Parallel sessie A

In this mini-symposium, an international panel of presenters discuss research on the meaning of citizenship for adults with disabilities. We elaborate on the different dimensions of citizenship relating to the lives of adults with disabilities. While some emphasise issues concerning social justice (e.g. equality, a barrier-free context), others refer to aspects of identity, belonging, reciprocity and the role of support services. We then zoom in on how older adults with cerebral palsy define their citizenship, what factors hamper or facilitate their citizenship. A woman with a neuro-muscular disease shares her lived experiences how she shapes citizenship and what citizenship means in her life, and a rehabilitation physician discusses how citizenship can be addressed in rehabilitation consults. In the remainder of the mini-symposium, the participants discuss the importance of citizenship in their practice and are invited to reflect on ways how to incorporate attention for citizenship in their consultations.

Person-centred rehabilitation takes patients’ needs, experiences, preferences and cultural values into account, as well as their history and biography. For this reason, citizenship is an important aspect to consider in rehabilitation medicine. However, citizenship is a multi-layered and complex construct. Understanding the various aspects of citizenship will help rehabilitation practitioners to design and improve rehabilitation interventions and connect these not only to citizenship rights but also to the various social roles and contributions of persons with disabilities in daily life.

Chair: Prof. dr. Vincent de Groot – Technology of today in the Amsterdam UMC – an overview

Speakers:

• Ka-Hoo Lam MD 
• Maaike Ouwerkerk MSc 
• Arianne Gravesteijn MSc 
• Dr. Erwin van Wegen 

Programme:
After a short introduction by prof. dr. Vincent de Groot in which he presents an overview of the technology projects (clinical and research) at the Department of Rehabilitation Medicine of the Amsterdam UMC, four presentations of 15 minutes each will follow. The mini-symposium will be concluded with a joint Q&A session.

14.10-14.25: Measuring cognitive and physical functions in MS with the smartphone - Ka-Hoo Lam MD
As technology has become inherent to our everyday lives, smartphone-based cognition and walking tests and typing on the smartphone can be utilized as digital biomarkers. In order to translate these digital biomarkers into clinical practice, the clinimetric properties are presented for these new applications in measuring and monitoring function in patients with MS.

14.25-14.40: Measuring meaningful societal participation with the Whereabouts app - Maaike Ouwerkerk MSc
Participation is often assessed in time-consuming semi-structured interviews or questionnaires that are limited in assessing real-time the pluriformity of societal participation. Therefore, the Whereabouts-app is developed to assess in real time individual-specific meaningful societal participation.

14.40-14.55: Measuring the strain of societal participation with Whereabouts - Arianne Gravesteijn MSc
Smartphones and smartwatches enable real-world measurement of societal participation over a prolonged period of time. In a 7-day period, people with MS used a smartphone app to determine perceived strain of societal participation. Physiological strain (i.e. heart rate) was determined with a smartwatch, allowing examination of the real-time relationship between perceived and physiological strain of societal participation.

14.55-15.10: Ecological momentary assessment of daily fluctuations in fatigue and physical activities - Dr. Erwin van Wegen
Simultaneously sampled self-report measures such as energy level, depression and fatigue with sensor-based recording of daily activity can elucidate the complex interaction between symptoms and physical activity, by applying an intensive repeated measurement design over a prolonged period of time.

Learning objective(s):

1. This mini-symposium allows participants to become acquainted with and gain knowledge about the various mHealth applications to improve rehabilitation care.
2. Participants understand the scientific principles and methodology of studying mHealth applications and ecological momentary assessment.
3. After the mini-symposium, participants can explain the links between clinical practice and technology and science with regard to patient and context-relevant data obtained with mHealth apps.

A4. Mini-symposium: Virtual Augmented and Mixed Reality: treatment or just a gadget?

The use of Virtual Reality (VR), Augmented Reality (AR) and Mixed Reality (MR) in rehabilitation is increasing in prevalence as it provides an opportunity for activity in an enriched environment, with resultant enhanced motivation and participation. This mini-symposium will focus on three themes: motor training, phantom limb pain (PLP) and patient education. For motor training, VR combined with motion assessment provides intensive, meaningful, task specific exercises in an enriched environment. VR based motor training applications for lower extremities, trunk and upper extremities will be presented. In the treatment of PLP, the VR/AR system creates an image of the missing limb and uses surface EMG data from the residual limb to enable the subject to control the limb and perform reaching movements. Use of this application can reduce a patient’s pain. For spinal cord injury an MR patient education module, explaining what a spinal cord injury is, has been developed in co-creation with patients. Experiences of this development and results of a pilot study in 25 patients will be presented.

The learning objective is to gain knowledge on treatment options of VR/MR in motor training, treatment of PLP and patient education. Furthermore, future applications of VR/AR/MR in rehabilitation will be discussed.

Chair: Dr. J. (Janneke) M. Stolwijk-Swüste, MD, PhD, De Hoogstraat Utrecht Rehabilitation, UMCU, Utrecht

Speakers: 

Chair: Ilse van Nes, MD, PhD, Sint Maartenskliniek, Nijmegen

Speakers:

• Rosanne van Dijsseldonk, Msc, Sint Maartenskliniek Research, Nijmgen
• Edwin van Asseldonk, PhD, Univeriteit Twente, Enschede
• Julie Blijdenstein, Team member of Project MARCH, Universiteit Delft

Programme:
In patients with complete spinal cord injury (SCI), an exoskeleton can be used as an exercise device (to promote physical health and well-being by reducing secondary health problems) and as an assistive device (to facilitate standing and walking capacity). Moreover, the wish to use an exoskeleton as a mobility device in daily life is evident from manufacturers’ claims and desired by potential users. In recent years, many exoskeletons have been developed. Despite very promising results, current available exoskeletons have limitations hampering its use. To evaluate the potential benefits of exoskeleton use, both in and outside the clinical setting, many areas need to be investigated. This workshop will give insight in the state-of-the-art knowledge and use of exoskeletons from a clinical, user, and technology perspective.

14.10-14.15: Introduction - Ilse van Nes

14.15-14.25: Improvement of quality of life after 2-month exoskeleton training in patients with chronic spinal cord injury - Ilse van Nes
Chronic complete SCI patients (n=21) followed a training program to learn how to walk with an exoskeleton. Besides the functional improvement in walking capacity, we also measured Quality of Life, satisfaction with bladder and bowel management, range of motion, pain and spasticity. The results of this study will be presented and discussed.

14.25-14.35: Needs and wishes for the future exoskeleton - Rosanne van Dijsseldonk
Exoskeleton use by people with complete SCI in daily life is still a challenge. To optimize its daily life use, a better understanding of the purpose of use and accompanying improvements from the perspective of exoskeleton users are needed. In this presentation, the results of an interview study among people with SCI with community-based exoskeleton experience (n=13) will be presented.

14.35-14.45: Supporting balance of exoskeleton users - Edwin van Asseldonk
One of the ongoing challenges in exoskeletons and an often-heard wish of their users is to assist in balance control and recovery and in doing so decrease the reliance on crutches or canes. Here we will present the recent efforts to improve balance control of exoskeleton users while standing and walking.

14.45-14.55: The experiences of a student team building their own exoskeleton - Julie Blijdenstein
Short summary: Project MARCH is a student team allied with the Delft University of Technology that annually designs and builds an exoskeleton, for someone with a spinal cord injury so that he can stand up and walk again. Project MARCH consists of 26 driven and motivated students who put their study on hold for a whole year. The 27th most important team member is the pilot Koen, who has a spinal cord injury. Project MARCH designs the exoskeleton in co-creation together with him. In this presentation, we will talk about our team, the MARCH exoskeletons, our innovations and plans for the future.

14.55-15.10: General discussion

Learning objective(s):

Participants to this mini-symposium will learn:

1. The state-of-the-art knowledge of the use of an exoskeleton in Spinal Cord Injury Rehabilitation
2. The differences between the use of an exoskeleton for training of walking capacity in patients with incomplete spinal cord injury and compensation of walking in patients with complete spinal cord injury.
3. The improvements that are necessary to be able to use the exoskeleton in daily live
4. The state-of-the-art knowledge about the research that is done regarding balance control of the exoskeleton
5. The experiences of a student team, building their own exoskeleton

Medical Education is a rapidly evolving field. Development of the new educational Blueprint of Medical Schools in 2020 brings focus on training the medical doctor of 2030 and beyond.
The Blueprint focuses on medical knowledge and interprofessional cooperation. The international classification of function, disability and health (ICF) forms a vital part of future medical education. This change is thus of interest to all people practising and teaching Rehabilitation Medicine (RM). In this symposium, we inform you about the content of the new Blueprint, focus on current practice in medical schools and outline research in medical education in the Netherlands. There are challenges ahead. Is it possible to restructure medical education with ICF elements? Interprofessional cooperation: Compilation of knowledge or just carry on as it is? What is our opinion about the medical professional in 2030?

Chair: Clemens Rommers

Speakers: 

• Willeke Kruithof
• Duco Steenbeek
• Jennifer Kuijlaars
• Imke Bloemen

Programme:

14.10-14.15: Introduction: New teaching and the Blueprint - Clemens Rommers / Duco Steenbeek

14.15-14.25: The Educational Patient Contact (EPC) in Limburg - Jennifer Kuijlaars

14.25-14.40: Education in Utrecht and Leiden patient/student contacts - Willeke Kruithof

14.40-14.55: Taking stock of Medical Education in the Netherlands: an overview - Imke Bloemen / Clemens Rommers

14.55-15.10: Discussion and future developments - Willeke Kruithof / Duco Steenbeek

Outline session: 
In this session, we inform the participants about the new outline of medical education's Blueprint. New academic challenges lie ahead. We share new educational concepts and discuss the value of ICF in medical school teaching. Educational research is presented about the EPC teaching in Rehabilitation Medicine including students' advice on implementing RM in the medical curriculum. A diverse array of educational developments in today's teaching are delivered to you from medical schools across the Netherlands
In the final presentation, we inform you about the current state of medical teaching in the Netherlands. Staff and medical students views about current and future developments are presented. To conclude the session, we actively involve participants in the discussion of how to train the medical doctor of 2030 and beyond.    

Neurological injury, such as spinal cord injury (SCI) or a cerebrovascular accident (CVA) leads to motor impairment, which affects daily physical activity and mobility. Several strategies are currently available to monitor physical activity status and predict energy expenditure among individuals: ranging from self-report questionnaires to the use of consumer or research-grade wearable devices. The implementation of these wearable devices in clinical practice is of utmost importance to determine interventions aimed at promoting physical activity. However, there are several barriers to widespread implementation. 
In addition to measuring the quantity of movement, motion sensors can also be used to determine the quality of movement. With regard to mobility, especially level of walking ability is important. Recent developments focus on applying  motion sensors to measure walking quality in a simple and fast way to be useful for routine clinical practice.
This instructional course will evaluate the currently available measurement tools used to quantify physical activity,  assess walking quality and predict energy expenditure in individuals with SCI or CVA. We will focus on the importance of measuring both quantity and quality of movement, both during in-patient rehabilitation and home-based environments after discharge from clinic. Barriers to implementation will be discussed.

Chair:  Dr .Vos- van der Hulst, Marije, MD PhD; Sint Maartenskliniek Nijmegen 

Speakers:

• Using sensor technology to measure gait during clinical rehabilitation: Maartje Hendriks, MS, Msc, department of Research, Sint Maartenskliniek Nijmegen en  department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University  Medical Center, Nijmegen
  (10 min + 2 min questions)
• Accuracy of heart rate measurement by Fitbit in people with spinal cord injury: Dirk Hoevenaars, Dirk, Msc, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam and Reade Rehabilitation and Research Center, Am­sterdam
  (10 min + 2 min questions)
• Objective measurement and quantification of daily life physical behaviour: Dr. Rutger Osterthun, MD, PhD, Rijndam Rehabilitation center, Rotterdam
  (10 min + 2 min questions)
• Implementation in clinical practice, Prof. dr. Jaap Buurke, Roessingh Research And Development, University of Twente (Department of Biomedical Signals & Systems), Enschede
  (15 min + 5 min questions)

A8. Mini-symposium: Geriatric rehabilitation: seizing the opportunity

Every year, 10% of the population aged 65 years and older are admitted to the hospital due to acute onset or exacerbation of a variety of diseases. Hospitalization is a major contributor to loss of muscle mass and strength, functional impairment and disability in older adults: 68% of patients are discharged from post-acute care settings below their pre-hospitalization level of function, more than half do not recover to their pre-admission function one year after discharge and more than one-third are discharged with a major disability that was not present before admission. These findings highlight the urgent need for effective interventions to both restore and maintain function and optimize self-dependency acutely and long-term post-discharge in this high-risk group of patients.

Geriatric rehabilitation may offer a major window of opportunity for regaining function and activity after hospitalization. In this mini-symposium, the latest results and insights from two large observational cohort- and intervention studies in hospitalized older- and geriatric rehabilitation inpatients will be presented: the Australian RESORT study (n > 2000) and the Dutch EMPOWER studies (n > 1000). These will be translated to a number of practical guidelines into how to seize the opportunities that (inpatient) geriatric rehabilitation offers to optimize function and level of activity post-discharge in older patients. 

Chairs: Prof dr. dr. Andrea Maier, internist-geriatrician, professor of ageing, VU University, Amsterdam and Dr. Carel Meskers, rehabilitation physician, associate professor, Amsterdam UMC, Amsterdam

Programme:
1. The perspective: introducing the RESORT and EMPOWER studies - Andrea Maier MD PhD 
2. From hospital to geriatric rehabilitation: how to organize in-hospital care - Kira Scheerman, PhD, Amsterdam UMC
3. RESORT study: seizing the opportunity: focus on muscle and malnutrition - Esmee Reijnierse, PhD, postdoctoral research fellow, Amsterdam UMC
4. EMPOWER-GR study: creating awareness and feasibility of embedded interventions -Laure Verstraeten, PhD student, VU University
5. Implications for geriatric rehabilitation (Carel Meskers, MD PhD
6. Closing remarks/discussion 

Learning objectives:

1. Participants are familiar with the major characteristics of resilience of hospitalized older patients;
2. The participants are familiar with the latest insight in interventions to optimize outcome after hospitalization for older patients.