss Paraplegic Centre, Nottwil, Switzerland
The short-term effect of hippotherapy on spasticity in patients
with spinal cord injury
Spinal Cord (2003) 41, 502 – 505
STUDY DESIGN - Assessment of spasticity before and after hippotherapy
treatment.
OBJECTIVE - To evaluate the short-term effect of hippotherapy on spasticity
Philadelphia Vierhouten
Gert Wubs – locatie manager
‘Eindelijk iets voor deze
doelgroep, waar zo weinig voor is’
Gert is launching customer en is overtuigd van
de meerwaarde van TMS voor mensen met een
Ernstig Meervoudige Beperking. Bezoekers zijn
altijd welkom.
16
testimonial
of spinal cord injured patients (SCIs).
SETTING - Swiss Paraplegic Centre, Nottwil.
METHODS - 32 patients with spinal cord injury with various degrees of
spasticity had repeated sessions (mean 11) of Hippotherapy-Ks. Spasticity
of the lower extremities was scored according to the Ashworth Scale.
RESULTS - In primary rehabilitation patients Ashworth values after
hippotherapy were significantly lower than before (Wilcoxon’s signed-rank
test: Po0.001). Highest improvements were observed in SCIs with very high
spasticity. No significant difference between short-termeffect in paraplegic
and short-term effect in tetraplegic subjects was found.
CONCLUSIONS - Hippotherapy significantly reduces spasticity of lower
extremities in SCIs.
hippotherapie
17
Margareta Håkanson, PT, MSca, Margareta Möller, PT, PhDb, Ingalill Lindström,
PT, PhDc, Bengt Mattsson, MD, PhDa
The horse as the healer - A study of riding in patients with
back pain.
Journal of Bodywork and movement Therapies (2009) 13, 43-52
Pablo Herrero*1,2,3, Ángel Asensio †3, Elena García †2, Álvaro Marco †3, Barbara
Oliván† 1,2,4, Alejandro Ibarz †3, Eva M Gómez-Trullén †2,5 and Roberto Casas †3
Study of the therapeutic effects of an advanced hippotherapy
simulator in children with cerebral palsy: a randomised controlled
trial
BMC Musculoskeletal Disorders 2010,11:71
SUMMARY
18
A total of 24 patients, considerably disabled in daily activities by back pain,
participated in an Equine Assisted Therapy (EAT) programme. The patients
also had several health problems in addition to their current pain. The
program emphasised the principles of body awareness. The study is aimed
at investigating not only whether symptom reduction would be achieved,
but also at identifying qualities of EAT that were particularly beneficial
for the patients’ wellbeing. The study was performed according to action
research principles.
The treatment reduced the pain and lessened other symptoms. The EAT
also had an influence on the patients’ self-image and a positive chain of
effects was observed. The consequences were described according to four
dimensions; the dimension of body awareness, competence, emotion and
environment. The dimensions were interrelated having the simultaneous
influence of a transition process and symptom reduction towards health.
ABSTRACT
hippotherapie
hippotherapie
BACKGROUND - Although hippotherapy treatment has been demonstrated
to have therapeutic effects on children with cerebral palsy, the samples used
in research studies have been very small. In the case of hippotherapy simulators,
there are no studies that either recommend or advise against their use in the
treatment of children with cerebral palsy. The aim of this randomised clinical
study is to analyse the therapeutic effects or the contraindications of the use
of a commercial hippotherapy simulator on several important factors relating
to children with cerebral palsy such as their motor development, balance
control in the sitting posture, hip abduction range of motion and electro­
myographic activity of adductor musculature.
METHODS / DESIGN - The study is a randomised controlled trial. It will be
carried out with a sample of 37 children with cerebral palsy divided into two
treatment groups. Eligible participants will be randomly allocated to receive
either (a) Treatment Group with hippotherapy simulator, maintaining sitting
posture, with legs in abduction and rhythmic movement of the simulator or
(b) Treatment Group maintaining sitting posture, with legs in abduction and
without rhythmic movement of the simulator.
DATA COLLECTION AND ANALYSIS - all measurements will be carried out by
a specially trained blind assessor. To ensure standardization quality of the
assessors, an inter-examiner agreement will be worked out at the start of
the study. The trial is funded by the Department of Research, Innovation and
Development of the Regional Government of Aragon (Official Bulletin of
Aragon 23 July 2007), project number PM059/2007.
DISCUSSION - Interest in this project is due to the following factors: Clinical
originality (there are no previous studies analysing the effect of simulators
on the population group of children with CP, nor any studies using as
many variables as this project); Clinical impact (infantile cerebral palsy is
a chronic multisystemic condition that affects not only the patient but
also the patient’s family and their close circle of friends); Practical benefits
(the development of an effective treatment is very important for introducing
this element into the rehabilitation of these children).
19
3
FYSIOTHERAPIE & NEURO REVALIDATIE
Hedendaagse fysiotherapie moet evidence-based zijn (Carr, Shepherd):
de therapeut volgt de protocollen die met behulp van clinical trials
wetenschappelijk zijn vastgesteld.
Daarbij kan de fysiotherapeut gebruik maken van tools zoals bijvoorbeeld
een oefentol - die niet gevalideerd is - of van Therapeutic Motion Simulation
voor patiënten die niet op een oefentol kunnen en die ook neuro revalidatie
nodig hebben en die met behulp van Therapeutic Motion Simulation
zelfstandig kunnen oefenen wat hun zelfverzekerdheid vergroot.
Als voorbeeld voor het gebruik van Therapeutic Motion Simulation dienen
de KNGF richtlijnen beroerte en Parkinson.
Jan Willem Bakker - spierdystrofie
‘Ik kan nu tegelijk bewegen
en ademen, fantastisch’
Door TMS:
• Kan bewegen en tegelijk ademhalen ▪
• Helpt om recht op te zitten ▪
• Geweldig om continue te bewegen
In de richtlijn beroerte met evidence niveau 1 - de hoogste bewijslast worden onder meer de interventies gericht op loopvaardigheid en mobiteitsgerelateerde vaardigheden met aantoonbare effectiviteit (hoofdstuk II.IV)
genoemd:
1
2
3
4
5
De zitbalans
Het opstaan en gaan zitten
Houdingscontrole tijdens het staan al dan niet m.b.v. forceplates (tool)
Spierkracht en uithoudingsvermogen
Loopbandtraining
Therapeutic Motion Simulation kan voor de punten 1 t.e.m. 4 worden
gebruikt en kan het herstelproces versnellen en daarmee de voorwaarden
voor punt 5 - om beter te kunnen lopen - schept.
In de richtlijn voor Parkinson worden eveneens behandelstrategieën
genoemd voor probleemgebieden (tabel 5, II.IV):
1
2
3
4
20
testimonial
Balans
Transfers
Mobiliteit
Vallen
fysiotherapie & neuro revalidatie
21
Therapeutic Motion Simulation kan ook voor deze 4 punten gebruikt worden
zelfmanagement te bevorderen en daarmee de kwaliteit van leven van
patiënten te verbeteren. Om de kwaliteit van leven te kunnen meten maakt
TMS gebruik van een app waarmee de patiënten bijvoorbeeld dagelijks een
paar door henzelf gekozen persoonlijke doelstellingen kunnen bijhouden.
Deze doelstellingen zijn direct gerelateerd aan de door het ICF protocol
vastgestelde waarden betreffende de functies, activiteiten en participatie
van patiënten. Voor de metingen wordt de PSK (patientspecifieke klachten)
methode gebruikt.
DISCUSSIE
Moet Therapeutic Motion Simulation - een tool voor de fysiotherapeut die gebruik maakt van gevalideerde bewegingen en oefeningen afzonderlijk
gevalideerd worden of volstaat de PSK evaluatie?
22
fysiotherapie & neuro revalidatie
Carr JH, Shepherd RB School of Physiotherapy, Faculty of Health Science,
University of Sydney, Lidcombe, Australia
The changing face of neurological rehabilitation
©Revista Brasileira de Fisioterapia, Vol. 10, No. 2 (2006), 147-156
ABSTRACT
BACKGROUND - Neurological rehabilitation and the contribution of physical
therapy have changed considerably over the past decades as scientific and
technological developments have enabled greater understanding of brain
reorganization and the mechanisms of motor control, motor performance,
impairments and adaptations.
OBJECTIVE - This paper presents a historical perspective covering the last
half-century.
DISCUSSION - Current scientific research, and the subsequent reevaluation
of the functional effects of impairments following an upper motor neuron
lesion, is leading to a changing focus in clinical interventions, with emphasis
on optimizing motor performance through task-oriented exercise and
training, strength and fitness training.
Findings in both animal and human models suggest that, for rehabilitation
to be effective in optimizing neural reorganization and functional recovery,
increased emphasis needs to be placed on challenging, engaging and
meaningful task training, to promote learning. The issues of the intensity
of task training and extent of cardiovascular stress during physical activity
are also discussed. Although there is much to become excited about in the
findings from clinical research, clinical practice in neurorehabilitation
continues to vary widely and depends largely on the preferred approach
of the individual therapist and on the continuing dominance of therapeutic
methods developed half a century ago. Physiotherapists need to embrace
the responsibility of using evidence-based, or at least scientifically acceptable,
methods of intervention and objective measurements of outcome.
fysiotherapie & neuro revalidatie
23
Clarissa B. Oliveira,I,II Ítalo R. T. Medeiros,III Mario G. Greters,III Norberto A. F. Frota, IV
Leandro Tavares Lucato, VI Milberto Scaff, II and Adriana B. Conforto IIV
I AACD - Adult Physiotherapy, São Paulo/SP, Brazil.
II Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Neurology Department, São Paulo/SP, Brazil.
III Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Otorhinolaryngology Department, São Paulo/SP, Brazil.
IV Fortaleza University - School of Medicine, Fortaleza/CE, Brazil.
V Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo/SP, Brazil.
VI Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Radiology Department, São Paulo/SP, Brazil.
Abnormal sensory integration affects balance control in
hemiparetic patients within the first year after stroke
Clinics (Sao Paulo). 2011 December; 66(12): 2043–2048
ABSTRACT
OBJECTIVE - Impairments in balance can be a consequence of changes in
the motor, sensory, and integrative aspects of motor control. Abnormal
sensory reweighting, i.e., the ability to select the most appropriate sensory
information to achieve postural stability, may contribute to balance
impairment. The Sensory Organization Test is a component of Computerized
Dynamic Posturography that evaluates the impact of visual, vestibular, and
somatosensory inputs, as well as sensory reweighting, under conditions
of sensory conflict. The aim of this study is to compare balance control in
hemiparetic patients during the first year post-stroke and in age-matched
neurologically normal subjects using the Berg Balance Scale and
Computerized Dynamic Posturography.
METHODS - We compared the Berg Balance Scale and Sensory Organization
Test scores in 21 patients with hemiparesis after first-ever ischemic stroke
and in 21 age-matched, neurologically normal subjects. An equilibrium score
was defined for each Sensory Organization Test condition.
RESULTS - Berg Balance Scale scores were significantly lower in the patients
than in the neurologically normal subjects. Equilibrium scores were
significantly lower in the patients than in the neurologically normal subjects
for those Sensory Organization Test conditions that did not provide appropriate
somatosensory information and under conditions of sensory conflict. A
history of falls was more frequent in patients with lower equilibrium scores.
CONCLUSION - During the first year after a stroke, defective sensory
reweighting significantly impacts balance control in hemiparetic patients.
These results are important for the planning of effective rehabilitation
interventions.
24
fysiotherapie & neuro revalidatie
Shumway-Cook A, Hutchinson S, Kartin D, Price R, Woollacott M.
Therapy, Department of Rehabilitation Medicine, School of Medicine,
University of Washington, Seattle, WA 98195-6490,
Effect of balance training on recovery of stability in children with
cerebral palsy. Division of Physical
PMID: 12948326 [PubMed - indexed for MEDLINE]
ABSTRACT
This study examined the effect of massed practice in balance recovery of
stability in six children (four males, two females; mean age 9 years 2 months,
SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy
(CP). Four children were diagnosed with spastic diplegia (Gross Motor
Function Classification System [GMFCS] level II) and two with spastic
hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental
design involving three pairs of children matched for diagnosis was used.
A moveable forceplate system was used to test and train reactive balance
control. Area per second (i.e. area covered by the center of pressure over
a one second period) and time to stabilization from center of pressure
measures were calculated following perturbations. The intervention phase
consisted of massed practice on the moving platform (100 perturbations/day
for 5 days). Analysis included hierarchical linear modeling and a repeated
measures ANOVA. All children demonstrated a significant improvement
in their ability to recover stability as demonstrated by reduced center of
pressure area and time to stabilization following training.
These improvements were still present 30 days following completion of
training. Results suggest that postural control mechanisms in school-age
children (7 to 13 years) with CP are modifiable.
fysiotherapie & neuro revalidatie
25
Michelle J Johnson*1,2,3,4
1. Medical College of Wisconsin, Dept. of Physical Medicine & Rehabilitation
2. Marquette University, Dept. of Biomedical Engineering, Olin Engineering Center, Milwaukee, WI
3. Clement J. Zablocki VA, Dept. of Physical Medicine & Rehabilitation, Milwaukee, WI
4. The Rehabilitation Robotics Research and Design Lab
Recent trends in robot-assisted therapy environments to
improve real-life functional performance after stroke
Journal of Neuro Engineering and Rehabilitation 2006, 3:29
ABSTRACT
Upper and lower limb robotic tools for neuro-rehabilitation are effective in
reducing motor impairment but they are limited in their ability to improve
real world function. There is a need to improve functional outcomes
after robot-assisted therapy. Improvements in the effectiveness of these
environments may be achieved by incorporating into their design and
control strategies important elements key to inducing motor learning and
cerebral plasticity such as mass-practice, feedback, task-engagement, and
complex problem solving.
This special issue presents nine articles. Novel strategies covered in this issue
encourage more natural movements through the use of virtual reality and
real objects and faster motor learning through the use of error feedback to
guide acquisition of natural movements that are salient to real activities.
In addition, several articles describe novel systems and techniques that use
of custom and commercial games combined with new low-cost robot systems
and a humanoid robot to embody the “supervisory presence” of the
therapy as possible solutions to exercise compliance in under- supervised
environments such as the home.
26
fysiotherapie & neuro revalidatie
A. Visker
Scriptie begeleiding: Aly Waninge, Annemarie Dijkhuizen
Balans verbeteren en plezier bevorderen bij mensen met een
(zeer) ernstige verstandelijke en visuele beperking door training
op de therapeutic movement simulator balancer
Bachelor scriptie Hanzehogeschool Groningen 2012
SAMENVATTING
INLEIDING - Bij mensen met een (zeer) ernstige verstandelijke en visuele
beperking is balans onderdeelvan fysieke fitheid en dus van belang voor de
gezondheid [1]. Uit onderzoek is gebleken dat de balans van de bewoners
van de Brink is afgenomen in de afgelopenvier jaar [2]. Daarom is verbeteren
van de balans een belangrijk aandachtspunt bij deze doelgroep.
De doelstelling van dit onderzoek is het bepalen of de balans op een voor de
deelnemer plezierige wijze verbeterd kan worden aan de hand van de TMS.
METHODE - Het quasi experimenteel interventie onderzoek wordt bij de
deelnemers (n = 4) uitgevoerd door middel van observatie en interventie.
De interventie bestaat uit zes weken trainen op de TMS Balancer. Er worden
voor- en nametingen gedaan van de mBBS, en de MIPQ vragenlijst op lange
termijn. Tijdens elke trainingssessie wordt de korte MIPQ vragenlijst
gescoord. Om verschillen voor en na de interventie te bepalen zijn de data
van de mBBS geanalyseerd met de Wilcoxon rangorde toets, terwijl de data
van de MIPQ op lange en korte termijn grafisch worden weergegeven.
RESULTATEN - De resultaten van de voor- en nameting van de mBBS laten bij
alle cliënten een toename van de mediaan van de score zien, deze is echter
niet significant (p = 0.06). Bij de MIPQ op korte en lange termijn zijn er
stijgende scores te zien, terwijl bij de lange MIPQ de scores per deelnemer
een verschillend verloop laten zien.
DISCUSSIE - De verschillen van de uitkomstmaat mBBS zijn waarschijnlijk niet
significant omdat de onderzoeksgroep klein was. Bij de uitkomstmaten van
de MIPQ vragenlijsten moet rekening gehouden worden met de lichamelijke
en geestelijke gemoedstoestand per dag, (nieuwe) omgevingsfactoren en
de invulling van de vragenlijsten van de begeleiding.
CONCLUSIE - Er is een positieve trend te zien wat betreft de effecten van
de TMS op de balans bij mensen met een (zeer) ernstige verstandelijke en
visuele beperking door training op de TMS Balancer. De training wordt in
het algemeen als plezierig ervaren door zowel deelnemers als begeleiders.
fysiotherapie & neuro revalidatie
27
4
PROPRIOCEPTION
Peter Rusbach – spasticiteit in de benen
‘minder last van spasmen’
Awarded with the Nobel Prize in 1932
The term proprioception was coined by Sir Charles Sherrington in 1906 when
he introduced the classification of the senses into exteroceptive (cutaneous),
interoceptive (visceral) and proprioceptive (deep) fields and postulated
proprioception as our “secret sixth sense” (McCloskey and Gandevia 1993:3,
Paterson 2009:769, Smetacek and Mechsner 2004:21, Sherrington 1961:132133, 320, Wade 2009:66).1 Sherrington’s identification of proprioception is
part of the scientific quest for inwardly oriented senses thought to constitute
a world “beneath the five senses”. From the beginning of the nineteenth
century onward, developments in physics, anatomy, and physiology allowed
researchers to specify and distinguish between the senses by reference to
such criteria as the quality of the experience, the nature of the stimulus, the
anatomy of the receptor system, and the pathways to, and representation of
the modeling on, the cortex. Empirical support was given to the division of
touch into a panoply of senses such as the muscle sense, the movement sense
and multiple dimensions of cutaneous sensitivity. The fractioning of the sense
of touch involved the questioning and reassessment of the number of the
senses (Howes 2009:22-23, Paterson 2009:768, Wade 2009:55-57, 60-63, 80).
Door TMS:
• Betere houding ▪
• Minder last van spasmen ▪
• Anderen sporten, hij TMS’t
28
testimonial
proprioception
29
30
Bryan L. Riemann; Scott M. Lephart University of Pittsburgh, Pittsburgh, PA
The Sensorimotor System, Part I: The Physiologic Basis of
Functional Joint Stability
Journal of Athletic Training 2002;37(1):71–79
Bryan L. Riemann; Scott M. Lephart, University of Pittsburgh, Pittsburgh, PA
The Sensorimotor System, Part II: The Role of Proprioception
in Motor Control and Functional Joint Stability
Journal of Athletic Training , 2002;37(1):80–84
OBJECTIVE - To define the nomenclature and physiologic mechanisms
OBJECTIVE - To discuss the role of proprioception in motor control and in
responsible for functional joint stability.
DATA SOURCES - Information was drawn from an extensive MEDLINE
search of the scientific literature conducted in the areas of proprioception,
neuromuscular control, and mechanisms of functional joint stability for
the years 1970 through 1999. An emphasis was placed on defining
pertinent nomenclature based on the original references.
DATA SYNTHESIS - Afferent proprioceptive input is conveyed to all levels
of the central nervous system. They serve fundamental roles in optimal
motor control and sensorimotor control over functional joint stability.
CONCLUSIONS/APPLICATIONS: Sensorimotor control over the dynamic
restraints is a complex process that involves components traditionally
associated with motor control. Recognizing and understanding the
complexities involved will facilitate the continued development and
institution of management strategies based on scientific rationales.
activation of the dynamic restraints for functional joint stability.
DATA SOURCES - IInformation was drawn from an extensive MEDLINE search
of the scientific literature conducted in the areas of proprioception, motor
control, neuromuscular control, and mechanisms of functional joint stability
for the years 1970-1999.
DATA SYNTHESIS - Proprioception is conveyed to all levels of the central
nervous system. It serves fundamental roles for op- timal motor control and
sensorimotor control over the dynamic restraints.
CONCLUSIONS/APPLICATIONS: Although controversy remains over the precise
contributions of specific mechanoreceptors, proprioception as a whole is an
essential component to con- trolling activation of the dynamic restraints and
motor control. Enhanced muscle stiffness, of which muscle spindles are a
crucial element, is argued to be an important characteristic for dynamic joint
stability. Articular mechanoreceptors are attributed instrumental influence
over gamma motor neuron activation, and therefore, serve to indirectly
influence muscle stiffness. In addition, articular mechanoreceptors appear
to influence higher motor center control over the dynamic restraints.
Further research conducted in these areas will continue to assist in providing
a scientific basis to the selection and development of clinical procedures.
proprioception
proprioception
31
Phil Page, MS,PT,ATC,CSCS
Sensorimotor training: A ‘‘global’’ approach for balance training
Journal of Bodywork and Movement Therapies (2006) 10, 77-84
5
SPIEGELNEURONEN
SUMMARY
Sensorimotor training was developed by Dr. Vladimir Janda as part of a
treatment approach to chronic musculoskeletal pain syndromes. He noted
that many of these syndromes exhibited characteristic patterns of muscle
imbalance, which were manifested with changes to the central nervous
system motor programming. Janda emphasized the importance of
proprioception in the rehabilitation process. In order to restore normal
muscle firing patterns and reflexive stabilization, he developed a
specific proprioceptive exercise progression for patients with chronic
musculoskeletal pain. Sensorimotor training emphasizes postural control
and progressive challenges to the sensorimotor system to restore normal
motor programs in patients with chronic musculoskeletal pain.
Patients progress through static, dynamic, and functional phases using
simple rehabilitation tools such as balance boards, foam pads, and elastic
bands. This paper will describe the scientific rationale for the program and
describe the clinical progression of sensorimotor training.
De ontdekking van spiegelneuronen in 1996 door Rizzolatti en Gallese
heeft een stroom van neuropsychologisch onderzoek op gang gebracht
dat in toenemende mate aantoont dat verbeelden nieuwe neurologische
verbindingen in het brein baant en dat verbeelden daarmee een belangrijke
rol vervult in leerprocessen (Iacoboni, M. 2008: Koch & Fried, 2000,
Markman e.a. 2009, Taal 2011).
Voor TMS zijn spiegelneuronen van belang omdat zij de patiënten stimuleren
om zich te vereenzelvigen met de filmbeelden die vanuit het perspectief
van de beweging zijn gemaakt.
Nature Neuroscience van 27 mei 2007
Spiegelneuronen zijn neuronen die actief worden wanneer je waarneemt
wat iemand anders doet, op dezelfde plek in de hersenen als bij degene die
de actie uitvoert. Onderzoekers van het Nijmegen Institute for Cognition
and Information en het FC Donders Centre for Cognitive Neuroimaging van
de Radboud Universiteit hebben nu ontdekt dat spiegelneuronen niet
alleen actief worden wanneer een waarnemer de waargenomen actie wil
imiteren; ze worden nog veel actiever als het de bedoeling is om de actie
op een andere manier aan te vullen.
Biological Psychiatry, Vol. 69 (9).
Onderzoekers van het Universitair Medisch Centrum Groningen (UMCG)
en het Nederlands Instituut voor Neurowetenschappen van de KNAW
(NIN-KNAW) hebben ontdekt dat het spiegelsysteem in het brein van
mensen met de hersenaandoening autisme wel functioneert, maar zich
langzamer ontwikkelt dan bij anderen.
32
proprioception
spiegelneuronen
33
Vittorio Gallese, Lucia Fadiga, Leonardo Fogassi and Giacomo Rizzolatti
(Instituto di Fisiologia Umana, Universita di Parma, Italy)
Action recognition in the premotor cortex
Brain (1996) 119, 593-609
6
MUZIEKTHERAPIE & PSYCHIATRIE
SUMMARY
We recorded electrical activity from 532 neurons in the rostral part of
inferior area (area F5) of two macaque monkeys. Previous data had shown
that neurons of this area discharge during goal-directed hand and mouth
movements.
We describe here the properties of a newly discovered set of F5 neurons
(‘mirror neurons’, n=92) all of which became active both when the monkey
performed a given action and when it observed a similar action performed
by the experimenter. Mirror neurons, in order to be visually triggered,
required an interaction between the agent of the action and the object of it.
The sight of the agent alone or the object alone (three-dimensional objects,
food) were ineffective. Hand and mouth were by far the most effective
agents. The actions most represented among those activating mirror neurons
were grasping, manipulating and placing. In most mirror neurons (92%)
there was a clear relation between the visual action they responded to and
the motor response they coded. In̴30% of mirror neurons the congruence
was very strict and the effective observed and executed actions corresponded
both in terms of general action (e.g. grasping) and in terms of the way
in which that action was executed (e.g. precision grip). We conclude by
proposing that mirror neurons form a system for matching observation and
execution of motor actions. We discuss the possible role of this system in
action recognition and, given the proposed homology between F5 and
human Brocca’s region, we posit that a matching system, similar to that
of mirror neurons exists in humans and could be involved in recognition
of actions as well as phonetic gestures.
34
spiegelneuronen
Therapeutic Motion Simulation maakt gebruik van special voor dat doel
geproduceerde (beweeg)films waarbij de audio input een belangrijke
rol speelt. Naast authentieke geluiden en muziek als ondersteuning
voor bijvoorbeeld sport gerelateerde films wordt muziek ook gebruikt
als uitgangspunt voor dans- en natuurfilms omdat muziek een krachtig
therapeutische waarde kan hebben.
Oliver Sacks, Clinical Professor of Neurology, Albert Einstein College of
Medicine, New York, USA
The power of music
Brain (2006) 129, 2528-2532
….. Another passionate musical philosopher, Nietzsche, said “We listen to
music with our muscles”. This, at least, is something we can see. It is evident
in all of us – we tap our feet, we “keep time”, hum, sing along or “conduct”
music, our facial expressions mirroring the rises and falls, the melodic
contours and feelings of what we are hearing. Yet all this may occur without
our knowledge or volition. …..
muziektherapie & psychiatrie
35
Sandra L. Siedliecki PhD RN CNS, Senior Nurse Researcher, Department of Nursing
Research and Innovation, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Marion Good PhD RN FAAN
Prof. Frances Payne, Bolton School of Nursing, Case Western Reserve
University, Cleveland, Ohio, USA
Effect of music on power, pain, depression and disability
Journal of Advanced Nursing (2006) 54(5), 553–562
AIM - This paper reports a study testing the effect of music on power,
pain, depression and disability, and comparing the effects of researcherprovided music (standard music) with subject-preferred music (patterning
music).
BACKGROUND - Chronic non-malignant pain is characterized by pain that
persists in spite of traditional interventions. Previous studies have found
music to be effective in decreasing pain and anxiety related to postoperative,
procedural and cancer pain. However, the effect of music on power, pain,
depression, and disability in working age adults with chronic non-malignant
pain has not been investigated.
METHOD - A randomized controlled clinical trial was carried out with a
convenience sample of 60 African American and Caucasian people aged
21–65 years with chronic non-malignant pain. They were randomly assigned
to a standard music group (n ¼ 22), patterning music group (n ¼ 18)
or control group (n ¼ 20). Pain was measured with the McGill Pain
Questionnaire short form; depression was measured with the Center for
Epidemiology Studies Depression scale; disability was measured with
the Pain Disability Index; and power was measured with the Power as
Knowing Participation in Change Tool (version II).
RESULTS - The music groups had more power and less pain, depression and
disability than the control group, but there were no statistically significant
differences between the two music interventions. The model predicting
both a direct and indirect effect for music was supported.
CONCLUSION - Nurses can teach patients how to use music to enhance the
effects of analgesics, decrease pain, depression and disability, and promote
feelings of power.
36
muziektherapie & psychiatrie
7
FELDENKRAIS EN PILATES
Therapeutic Motion Simulation laat zich ook inspireren door andere
oefenmethodes zoals Feldenkrais en Pilates, die ook wetenschappelijk zijn
getoetst. Onderstaand enkele voorbeelden van onderzoeken naar deze
methoden, die met name ook oefeningen voor het bekken bevatten.
Karol A. Connors,1, 2 Mary P. Galea,1, 3 and Catherine M. Said 1, 3
1 Rehabilitation Sciences Research Centre, School of Physiotherapy,
University of Melbourne, Parkville, VIC 3010, Australia
2 Calvary Health Care Bethlehem, Caulfield South, Australia
3 Austin Health, Heidelberg, Victoria, Australia
Feldenkrais Method Balance Classes Improve Balance in Older
Hindawi Publishing Corporation, Evidence-Based Complementary and
Alternative Medicine Volume 2011, Article ID 873672, 9 pages
SUMMARY
The objective of this study was to investigate the effects of Feldenkrais
Method balance classes on balance and mobility in older adults. This was a
prospective non-randomized controlled study with pre/post measures. The
setting for this study was the general community. A convenience sample
of 26 community-dwelling older adults (median age 75 years) attending
Feldenkrais Method balance classes formed the Intervention group.
Thirty-seven volunteers were recruited for the Control group (median age
76.5 years). A series of Feldenkrais Method balance classes (the “Getting
Grounded Gracefully” series), two classes per week for 10 weeks, were
conducted. Main outcome measures were Activities-Specific Balance
Confidence (ABC) questionnaire, Four Square Step Test (FSST), self-selected
gait speed (using GAITRite instrumented gait mat). At re-testing, the
Intervention group showed significant improvement on all of the measures
(ABC, P = .016, FSST, P = .001, gait speed, P < .001). The Control group
improved significantly on one measure (FSST, P < .001). Compared to the
Control group, the Intervention group made a significant improvement in
their ABC score (P = .005), gait speed (P = .017) and FSST time (P = .022).
These findings suggest that Feldenkrais Method balance classes may improve
mobility and balance in older adults.
feldenkrais en pilates
37
Kloubec JA. Department of Health and Exercise Science, Gustavus Adolphus
College, St. Peter, Minnesota, USA.
Pilates for improvement of muscle endurance, flexibility, balance,
and posture.
J Strength Cond Res. 2010 Mar;24(3):661-7
ABSTRACT
Many claims have been made about the effectiveness of Pilates exercise on
the basic parameters of fitness. The purpose of this study was to determine
the effects of Pilates exercise on abdominal endurance, hamstring flexibility,
upper-body muscular endurance, posture, and balance. Fifty subjects were
recruited to participate in a 12-week Pilates class, which met for 1 hour 2
times per week. Subjects were randomly assigned to either the experimental
(n = 25) or control group (n = 25). Subjects performed the essential (basic)
mat routine consisting of approximately 25 separate exercises focusing on
muscular endurance and flexibility of the abdomen, low back, and hips
each class session. At the end of the 12-week period, a 1-way analysis of
covariance showed a significant level of improvement (p < or = 0.05) in all
variables except posture and balance. This study demonstrated that in active
middle-aged men and women, exposure to Pilates exercise for 12 weeks,
for two 60-minute sessions per week, was enough to promote statistically
significant increases in abdominal endurance, hamstring flexibility, and
upper-body muscular endurance. Participants did not demonstrate
improvements in either posture or balance when compared with the control
group. Exercise-training programs that address physical inactivity concerns
and that are accessible and enjoyable to the general public are a desirable
commodity for exercise and fitness trainers. This study suggests that
individuals can improve their muscular endurance and flexibility using
relatively low-intensity Pilates exercises that do not require equipment or a
high degree of skill and are easy to master and use within a personal fitness
routine. PMID: 20145572
38
whole body vibration
8
WHOLE BODY VIBRATION
Met de door Therapeutic Motion Simulation toegepaste beweegtechnolgie
kunnen vibraties tot 100 HZ worden geproduceerd. De meeste trilplaten
zoals bijvoorbeeld van Power Plate - toonaangevend op het gebied van
WBV - gaan tot ~50 HZ. Uit wetenschappelijk onderzoek blijkt dat WBV een
heilzaam effect kan hebben op pijnbestrijding en conditieverbetering voor
zowel ouderen als sporters.
Bastian, J., C. Trittel, and W. Franz.
Vibrationstraining nach vorderer Kreuzbandplastik
Deutsche Zeitschrift fur Sportmedizin. Vol. 56, no. 7/8, pp: 228. 2004.
ABSTRACT
BACKGROUND - A major problem after reconstruction of the anterior
cruciate ligament of the knee is the weakness of the M. quadriceps femoris.
The aim of this study was to examine the effects of an additional whole
body vibration (WBV) on a platform training in these patients. Different
positive effects of this kind of training are still investigated: Whole body
vibration leads to an increased co-activation of lower extremity extensor
and flexor muscles, positive effects on joint stabilization, increased blood
flow.
METHODS AND RESULTS - The WBV group trained two times weekly for ten
weeks with beginning in the third week posttreatment. The results show,
that the group with additional WBV-training had six weeks postoperative
no significant reduction of the muscle thickness 10 and 20 cm proximal the
patella as the control group did. As a second effect, these group reached
more contentness.
CONCLUSION - An additional whole body vibration exercise is an effective
training after acl-reconstruction in young patients and sportsmen.
whole body vibration
39
40
Bautmans, I., E. van Hees, J. Lemper, and T. Mets.
The feasibility of whole body vibration in institutionalized
elderly persons and its influence on muscle performance,
balance and mobility: a randomized, controlled trial
BMC Geriatrics. Dec; 5:17. 2005.
Bogaerts, A., C. Delecluse, A. Claessens, W. Coudyzer, S. Boonen, and S. Verschueren.
Impact of Whole-Body Vibration Training Versus Fitness Training
on Muscle Strength and Muscle Mass in Older Men: A 1-year
Randomized Controlled Trial
Journal of Gerontology: Medical Sciences. Vol. 62A, No. 6, pp: 630–635. 2007.
ABSTRACT
ABSTRACT
BACKGROUND - Fatigue or lack of interest can reduce the feasibility of
BACKGROUND - This randomized controlled study investigated the effects of
intensive physical exercise in nursing home residents. Low-volume exercise
interventions with similar training effects might be an alternative. The aim
of this randomised controlled trial was to investigate the feasibility of
Whole Body Vibration (WBV) in institutionalised elderly, and its impact on
functional capacity and muscle performance.
METHODS - Twenty-four nursing home residents (15 female, 9 male; mean
age 77.5 ± 11.0 years) were randomised (stratification for age, gender and
ADL-category) to 6 weeks static WBV exercise (WBV+, N = 13) or control
(only static exercise; N = 11). Outcome measures were exercise compliance,
timed up-and-go, Tinetti-test, back scratch, chair sit-and-reach, handgrip
strength and linear isokinetic leg extension.
RESULTS - At baseline, WBV+ and control groups were similar for all outcome
variables. Twenty-one participants completed the program and attended
respectively 96% and 86% of the exercise sessions for the WBV+ and control
groups. Training-induced changes in timed up-and-go and Tinetti-test were
better for WBV+ compared to control (p = 0.029 for timed up-and-go,
p = 0.001 and p = 0.002 for Tinetti body balance and total score respectively).
In an alternative analysis (Worst Rank Score & Last Observation Carried
Forward) the differences in change remained significant on the Tinetti body
balance and total score. No other significant differences in change between
both groups were observed.
CONCLUSION - In nursing home residents with limited functional dependency,
six weeks static WBV exercise is feasible, and is beneficial for balance and
mobility. The supplementary benefit of WBV on muscle performance
compared to classic exercise remains to be explored further.
1-year whole-body vibration (WBV) training on isometric and explosive
muscle strength and muscle mass in community-dwelling men older than
60 years.
METHODS - Muscle characteristics of the WBV group (n¼ 31, 67.3 6 0.7 years)
were compared with those of a fitness (FIT) group (n ¼ 30, 67.4 6 0.8 years)
and a control (CON) group (n ¼ 36, 68.6 6 0.9 years). Isometric strength of
the knee extensors was measured using an isokinetic dynamometer,
explosive muscle strength was assessed using a counter movement jump,
and muscle mass of the upper leg was determined by computed tomography.
RESULTS - Isometric muscle strength, explosive muscle strength, and muscle
mass increased significantly in the WBV group (9.8%, 10.9%, and 3.4%,
respectively) and in the FIT group (13.1%, 9.8%, and 3.8%, respectively)
with the training effects not significantly different between the groups.
No significant changes in any parameter were found in the CON group.
CONCLUSION - WBV training is as efficient as a fitness program to increase
isometric and explosive knee extension strength and muscle mass of the
upper leg in community- dwelling older men. These findings suggest that
WBV training has potential to prevent or reverse the age-related loss in
skeletal muscle mass, referred to as sarcopenia.
whole body vibration
whole body vibration
41
Bogaerts, A.C.G., C. Delecluse, A. L. Claessens, T. Troosters, S. Boonen,
and S.M.P. Verschueren.
Effects of whole body vibration training on cardiorespiratory
fitness and muscle strength in older individuals (a 1-year
randomised controlled trial)
Age and Ageing. Vol. 38(4), pp: 448-454. 2009.
Moezy, A., G. Olyaei, M. Hadian, M. Razi, and S. Faghihzadeh.
A comparative study of whole body vibration training and
conventional training on knee proprioception and postural
stability after Anterior Cruciate Ligament reconstruction
British Journal of Sports Medicine. Vol. 42(5). pp: 373-378. 2008.
ABSTRACT
42
ABSTRACT
OBJECTIVE - To determine the effect of whole body vibration training
BACKGROUND - whole body vibration (WBV) training appears to be an
efficient alternative for conventional resistance training in older individuals.
So far, no data exist about the vibratory effect on
CARDIORESPIRATORY FITNESS. OBJECTIVES: this randomized controlled trial
assessed the effects of 1-year WBV training on cardiorespiratory fitness and
muscle strength in community-dwelling adults over the age of 60.
METHODS - a total of 220 adults (mean age 67.1 years) were randomly
assigned to a WBV Fitnessgroup or control group. The WBV group exercised
on a vibration platform, and the fitness group performed cardiovascular,
resistance, balance and stretching exercises.
The control group did not participate in any training. Heart rate was
measured during a single WBV session. Peak oxygen uptake (VO2peak)
and time-to-peak exercise (TPE) were measured during progressive bicycle
ergometry. Muscle strength was assessed by a dynamometer.
RESULTS - heart rate increased significantly during WBV training. After 1
year, VO2peak, TPE and muscle strength increased significantly in the WBV
and fitness groups. Both training groups improved similarly in VO2peak and
muscle strength. The fitness group improved significantly more in TPE than
the WBV group.
CONCLUSION - WBV training in community-dwelling elderly appears to be
efficient to improve cardiorespiratory fitness and muscle strength.
program (WBVT) in comparison with conventional training (CT) program
on knee proprioception and postural stability after anterior cruciate
ligament (ACL) reconstruction.
METHODS - Twenty athletes with unilateral ACL reconstruction were
randomly assigned in two groups; WBVT and CT, all participants received
12 sessions of WBVT or conventional training. Absolute error in joint
repositioning test in two target angles (30° and 60°) with Biodex
dynamometer, bilateral dynamic postural stability (anteroposterior,
mediolateral and overall stability indices) with Biodex Stability System
were measured pre and post intervention.
RESULTS - The improvement of postural stability in the WBVT group was
significantly greater than CT group (p = 0.05). The p values of the changing
scores of open overall, open anteroposterior, open mediolateral, closed
overall, closed anteroposterior and closed mediolateral stability indices were
respectively 0.002, 0.010, 0.0001, 0.001, 0.0001, and 0.046. In addition, there
were significant differences in all averages of absolute angular error at
60° and 30 º between WBVT and CT groups in both knees ( p values were
respectively 0.001, 0.001, 0.0001), with exception, the healthy
knees, at 30 º target position which was not significant (p = 0.131).
CONCLUSION - Whole body vibration training improved proprioception
and balance in ACL reconstructed athletes.
whole body vibration
whole body vibration
43
9
SNOEZELEN
Snoezelen ook bekend als multisensory environment intervention dient ook
als inspiratiebron voor Therapeutic Motion Simulation met name op het
gebied van ontspanning ten behoeve van bijvoorbeeld Alzheimer patiënten.
Julia van Weert (a), Sandra van Dulmen (a), Ada Kerkstra (a),
Peter Spreeuwenberg (a), Miel Ribbe (b), Jozien Bensing (a)
a NIVEL, Nederlands instituut voor onderzoek van de gezondheidszorg, Utrecht
b Vrije Universiteit/EMGO Instituut, Amsterdam
Effecten van snoezelen op demente ouderen en zorgverleners
NIVEL 2003
Willy Hemelaar – postpoliosyndroom
‘Het roept herinnering aan
paardrijden op’
Door TMS:
• Belevenissen die ze anders niet kan ervaren ▪
• Roept herinnering aan paardrijden op ▪
• Betere houding, spieren aanspannen om te blijven zitten tijdens paardrijden ▪
• Activeert ongebruikte spieren
SAMENVATTING
In dit onderzoek is het effect van snoezelen op demente ouderen en op
zorgverleners onderzocht in zes Nederlandse verpleeghuizen. Snoezelen
is een benaderingswijze om door middel van actieve zintuigprikkeling
een ingang te vinden in de belevingswereld van de demente oudere,
met als doel het welbevinden te optimaliseren of in stand te houden.
De vraagstellingen van het onderzoek luidden:
1. Wat is het effect van snoezelen op het gedrag van dementerende
verpleeghuisbewoners?
2. Wat is het effect van snoezelen op de arbeidstevredenheid, burn-out, ervaren werklast en de ervaren problemen in de omgang met demente bewoners van verzorgenden?
3. Hoe verloopt de implementatie en de toepassing van snoezelen op de afdelingen?
>> vervolg samenvatting op de volgende pagina
44
testimonial
snoezelen
45
10
Het effect is onderzocht door middel van een veldexperiment waarin
snoezelen geïmplementeerd werd op zes experimentele afdelingen die
vergeleken werden met zes controle afdelingen. In de voormeting is het
gedrag van 120 bewoners en 120 verzorgenden in kaart gebracht door
middel van video-observaties tijdens de ochtendzorg.
Daarnaast gaven de verzorgenden een beoordeling van het gedrag van de
bewoners over een langere periode met behulp van gedragsobservatielijsten.
Tevens vulden verzorgenden een vragenlijst in over werkbeleving, ervaren
werklast, ervaren problemen in de omgang met demente ouderen,
arbeidssatisfactie en burn-out. Vervolgens kregen zestig verzorgenden
van de experimentele afdelingen de cursus “snoezelen door uitvoerenden”
aangeboden door Bernardus.
Expertisecentrum / Fontis. Na afloop van de cursus zijn de experimentele
afdelingen gestart met het integreren van snoezelen in de 24-uurszorg
op de afdeling. Het implementatietraject is nauwkeurig geëvalueerd.
Na anderhalf jaar vond een nameting plaats die identiek was aan de
voormeting. De resultaten van het onderzoek laten zien dat de integratie
van snoezelen in de 24- uurszorg bij een goede implementatie kan leiden
tot positieve effecten op de stemming en het gedrag van bewoners en op
de werkbeleving van verzorgenden.
E-HEALTH
Therapeutic Motion Simulation is hoofdzakelijk een software driven systeem
dat optimaal kan fuctioneren als het online gebruikt wordt. Doordat
het online staat kan er op een gestructureerde wijze informatie worden
verkregen, die kan worden gebruikt om de functionaliteit van TMS continue
te verbeteren. Verder kan de gebruiksinformatie gerelateerd worden aan
de door de patient bijgehouden informatie inzake de kwaliteit van leven
en ook dit kan weer gebruikt worden om het inzicht op de toepassings­
mogelijkheden van TMS te vergroten. Tenslotte kan de online verbinding
worden gebruikt om TMS bij patient thuis te monitoren en om andere
diensten zoals webfysio, beeldtelefonie en andere vormen van e-health
aan te bieden resp. te integreren in de firmware van TMS.
Actionplan Europe E-Health, 2012 - 2020
Zorg moet digitale revolutie omarmen
De gezondheidszorg moet de digitale revolutie omarmen. Alleen dan kan
aan de stijgende zorgvraag voor mensen met chronische aandoeningen
beantwoord (blijven) worden. Dat schrijft Neelie Kroes, Europees commissaris
digitale agenda, en Tonio Borg, Europees commisaris voor gezondheid en
consumentenbescherming op EuropeanVoice.com. ter gelegenheid van het
nieuwe Europese e-Health Action Plan, dat deze week wordt gelanceerd.
In het stuk wijzen de eurocommissarissen op de angst die veel ouderen
hebben over de vraag of zij in de toekomst nog wel voldoende zorg kunnen
krijgen. Er is een dilemma: aan de ene kant stijgen de uitgaven voor de zorg
enorm en aan de andere kant zullen jongere generaties die kosten niet meer
kunnen opbrengen. Kroes en Borg zien de oplossing in digitale hulpmiddelen.
Technologie
De trend is dat mensen steeds ouder worden en dat chronische patiënten
liever thuis wonen. Daar komt bij dat ze de constante, tijdverslindende
uitstapjes naar de dokter willen vermijden. Dan komt digitale technologie
om de hoek kijken, hetzij door middel van remote monitoring-apparaten
die op afstand zaken kunnen meten en bewaken, hetzij door middel van
telemedicine die de zorg in staat stelt om specialistische medische hulp te
geven. Voorbeelden hiervan zijn de mobile applicaties.
46
snoezelen
e-health
47
De twee eurocommissarissen wijzen erop dat het niet om science fiction
gaat, maar dat veel oplossingen al bestaan. Veel van de digitale oplossingen
zijn in Europa bedacht en kunnen, mits goed ingezet, leiden tot lagere
kosten en meer efficiëntie.
INDEX MEDISCHE PUBLICATIES
1
Kloof
Kroes en Borg constateren nog altijd een kloof tussen e-Health-technologie
en traditionele patiëntenzorg.”De sector is huiverig om de digitale revolutie
te omarmen. Men houdt liever vast aan traditionele methoden en modellen.
Politici hebben ook liever niet dat een systeem dat in het verleden goed
heeft gewerkt nu door e-Health wordt verstoord”.
SERIOUS EXERGAMING
Lamoth CJ, Alingh R, Caljouw SR - Exergaming for elderly: effects of
pag. 9
different types of game feedback on performance of a balance task.
Sveistrup - Motor rehabilitation using virtual reality
pag. 10
Maureen K. Holden - Virtual Environments for Motor
pag. 11
Rehabilitation: Review
Opheffen
In het nieuwe European e-Health Action Plan wordt uiteengezet hoe de
gezondheidszorg de digitale voordelen kan benutten.”Alleen zo kunnen een
betere zorg voor onze burgers garanderen”, aldus het rapport. De slogan is:
barrières opheffen om te komen tot een slimmer, veiliger en patiëntgerichte
gezondheidszorg.
Anat Mirelman, Paolo Bonato, Judith E. Deutsch - Effects of Training
pag. 12
With a Robot-Virtual Reality System Compared With a Robot Alone
on the Gait of Individuals After Stroke
E.D de Bruin, D. Schoene, G. Pichierri, S.T. Smith - Use of virtual reality
pag. 13
technique for the training motor control in the elderly
Dori Rosenberg, Colin A. Depp, Ipsit V. Vahia, Jennifer Reichstadt, Barton
W. Palmer, Jacqueline Kerr, Greg Norman and Dilip V. Jeste - Exergames
pag. 14
for Subsyndromal Depression in Older Adults: A Pilot Study of a
Novel Intervention
2
HIPPOTHERAPIE
HE Lechner, S Feldhaus, L Gudmundsen, D Hegemann, D Michel, GA Zach
and H Knecht - The short-term effect of hippotherapy on spasticity in
pag. 17
patients with spinal cord injury
Margareta Håkanson, Margareta Möller, Ingalill Lindström, Bengt Mattsson -
pag. 18
The horse as the healer - A study of riding in patients with back pain
Pablo Herrero, Ángel Asensio, Elena García, Álvaro Marco, Barbara Oliván,
Alejandro Ibarz, Eva M Gómez-Trullén and Roberto Casas - Study of
pag. 19
the therapeutic effects of an advanced hippotherapy simulator in
children with cerebral palsy: a randomised controlled trial
48
e-health
index medische publicaties
49
3
7
FYSIOTHERAPIE & NEURO REVALIDATIE
Carr JH, Shepherd RB - The changing face of neurological rehabilitation
pag. 23
FELDENKRAIS EN PILATES
Karol A. Connors, Mary P. Galea and Catherine M. Said - Feldenkrais
pag. 37
Method Balance Classes Improve Balance in Older
Clarissa B. Oliveira, Ítalo R. T. Medeiros, Mario G. Greters, Norberto A. F.
Frota, Leandro Tavares Lucato, Milberto Scaff and Adriana B. Conforto -
pag. 24
Kloubec JA. - Pilates for improvement of muscle endurance, flexibility,
Abnormal sensory integration affects balance control in hemiparetic
patients within the first year after stroke
Shumway - Cook A, Hutchinson S, Kartin D, Price R, Woollacott M -
pag. 25
8
Effect of balance training on recovery of stability in children with
cerebral palsy. Division of Physical
Michelle J Johnson - Recent trends in robot-assisted therapy environ-
pag. 38
balance, and posture
WHOLE BODY VIBRATION
Bastian, J., C. Trittel, and W. Franz. - Vibrationstraining nach vorderer
pag. 39
Kreuzbandplastik
pag. 26
Bautmans, I., E. van Hees, J. Lemper, and T. Mets - The feasibility
ments to improve real-life functional performance after stroke
pag. 40
of whole body vibration in institutionalized elderly persons and
A. Visker - Balans verbeteren en plezier bevorderen bij mensen
pag. 27
its influence on muscle performance, balance and mobility:
met een (zeer) ernstige verstandelijke en visuele beperking door
training op de Therapeutic Movement Simulator Balancer
4
a randomized, controlled trial
Bogaerts, A., C. Delecluse, A. Claessens, W. Coudyzer, S. Boonen,
and S. Verschueren - Impact of Whole-Body Vibration Training Versus
PROPRIOCEPTION
Bryan L. Riemann, Scott M. - The Sensorimotor System, Part I:
Fitness Training on Muscle Strength and Muscle Mass in Older Men:
A 1-Year Randomized Controlled Trial
pag. 30
The Physiologic Basis of Functional Joint Stability
Bryan L. Riemann; Scott M - The Sensorimotor System, Part II: The Role
pag. 41
Bogaerts, A.C.G., C. Delecluse, A. L. Claessens, T. Troosters, S. Boonen,
and S.M.P. Verschueren - Effects of whole body vibration training on
pag. 31
pag. 42
cardiorespiratory fitness and muscle strength in older individuals
of Proprioception in Motor Control and Functional Joint Stability
(a 1-year randomised controlled trial)
Phil Page - Sensorimotor raining: A ‘‘global’’ approach for balance
pag. 32
training
Moezy, A., G. Olyaei, M. Hadian, M. Razi, and S. Faghihzadeh. -
pag. 43
A comparative study of whole body vibration training and
5
Vittorio Gallese, Lucia Fadiga, Leonardo Fogassi and
Giacomo Rizzolatti - Action recognition in the premotor cortex
6
conventional training on knee proprioception and postural stability
SPIEGELNEURONEN
after anterior cruciate ligament reconstruction
pag. 34
9
SNOEZELEN
Julia van Weert, Sandra van Dulmen, Ada Kerkstra, Peter Spreeuwenberg,
Miel Ribbe, Jozien Bensing - Effecten van snoezelen op demente
MUZIEKTHERAPIE & PSYCHIATRIE
pag. 45
ouderen en zorgverleners
Oliver Sacks - The power of music
pag. 35
Sandra L. Siedliecki, Marion Good, Prof. Frances Payne - Effect of music
pag. 36
10 E-HEALTH
Actionplan Europe E-Health, 2012 - 2020
pag. 47
on power, pain, depression and disability
50
index medische publicaties
index medische publicaties
51
EPILOOG
De kracht van technologie gebruiken om het leven van mensen die niet
(meer) kunnen of willen bewegen te verbeteren.
In slechts drie jaar krijgt TMS internationaal erkenning voor haar bijdrage
op het gebied van revalidatie en als een methode om de kwaliteit van
leven van chronisch zieken te verbeteren.
Het gebruik van low cost robotfysio en gaming technologie in combinatie
met e-health neemt exponentieel toe .
De TMS technologie biedt enorme kansen. TMS heeft als doelstelling om
een belangrijke speler te worden op het gebied van serious gaming en
neuro revalidatie.
Wilt u meer informatie of uw gedachten met ons delen neemt u dan
contact met ons op.
COLOFON
hoewel deze uitgave met grote zorgvuldigheid is
samengesteld kunnen er geen rechten aan worden
ontleend.
© Vita Care 2013
auteurs
Herbert Krakauer
Tanja Ivanovski
Julius van de Voort, LLM
layout & design Klaassen ontwerp
fotografieCarlo Galli
website www.vita-care.eu
[email protected]
Telefoon +31(0)88 144 12 20
52
epiloog
53
website www.vita-care.eu
[email protected]
Telefoon +31(0)88 144 12 20
54