DCRM 2024

On the road to optimize rehabilitation for young individuals with acquired brain injury

Identifying, targeting, and evaluating the consequences of Acquired Brain Injury (ABI) in young individuals (4-25 years old) are essential elements of medical specialist rehabilitation care for this group. Several knowledge gaps regarding the occurrence and severity of consequences and the delivery of rehabilitation existed.

This thesis enhanced the understanding of ABI-related consequences and aimed to optimize rehabilitation care provided to young Dutch individuals with ABI.

Section 1 of this thesis investigated the severity and course over 2 years of persisting ABI-related problems in young people with ABI and their families. In this cohort, many problems were found in the domains of Health-related Quality of Life (HRQoL), fatigue, participation, and family impact at time of referral to rehabilitation and these problems tended to persist over time.

In section 2, the structure and process of rehabilitation for young patients with ABI across Dutch rehabilitation centers and the development of a national consensus-based framework for clinical practice, including preferred assessments, interventions, and psychoeducation, for young people with ABI was described.

This thesis emphasizes the importance of a holistic approach to rehabilitation and lays the foundation for future initiatives aiming to further optimize rehabilitation treatment for young individuals with ABI and their families.

Florian Allonsius is an enthusiastic postdoc researcher at Basalt Rehabilitation Center in The Hague, The Netherlands and a lecturer in Pediatric Physical Therapy at the Avans University of applied sciences in Breda. He started his career as a pediatric physical therapist and worked in several (academic) hospitals and at Basalt Rehabilitation Center. During his master studies in Physical Therapy he became very interested in doing research. His current field of research contains brain injuries in young patients (children, adolescents, and young adults) in the rehabilitation phase after the onset of brain injury. He completed his PhD at the Leiden University Medical Center (Leiden, The Netherlands) with the thesis ‘On the road to optimize rehabilitation for young individuals with Acquired Brain Injury’. He currently works as a postdoc researcher on several research projects.

The effectiveness and cost-effectiveness of upper limb prostheses

Last decade, the cost of upper limb prostheses increased substantially. One reason might be the introduction of expensive multi-grip myoelectric hands, which can perform multiple grips. However, literature suggests that the additional grip options of these hands are not always used. Paired with the high rejection rates of upper limb prostheses, this suggests that there is room for improving both the effectiveness and cost-effectiveness of upper limb prostheses.

In this thesis the multi-grip and ‘standard’ myoelectric hands were compared using physical tests and questionnaires, which showed no clear advantages for multi-grip over ‘standard’ hands. Furthermore, our nationwide survey study showed that the average annual cost of myoelectric hands, especially multi-grip hands, is higher than other hand prostheses while no differences in quality of life or user experiences were found. More specifically, multi-grip hands were less cost-effective than ‘standard’ myoelectric hands. Lastly, to support the prosthesis selection process and help inform potential prosthesis users, we developed a digital patient decision aid in a systematic co-creation process.

Ultimately, we hope this thesis will help to improve the prosthesis prescription process, decrease rejection rates of upper limb prostheses, and increase the cost-effectiveness of upper limb prosthesis related healthcare.

Nienke Kerver started her academic journey in 2010 with a Bachelor of Human Movement Sciences at the University of Groningen. After completing the Bachelor’s, she started the Pre-Master and Master of Medicine in 2013. Subsequently, in 2018, she worked as a medical doctor at the neurology department at the Isala Hospital in Zwolle. During this period, she gained experience as a doctor, however, research also continued to interest her. In December 2018, Nienke started her PhD research at the department of Rehabilitation Medicine of the University Medical Centre Groningen. The results are described in this thesis (see above). During her “journey”, she found out that within the rehabilitation medicine all her interests came together. Currently, Nienke works as a medical trainee in rehabilitation medicine. After finishing her specialization, she hopes to combine research and clinical work.

Compensation strategies for gait impairment in Parkinson’s disease: towards personalized gait rehabilitation

Parkinson’s disease is a neurodegenerative disorder that is becoming increasingly prevalent. Many people with Parkinson’s disease experience difficulty walking, which seldomly responds well to dopaminergic treatment alone. Fortunately, they often spontaneously invent creative ‘tricks’ to still get ahead. For example: walking to the rhythm of music, counting, imitating someone else, or hopping. This dissertation shows that these compensatory strategies seem to make use of different ‘routes’ in the brain to improve walking, by bypassing the part of the brain that is most affected by Parkinson’s disease. The studies presented demonstrate that these strategies generally work very well, but that the effect of specific compensation strategies does vary greatly from person to person: what helps one person, may actually make walking more difficult for another. Therefore, individually tailored treatment is essential. The insights from this dissertation contribute to improving the knowledge of patients and healthcare professionals on the wide range of compensation strategies available to support walking, and facilitate the development of  a more personalized gait rehabilitation approach.

Anouk Tosserams was born on November 13^th 1994 in ‘s-Hertogenbosch. She obtained her medical degree in 2019, graduating cum laude from the Radboud University, Nijmegen. She then started her PhD trajectory at the Radboudumc Centre of Expertise for Parkinson and Movement Disorders, aimed at gaining a deeper understanding of compensation strategies for gait impairment in Parkinson’s disease. She was supervised by Prof. dr. Bastiaan R. Bloem, Prof. dr. Vivian Weerdesteyn and dr. Jorik Nonnekes. Anouk implemented her research findings in clinical practice through the co-development of an interactive online platform on gait compensation strategies (EN: www.walkingwithparkinson.com; NL: www.radboudumc.nl/lopenmetparkinson). Her work was highlighted by international media, and awarded with the Klokhuis Wetenschapsprijs 2023. As of May 2023, Anouk works as a resident in Neurology at the Radboudumc. As a postdoctoral researcher, she continues to be involved in several projects on gait rehabilitation for people with Parkinson’s disease.

Plasticity of neural networks

In the Netherlands, nearly 400,000 people live with the consequences of a stroke, most of whom experience upper limb impairments. The current standard of care for post-stroke upper limb impairment is intensive rehabilitation, which consists primarily of training-based therapies, such as physical and occupational therapy. Despite these efforts, many patients continue to experience persistent impairments, hampering daily activities, societal participation and quality of life.

Transcranial magnetic stimulation (TMS), a form of non-invasive brain stimulation, is a promising tool to improve upper limb recovery after stroke. The efficacy of TMS in improving post-stroke upper limb recovery is currently being investigated in the B-STARS2 trial, a phase III randomized controlled trial (RCT) with 16 participating rehabilitation centers in the Netherlands. The outcome of this trial will determine whether TMS treatment can be applied as standard of care in post-stroke rehabilitation.

This thesis describes the background, rationale and current evidence for the application of TMS treatment in post-stroke upper limb rehabilitation. It outlines how TMS can activate and modulate brain networks, presents evidence supporting the proposed mechanism of action and details the results of the B-STARS trial that preceded B-STARS2 — a phase II monocenter trial where 60 patients at De Hoogstraat Rehabilitation received TMS treatment.

Jord Vink is a technical physician and postdoctoral researcher at the University Medical Center Utrecht and De Hoogstraat Rehabilitation. His primary research focus is the use of transcranial magnetic stimulation (TMS), a non-invasive brain stimulation method, to enhance neuroplasticity and recovery after stroke. At Beth Israel Deaconess Medical Center and the UMC Utrecht, he combined TMS with neuroimaging methods, such as electroencephalography and functional magnetic resonance imaging, to better our understanding of the effect of TMS on brain networks. During his PhD, he successfully conducted the B-STARS trial, a phase II monocenter trial on TMS treatment to promote upper limb recovery after stroke. The promising results of the B-STARS trial allowed him to setup a multicenter trial across 16 Dutch rehabilitation centers, named B-STARS2. The outcome of this trial will determine whether TMS treatment can be integrated in standard rehabilitative care to promote upper limb recovery after stroke.