Parallel sessie A

Het Landelijk Opleidingsplan ‘BETER in Beweging’ is inmiddels in werking gesteld. Om het scholingsprogramma aan te laten sluiten bij het opleidingsplan is modernisering noodzakelijk. De Scholingscommissie en het Concilium zijn bezig met de ontwikkeling hiervan en delen graag hun ervaringen. In deze workshop leggen we uit waarom en hoe het scholingsprogramma gemoderniseerd gaat worden. Na een toelichting op de onderliggende onderwijskundige principes, zullen de contouren van het nieuwe scholingsprogramma worden geschetst. Daarmee is het nieuwe programma echter nog niet af; de exacte invulling moet de komende jaren nog plaatsvinden. Daarom gaan we vervolgens actief aan de slag: hoe kun je zelf landelijk, regionaal of lokaal onderwijs moderniseren? Hoe start je hiermee, en welke tools zijn er al beschikbaar voor blended learning? Ter afsluiting zullen de resultaten van de pilot van de scholingscommissie getoond worden.

Deze interactieve sessie is bedoeld voor alle betrokkenen bij onderwijs van de opleiding tot revalidatiearts.

Chair(s): Laura Haffmans, revalidatiearts en voorzitter Scholingscommissie

Sprekers:

• Marieke Bolk (Federatie Medisch Specialisten)
• Vincent de Groot (Amsterdam UMC)
• Laura Haffmans (Rijndam)
• Danique Ploegmakers (Klimmendaal, the Netherlands)

Programma:

• Introductie door voorzitter scholingscommissie Laura Haffmans
   
• Aanleiding (LOP, individualisering) door voorzitter Concilium Vincent de Groot
   
• Leren door volwassenen door Marieke Bolk
   
• Contouren nieuwe scholingsprogramma aios Scholingscommissie door Danique Ploegmakers
   
• Opdracht: ontwerp onderwijs door Marieke Bolk
   
• Ervaringen pilot kinderrevalidatie door betrokkene pilot
   
• Afsluiting door Laura Haffmans en Vincent de Groot

Learning objective(s):
Op de hoogte zijn van laatste ontwikkelingen in modernisering scholingsprogramma Handvatten krijgen om zelf het scholingsprogramma te moderniseren.

Cochrane is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health professionals, patients and policy makers. The idea of a Cochrane Rehabilitation (CR) Field was launched in 2016. CR is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice, combining the best available evidence as gathered by high quality Cochrane systematic reviews (CSR). Rehabilitation interventions are complex, difficult to standardise, with different components and contents and a lack of existing 'standard care'. As a consequence, RCTs are complex or lacking because they are unfeasible due to some clinical questions and it is difficult or impossible to include alternative designs in CSRs. In CSRs, the evidence of Rehabilitation research is systematically downgraded due to unavoidable characteristics of rehabilitation (e.g. lack of blinding). However, one in 11 CSRs are on rehabilitation interventions. In this workshop, members of CR and a CSR author will help you bringing evidence into practice, give examples of reporting in Rehabilitation research, give examples of alternatives for RCTs and share experiences in writing a CR.

Chair(s): 

• Lotty Hooft, PhD (director Cochrane Nederland), Asssociate professor Department of Epidemiology Julius Center Research Program Methodology
• Carlotte Kiekens, MD (Co-Director Cochrane Rehabilitation), Spinal Unit Director, Montecatone Rehabilitation Institute, Imola (Bologna), Italy
• Prof. Thorsten Meyer, PhD, psy and MD (executive committee Cochrane Rehabilitation), Head of the Integrative Rehabilitation Research Unit at the Institute for Epidemiology, Social Medicine and Health System Research of Hannover Medical School, Germany
• Prof. Stefano Negrini, MD (Director Cochrane Rehabilitation), Department of Biomedical, Surgical and dental Sciences, University “La Statale”, Mila, Italy. IRCCS Istituto Ortopedico Galezzi, Milan, Italy.
• Nicole Voet, PhD and MD (Cochrane Review author), Rehabilitation physician Rehabilitation centre Klimmendaal, Arnhem, the Netherlands and Radboud University Medical Centre Nijmegen, the Netherlands

Outline session: 

• Cochrane in the Netherlands, Lotty Hooft (director Cochrane Netherlands)
   
• How can Cochrane Rehabilitation help you to bring evidence to practice? Carlotte Kiekens (co-director Cochrane Rehabilitation)
   
• Cochrane Rehabilitation projects: reporting in rehabilitation research (REREP, RCTRACK), rehabilitation definition for research purposes, Stefano Negrini (director Cochrane Rehabilitation)
   
• What to do when a Randomized Controlled Trial (RCT) is not possible? Thorsten Meyer (executive committee Cochrane Rehabilitation)
   
• Experience from a Cochrane Review author, Nicole Voet (Cochrane Review author)

Learning objective(s):

1. learn more about the Cochrane organization
2. learn practical skills to report rehabilitation research
3. learn about alternatives for randomized controlled trials
4. learn about the experiences from a Cochrane author

The rehabilitation medicine sector is an innovative sector. Scientific research reveals a lot of knowledge, new technology is continuously developed to support rehabilitation programs, but how does the patient benefit from innovation in the daily practice?

For 8 years the Ipsen Rehabilitation annual award for innovation within patient care* is awarded within the Netherlands. This price has been rewarded to a project which has the best innovative initiative to improve direct patient care, preferably for a larger group of patients. The innovation needs to be implemented within one year after winning the award. A committee selects the best initiative to improve patient care.

A selection of the award winners will present their results and experiences on implementing patient innovation within rehabilitation. Questions they will answer: what have they done and what are results of their innovations? How did the patient benefit from their innovation? What are their lessons learned when implementing new initiatives? How did they share their innovations? What are (future) plans, with focus on further development and implementation?

*The Ipsen Rehabilitation annual award for innovation within patient care is financially support by Ipsen Farmaceutica B.V. for terms and regulations of this award see: https://revalidatiegeneeskunde.nl/ipsen-revalidatie-jaarprijs

Chair(s): I. (Inez) van der Ham MD, Rijndam Revalidatie

Outline session:

• introduction by chair Inez van der Ham
   
• presentation price winning innovation number 1 Guido Limburg (2013)
   
• presentation price winning innovation number 2 Eric Voorn (2016)
   
• presentation price winning innovation number 3 Nynke Biegel-Slappendel en Wolanda Werkdam
   
• presentation price winning innovation number 4 Iris van Wijk (2018)
   
• presentation price winning innovation number 5 Annette van Kuijk (2019)
   
• Overall conclusion implementation of innovations, by chair Inez van der Ham

Learning objective(s):
Learn from best practices and pitfalls which are shared about improving implementation of innovation.

Comment(s): Speakers are not yet known 

In children with Cerebral Palsy muscle weakness is a very important disabling factor in daily functioning. Assessment of upper limb muscle strength should be an essential part of rehabilitation both in clinical reasoning and evaluation. During this workshop new insights regarding muscle strength measurements of the upper limb in children with CP will be presented; we will start with an overview of the assessment methods of muscle strength, strength measurements in fatigability and functional strength. The relevance as well as gaps for clinical reasoning and evaluation of these assessment tools will be presented on the basis of known clinimetric characteristics such as reliability, validity and responsiveness. Next, the development and clinimetric data of an innovative ADL- test and training device will be discussed, followed by the demonstration of the potential of gaming in ADL strength training interventions as an innovative future rehabilitation technology. These innovative possibilities will be presented and discussed in the context of multidisciplinary treatment programs, especially focused on near future home- based ADL strength training in children with CP. Finally, the potential use for other patient groups will be discussed.

Chair(s):

• Prof. Rob J.E.M. Smeets (MD, PhD), professor in Rehabilitation Medicine, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht University, the Netherlands; CIR Revalidatie, location Eindhoven, the Netherlands
• Eugene Rameckers, PhD PT. Senior Researcher Centre of Expertise, Hoensbroek, the Netherlands and Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands and Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium;

Speakers:

• Koen Dekkers; PhD student, Revant Rehabilitation Centres, Breda , The Netherlands. and Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.
• Lieke Brauers; PhD student, Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium and Department of Rehabilitation Medicine and Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.
• Mellanie Geijen; PhD student, Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands.
• Eugene, Rameckers, PhD PT. Senior Researcher Centre of Expertise , Hoensbroek, The Netherlands. and Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands and Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium;
• Jasper de Boer; Ing, Umaco B.V. A Lode Holding Company

Outline session:

• Assessing Strength: an update about the status quo (Dr. K. Dekkers) 
   
• Strength: peak or fatigue: new aspects of measurement (L.Brauers) 
   
• Assessment of task-oriented strength: new evidence (Dr. M. Geijen) 
   
• Strength and daily activities: new developments in testing and training:
   
• ADL-TTD & gaming. ( Dr. E.Rameckers & Ing. J. de Boer) 
   
• Questions & Group discussion (led by the chairman, Dr. R. Smeets) 

Learning objective(s):

1. To give an overview of the clinimetric properties of different types of strength assessments including strength measures to calculate fatigability.
2. To demonstrate new approaches in functional strength testing in daily activities, including the presentation of novel technological assessment methods
3. To demonstrate gaming possibilities for ADL strength training and the use of gaming in children with CP

Regaining independent gait is often an important goal of a patients’ rehabilitation after stroke. Physiatrists are aware of the high variety among clinical settings in the Netherlands concerning the management of gait problems after stroke. Different views, clinical experience and a lack of scientific evidence on more conservative vs. more invasive treatment options contribute to this variation. As gait labs are emerging throughout the country, the need for a uniform approach in treating gait problems after stroke is growing. In 2018 a working group was formed, consisting of gait experts from different Dutch rehabilitation centres, which aims to reach (inter)national consensus and development of a treatment algorithm.

In this minisymposium we present a framework in which we show that independent gait requires balance control and leg motor control. Both balance control and leg motor control are typically affected after stroke, and require different interventions in time. Balance control requires training, not only in the (sub)acute but also in the chronic phase. In addition, medical-technical interventions become more important in the chronic phase to enable full utilization of residual leg motor control. We subsequently elaborate when, how and where these interventions may take place.

Chair(s): Mirjam Kouwenhoven, De Hoogstraat, Utrecht, the Netherlands

Outline session: 

• Introduction symposium, by  presenter/chair Mirjam Kouwenhoven 
   
• Presentation: The complex interactions between balance control, leg motor control and gait post-stroke: introduction of a framework, by Vivian Weerdesteyn
   
• Presentation: Training to improve balance control, the right type at the right time, by Hanneke van Duijnhoven
   
• Presentation: Interventions to improve leg motor control, leaving a stepwise approach behind? by Judith Fleuren 
   
• Conclusion and discussion, by chair Mirjam Kouwenhoven

Learning objective(s):

1. To get insight in the contribution of balance control, leg motor control and time after stroke on poststroke gait
2. To acquire knowledge about the possible treatment options and their timing

Assistive and therapeutic technology each has its place in rehabilitation. Assistive technology, by definition, is technology through which users can do activities that are impossible or more difficult without the technology. Therapeutic technology, by definition, is technology with which the user practices to improve functioning and, ideally, this improved function is maintained after the use of the technology is discontinued.

Traditionally, therapeutic technology was primarily aimed at stimulating recovery or compensation strategies, while assistive technology took over the functions that were no longer present. Nowadays, however, assist-as-needed principles are increasingly incorporated in both assistive and therapeutic technology. With the emergence of highly-adaptive devices questions rise, such as: Can the use of assist-as-needed technology support patients beyond assistance? Can patients actually use and take optimal advantage of such adaptive technology? We state that we need to consider such technology on another level than the technology itself, and pay particular attention to the user-technology interaction. We then encounter interesting concepts that underline a merge of the two fields: Training by assistance and assistance by training.

In this workshop we will present our hypotheses and results of experimental research regarding assist-as-needed rehabilitation technology. This will be followed by group discussions.

Chair(s): Prof Hans Rietman, MD, PhD

Outline session: 

• Introduction symposium by chair Prof. Hans Rietman 
   
• Rehabilitation technology to train, by Gerdienke Prange, PhD 
   
• Rehabilitation technology to assist, by Erik Prinsen, PhD 
   
• Rehabilitation technology: to train or to assist? by Gerdienke Prange and Erik Prinsen 
   
• General discussion and questions, by Prof. Hans Rietman 

Learning objective(s):

1. First, we want to share our experiences and results from clinical evaluation studies of therapeutic and assistive technology and support our statement that these fields are merging together, with evidence.
2. The second goal is to have a group discussion in which participants can reflect on and discuss our statements from a clinical perspective, with a particular aim to discuss how both fields can learn from each other. This will be essential to drive and direct future progress within both fields of technology with attention to the clinical perspective.