Parallel sessie C
C1. Workshop: The value of PROMIS (Patient-Reported Outcomes Measurement Information System) in stroke populations; recommendations and limitations
C2. Workshop: De techniek staat voor niets: technologische ontwikkelingen in de zorg voor patiënten met een spierziekte
C3. Mini-symposium: Ambulatory 3D movement analysis using inertial sensors. Enabling 3D movement analysis in everyday clinical practice
C4. Mini-symposium:Impact through joint innovation, research and implementation: The Next Step for young patients (<25 years) with acquired brain injuries in need of rehabilitation treatment
C5. Mini-symposium: Rehab at work in progress
C6. Mini-symposium: Gait analysis of tomorrow: Precision diagnostics using instrumented treadmill technology
C7. Mini-symposium: Lifestyle in people with a disability: the role of the environment and data driven decision making
C8. Mini-symposium: Mitigating Post-Intensive Care Syndrome throughout the care continuum: state of the art and challenges for rehabilitation
Alle sessies worden in het Nederlands gegeven, tenzij dit anders staat vermeld achter de titel van de sessie.
Patient reported outcome measures (PROMs) are essential in evaluating the outcomes of health care. However, current PROMs are limited by a lack of precision, standardization, and comparability of scores across studies and diseases. The challenge is to select a questionnaire that firstly fits the research question optimally, and secondly has adequate psychometric properties in the field of interest.
In 2007 the Patient-Reported Outcomes Measurement Information System (PROMIS) became available. PROMIS measures are questionnaires that cover generic as well as specific domains. All PROMIS measures use the same metric and are standardized to the US population. The use of a normalized distribution (scale T-score with a mean of 50, and SD of 10 in a general population) enhances interpretability. PROMIS measures have been applied in numerous patient groups such as spinal surgery, critical illness, low back pain, anxiety in young cancer patients, chronic pain and general rehabilitation populations.
The International Consortium for Health Outcomes Measurement (www.ICHOM.com) promotes the use of PROMIS-GH (Global Health) as a part of routine outcome measurement for stroke patients (follow up to 3 months). The PROMIS-GH consists of 10 items and leads to two generic component scores measuring symptoms and quality of life: global physical health and global mental health.
Chair: P.H. Goossens (RvB Merem en revalidatiearts; lid van wetenschappelijke raad van Stichting Revalidatie Impact
Speakers:
- C.B. Terwee, Associate Professor, Epidemiology and Data Science, Amsterdam UMC
- H.J. Arwert, revalidatiearts Basalt Revalidatie
- J.A. de Graaf, revalidatiearts UMC Utrecht & PhD student Kenniscentrum Revalidatiegeneeskunde Utrecht
- D.M. Oosterveer, revalidatiearts Basalt Revalidatie
Outline session:
- The do’s and don’ts in value based health care, an introduction - P.H. Goossens
- The value of PROMIS item banks in value based health care, general perspectives and pitfalls - C.B. Terwee
- The use of PROMIS in stroke populations, an overview -H.J. Arwert
- Towards value-based stroke care: a comparison among commonly used Patient-Reported Outcome Measures (PROMs) to evaluate stroke outcomes - J.A. de Graaf
- Measurement properties of PROMIS item banks in stroke - D.M. Oosterveer
Learning objective(s):
Health outcome measurement can serve several goals, it can stimulate the improvement of care in specific populations, can contribute to clinical decision making in individual patients or can serve as a benchmark. In this workshop the most recent insights will be shared regarding the choices to made in
Binnen de neurologie in Nederland wordt echografie voor een toenemend aantal indicaties toegepast. Zo toonde recent onderzoek dat echografie beter in staat is een diafragmaparese aan te tonen dan röntgenfoto’s of een EMG, bovendien kan dit onderzoek ook dynamisch worden ingezet. Diafragmadisfunctie blijkt meer voor te komen bij spierziekten dan aanvankelijk werd gedacht en kan voor een fors verminderd functioneren zorgen. In de richtlijn ‘ carpaletunnelsyndroom ‘ wordt echografie zelfs als eerste voorkeur genoemd boven EMG op basis van patientvriendelijkheid.
Voor mensen met een spierziekte is de wereld door Corona nog kleiner geworden. Gamen wordt daardoor een nog belangrijker tijdverdrijf. Maar de normale besturingssystemen van spelcomputers zijn niet altijd geschikt. Het aangepast gamen heeft in het afgelopen coronajaar een vlucht genomen in Nederland.
In Nederland zijn technische universiteiten samen met revalidatie-afdelingen toenemend actief in het ontwikkelen van exoskeletten voor armen, benen en/of romp.
Uiteindelijk is het idee om alle componenten te integreren tot een full body exoskelet dat licht en comfortabel draagbaar is, de spierfunctie ondersteunt en daarmee de functionaliteit behoudt. De dag dat revalidatieartsen naast een enkel-voet-orthese een exoskelet, een aangepaste gamecontroller of een echo van het diafragma gaan voorschrijven, komt steeds dichterbij: wees voorbereid!
Dit programma is samengesteld vanuit de VRA NMA werkgroep, onder voorzitterschap van dr. Nicole Voet, revalidatiearts Klimmendaal/ Radboudumc.
Programma:
14.10-14.20: De (on)mogelijkheden van aangepast gamen voor kinderen en volwassenen met een spierziekte - Drs. Ties Klok, kinderfysiotherapeut Klimmendaal
14.20-14.45: Echografie van het diafragma en de carpale tunnel: waardevolle diagnostiek in de neurologie - Dr. Nens van Alfen, neuroloog en Dr. Jonne Doorduin, technisch geneeskundige afdeling neurologie Radboudumc
14.45-15.10: Doe-het-zelf: ontwerp een exoskelet voor armondersteuning voor jongens met Duchenne - Dr. Mariska Janssen, medior onderzoeker en Nicole Voet, revalidatiearts Klimmendaal en afdeling Revalidatie Radboudumc
Learning objective(s):
1. Leer welke mogelijkheden beschikbaar zijn om gamen toegankelijk te maken voor mensen met een beperking en hoe dit kan bijdragen aan het welbevinden van uw patiënt
2. Leer over de nieuwste ontwikkelingen en mogelijkheden op het gebied van echografie bij spier- en zenuwziekten
3. Krijg informatie over het ontwerpproces van een exoskelet
4. Leer de wensen van de patiënt mee te nemen in het ontwerp van een exoskelet
5. Leer hoe artsen en technici samenwerken in de ontwikkeling van medische hulpmiddelen
In current clinical practice, 3D movement analysis is an important tool to assess patients and guide clinical decision making. It provides objective data about individual walking patterns and effects of treatments aiming to improve walking. 3D movement analysis however is lab based, expensive and labour and time intensive. Wearable sensors are cheap and easy to apply within limited amount of time. As such, wearable sensors not only have the potential to replace expensive lab based 3D opto-electronic devices but also offer the possibility to assess individuals outside the lab during therapy or in their natural habitat. This symposium will combine knowledge from different projects targeting the use and development of wearable sensors for 3D movement analysis inside and outside the lab.
The first contribution focuses on the clinical applicability of IMUs and why it is clinically relevant to acquire kinematics (and kinetics) outside the lab. The latter is related to the Hawthorne effect, a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed. This is followed by an overview of commercially available and newly developed systems and their suitability for 3D assessment in pathological gait. Finally the validity and usability of such a newly developped application will be presented and discussed. This will be the Portable Gait Lab, a 3 IMU set-up able to measure kinematics and kinetics in patients with an asymmetric gait (e.g. stroke).
Chair: Prof. J.H. Buurke, PT, PhD, Roessingh Research And Development (Enschede), Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente (Enschede), Roessingh Rehabilitation Centre (Enschede)
Speakers:
- M. Oude Alink, MD, Roessingh Rehabilitation Centre, Enschede
- C. Baten, Ir, Roessingh Research And Development, Enschede
- R. Russcher, MSc, Department of Biomedical Signals & Systems, Technical Medical Centre, University of Twente,
- M. Nederhand, MD, PhD, Roessingh Research And Development (Enschede), Roessingh Rehabilitation Centre (Enschede)
Outline session:
9.05-9.08: Introduction symposium - Prof. J.H. Buurke
9.08-9.23: Clinical applicability of IMUs for 3D movement analysis - M. Oude Alink, MD
9.23-9.38: Commercially available and newly developed systems. Suitability for 3D assessment of pathological gait - C. Baten, Ir
9.38-9.53: Validation study of the Portable Gait Lab for patients after stroke - R. Russcher, MSc
9.53-10.05: General discussion and questions - M. Nederhand, MD, Phd
Learning objective(s):
1. Acquire knowledge about the advantages and disadvantages of using wearable sensors in 3D movement analysis.
2. Understand the added value of acquiring 3D data outside the lab.
3. Insight in the validity and usability of the Portable Gait Lab for patients after stroke.
Every year around 400/100.000 children, adolescents and young adults in the Netherlands suffer from acquired brain injury (ABI), including traumatic brain injuries (TBI) and non-traumatic brain injuries (nTBI). Consequences after onset may vary, but approximately 30% of these patients need help due to (often “invisible”) daily life problems, which frequently results in referral to rehabilitation.
To guide the chain of care, a standard of care was developed for young patients with TBI in 2016. However, not all patients with ABI receive the care they need to counteract all their problems in daily life due to multiple causes, such as inadequate referral and/or variation in treatment strategies. In addition, many questions remain regarding the content and effects of (physical) rehabilitation interventions in young people with ABI. Furthermore, patients report a need for peer contact and more and better information, including ‘return to participation’.
Therefore, we are currently in need of further developed guidelines to be able to provide ‘the right treatment, at the right time, in the right place’ for these young patients with ABI. To achieve this, multiple projects were started with the ultimate goals to provide uniformity and innovative treatment, better information provision and peer support. For these projects, multicenter research and collaboration has been set-up and novel ways of interpreting patient (and parent) reported outcomes have been created and the latest insights into rehabilitation treatment in this patient group has been investigated. In addition, the use of e-health and other innovative ways to improve peer support and information provision have been explored leading to new products to optimize care for patients with ABI.
This mini symposium brings together different experts from the field of ABI research, innovation and treatment in rehabilitation. They will share with other health professionals the latest insights in treatment, outcome interpretation, peer support and information provision (through e-health and other innovations) and the future vision for rehabilitation treatment in young people with ABI. This mini symposium will also be of interest to healthcare professionals interested in learning how to create collaborations and using innovations to enhance treatment in other chronic conditions.
Chair: Dr. Arend de Kloet, Basalt
Speakers:
- Dr Menno van der Holst, Basalt
- Florian Allonsius, Basalt
- Sandra te Winkel chair of the taskforce Hej, part of the “kindersectie VRA”
- Christiaan Gmelig Meyling, De Hoogstraat Revalidatie
Programme:
9.05-9.08: Introduction: Rehabilitation in young patients with ABI, where do we stand? - Dr Arend de Kloet, chair
9.08-9.15: Meedoen Next Step; towards the right care, at the right time, at the right place - Dr Menno van der Holst
9.15-9.25: Outcome measures and their interpretation in Rehabilitation treatment - Florian Allonsius
9.25-9.35: Physical rehabilitation interventions in children and youth during subacute rehabilitation; outcomes of scoping review - Christiaan Gmelig Meyling
9.35-9.45: Breinstraat; an innovative way to facilitate peer expert support and information provision - dr Arend de Kloet, Basalt/Patient partner
9.45-9.55: The future of (e-)rehabilitation treatment for patients with ABI; the vision of HeJ - Sandra te Winkel
9.55-10.05: Q&A
Learning oblectives:
- The path towards creating a uniform treatment for patients with ABI
- The use of outcome measures (participation, quality of life, fatigue and family impact) and optimizing their interpretation to enhance shared decision making in rehabilitation treatment
- The latest insight in physical rehabilitation interventions to enhance functional recovery and performance in daily functioning
- Novel ways to enhance peer support and information provision
- Improving psychoeducation/information on practical problems in daily life such as returning to participation
- The vision for the future of rehabilitation treatment for ABI in the Netherlands
This session gives you an update on guidelines, reimbursement, measurements and innovative vocational activities.
The session starts with an overview of vocational rehabilitation activities focusing on improvement of work participation and their relationship with reimbursement under the Dutch healthcare insurance law. Secondly, the revised Dutch guideline on ABI and work is presented with special focus on the tasks of rehabilitation professionals.
The session continues how to assess work-related functioning. The WORQ consists of a selection of categories from the ICF. A comprehensive and a brief version are available [https://myworq.org]. The measurement properties in persons with physical disabilities will be presented. Furthermore, content validity of the WORQ in persons with SCI will be discussed.
The session ends with two practical examples of vocational rehabilitation:
- Vocational rehabilitation programs, for example in patients with chronic MSD, have 3 main components: work-directed rehabilitation, work modifications and service coordination. A work module is designed to go beyond ‘clinic-based’ rehabilitation and reimbursed by the employer. Worth the extra effort and costs?
- IPS is an effective method to support people with psychiatric disorders without an employer in finding and staying in paid work. It is now investigated whether IPS can also be used in people with ABI. An outline of IPS and the research that is performed will be presented.
Chair/speaker: Coen van Bennekom
Speakers:
- Harald Miedema
- Ellen Roels
- Michel Reneman
- Jdith van Velzen
Outline session:
- Vocational rehabilitation activities within in Rehabilitation Care - Harald Miedema
- How to implement the Dutch guideline on acquired brain injury (ABI) and work in daily practice - Coen van Bennekom
- The Work Rehabilitation Questionnaire (WORQ): Measurement properties of the full and brief version in persons with physical disabilities and content validity for persons with spinal cord injury - Ellen Roels
- Evaluation of work- and economic outcomes of Dutch care-as-usual vocational rehabilitation with and without an additional work module for patients with chronic musculoskeletal disorders - Michiel Reneman
- Individual Placement and Support in people with Acquired Brain Injury - Judith van Velzen
Learning objective(s):
- To have insight in vocational rehabilitation activities that can be part of reimbursable rehabilitation programs and can enhance work participation as well as health outcomes.
- To hear about the recently revised Dutch guideline on acquired brain injury (ABI) and work and the tasks of the rehabilitation professionals.
- To have knowledge about the measurement properties of the full and the brief version of the WORQ in persons with physical disabilities and the content validity of the WORQ for use in persons with spinal cord injury (SCI) specifically.
- To learn about 3 main components of successful vocational rehabilitation and how it is applied in Dutch care-as-usual for patients with musculoskeletal disorders (MSD).
- To hear about the Individual Placement and Support (IPS) method and its (possible) feasibility for use in people with ABI.
Clinical gait analysis is a common tool in rehabilitation medicine to unravel the underlying causes of gait problems in various patient populations. Typically, gait analysis is performed on an overground walkway of around 10m, but this limits the analysis to just a few steps of unperturbed, unfatigued walking at a comfortable pace. Recent advances such as the Gait Realtime Analysis Interactive Lab (GRAIL) allow for real-time analysis in a virtual environment on an instrumented treadmill, opening up new opportunities for advanced gait assessment in more challenging environments.
In this mini-symposium we present our recent scientific work using advanced treadmill technology, focusing on the effects of AFO tuning, the assessment of spasticity during gait, and the evaluation of gait problems that arise with longer walking and the occurrence of fatigue. Furthermore, we present how to apply this technology in a clinical rehabilitation setting, using standardized clinical protocols that help improve the diagnostics of complex gait problems. We focus on the application of these protocols in both paediatric and adult neurological populations.
Chair: Prof. Annemieke Buizer, MD, Phd
Outline session:
9.05-9.10: Introduction to gait problems in rehabilitation medicine - Prof. Annemieke Buizer, MD, PhD (chair)
9.10-9.15: How advanced technology can help improve gait diagnostics - Marjolein van der Krogt, PhD
9.15-9.25: Stay Tuned! How do manipulations in ankle-foot orthosis alignment affect gait in children with cerebral palsy? - Laura Oudenhoven, MSc
9.25-9.35: Functional assessment of hyperreflexia using treadmill perturbations and the use of dynamic ultrasound in children with cerebral palsy - Eline Flux, MSc
9.35-9.45: Interaction between walking-induced fatigue and gait problems in children with cerebral palsy - Laura Oudenhoven, MSc
9.45-9.55: Prolonged walking assessment to understand the determinants of gait and balance problems in people with multiple sclerosis - Sjoerd Timmermans, MD:
9.55-10.05: Interactive discussion
Learning objective(s):
Discover the latest advances in gait diagnostics using instrumented treadmill technology, learn about their theoretical background and recent research findings, and find out how to apply the developed protocols in your own clinical practice.
This Mini Symposium will be organised by the VRA Werkgroep Bewegen en Sport (WVBS).
Rationale: Direct surroundings influence the choices we make: readily available delicious looking food invite us to choose a healthy option. Massive data collection and processing (e.g. on smart watches) also guide our decisions on hours of sleep or heart-rate while running.
A lifestyle with regular physical activity, sufficient sleep, and healthy eating behaviour is crucial for people with a disability; not only to preserve treatment effects but also to prevent the development of cardiometabolic diseases and other secondary health problems. However, a growing body of evidence points at unfavourable lifestyles in people with a physical disability. Fortunately, rehabilitation professionals increasingly focus on promotion of a healthy lifestyle in their patients.
We feel that current lifestyle interventions may gain from strongly incorporating the environment (e.g. healthy options, peer support) and data driven decisions (e.g. physical activity trackers) to enhance long-term (cost-) effectiveness.
Chair: Janneke Haisma, revalidatiearts Spaarne Gasthuis Haarlem, voorzitter WVBS
Programma:
- Rita van den Berg-Emons, Associate Professor "Health-related physical fitness and lifestyle interventions”, Rijndam RC en Erasmus MC
Presentatie over RCT's naar het effect van gedragsmatige interventies op objectief gemeten physical activity en evt fitness; rcts bij dwarslaesie, cerebrale parese, en cardiorevalidatie patienten (met en zonder obesitas). Tendens: je kan gedrag veranderen, maar effecten zijn niet heel groot, en vaak verdwijnen ze ook weer (deels). Verschillende mogelijkheden om deze effectiviteit te vergroten, een ervan is om de omgeving te betrekken. - Deskundige op het gebied van objectieve activiteitenmeting: Hoe kan objectieve data verzameling (over activiteiten) aanzetten tot verandering in gedrag?
- Marketing strateeg: Welke marketing strategie kan worden gebruikt om mensen aan te zetten tot gezond gedrag?
- Gedragsdeskundige: Hoe bepaalt de fysieke en sociale omgeving de gezonde (on)bewuste keuzes die je maakt?
Learning objective(s):
Speakers from both rehabilitation and corporate settings show us how the decisions we make are influenced by our environment and by the visualisation of data. With this knowledge we can help our patients make healthy choices.
The audience will be taken at a patient journey through his rehabilitation trajectory from the ICU to his own home.
14.10-14.12: Welcome by Marike van der Schaaf
14.12-14.22:Rehabilitation for patients with the Post Intensive Care Syndrome from ICU to home; the state of the art. (including discussion by Marike van der Schaaf)
With the COIVD-19 pandemic the awareness of the urgency for a seamless rehabilitation trajectory for survivors of critical illness with the Post Intensive Care Syndrome has raised. In this presentation, an overview of the current state of the art on rehabilitation interventions will be provided.
14.22-14.32: Rehabilitation in the ICU: walking towards independence using novel technology (ncluding discussion by Robin Kwakman)
Ambulation training with critically ill patients is difficult because of muscle weakness, low exercise capacity and the attachment of medical and monitoring equipment. Using a mobile treadmill with the ability to support body weight may overcome the barriers and facilitate early ambulation training in critically ill patients, but does it shorten the recovery time of independent ambulation?
14.32-14.42: Practical and organizational aspects of rehabilitation care at the hospital ward (including discussion by Martijn Dremmen)
Which practical and organizational challenges do we have to face in delivering the right rehabilitation care at the right moment at the right place, during hospital stay? In this presentation we will discuss possible problems to face, but also changes to take in improving the rehabilitation care for the critical ill patient in the hospital phase.
14.42-14.52: Recovery at home: multidisciplinary rehabilitation interventions for patients with PICS in the community: REACH (including discussion by Mel Major)How can we best provide rehabilitation interventions after hospital discharge for patients who have survived critical illness? An overview of the latest evidence on interdisciplinary, personalized interventions targeting health holistically, in light of a best practice example: the REACH network.
14.52-15.02: Introduction to the VRA working group on PICS (including discussion by Bea Hemmen)
In this interactive session, the aims and actions of this new VRA working group will be discussed with the audience.
15.02-15.10: Discussion Towards a seamless rehabilitation trajectory for PICS
Speakers and audience