Parallel sessie C

In the Netherlands, 2 million patients experience musculoskeletal chronic pain. This has a considerable socio-economical impact caused by healthcare costs and work disability. There is a large interindividual variation of the impact of biopsychosocial factors on the patients’ functioning and participation. Current healthcare organization for management of chronic pain is insufficient and inefficient. Often, a patient receives a large variety of treatments based on different frameworks and explanations for the pain problem. This time-consuming search, for often a solution for pain, repeatedly leads to disappointment. According to reports from the Taskforce ‘De juiste zorg op de juiste plek’ (2018) and the ‘Zorgstandaard Chronische Pijn (2017)’ an integrated biopsychosocial view, assessment and treatment is indicated. The workshop will explore initiatives, barriers and facilitators, and effectivity of organizing chronic pain rehabilitation networks.
All presented networks in this mini-symposium contain elements of:

• Transdisciplinary collaboration (within and between primary, secondary and tertiary care); lead to better understanding between healthcare professionals and a patient centered approach
• Integration of the biopsychosocial view
• Transparency in determination of complexity and referral of the patients to the right place based on the complexity of their complaints (Matched care).
• Transparency of the treatment protocols.

Chair(s): Dr. Ivan Huijnen, Adelante/Maastricht University

Outline session: 

• Introduction: Dr. Huijnen 
   
• Transdisciplinary care in chronic pain; a fundament for patient centered care, by Prof. Dr. C. Paul van Wilgen (Transcare and Vrije Universiteit Brussel) 
   
• The health journey and satisfaction of patients suffering from chronic pain in Twente, by Dr. ir. Wendy Oude Nijeweme-d'Hollosy (University of Twente and Roessingh Research & Development (RRD)  
   
• Results of a transmural network in chronic pain: the Network Pain Rehabilitation Limburg, by Cynthia Lamper, MSc. (Maastricht University) 
   
• Specialist care in the primary care setting, by Vera Baadjou, MD PhD. (Maastricht University and Adelante) 
   
• General discussion

Learning objective(s):

1. Learn about examples of initiatives of organizing chronic pain rehabilitation in networks
2. Learn about barriers and facilitators in starting and working in these networks.

Novel insights in fatigue and fatigability demonstrate that both are underestimated problems occurring in a large variety of pathologies. Despite their high prevalence and large impact on patients’ participation, quality of life and ability to participate in rehabilitation programs, these symptoms are often overlooked and their consequences in rehabilitation are insufficiently understood. In the current session, we aim to summarize the literature on definitions, taxonomy, assessment protocols, outcome measures and interventions for fatigue and fatigability in the domains of walking biomechanics, neuromotor, cardiorespiratory and paediatric rehabilitation. The definitions and underlying factors of different types of fatigue and fatigability, including trait and state fatigue and cognitive and motor fatigability, are discussed throughout the session and an updated taxonomy is presented. An overview of the different assessment methods, currently used clinical tools and novel methods based on innovative technologies will be discussed. Finally, the scientific evidence regarding different types of interventions for fatigue and fatigability is summarized, highlighting the importance of multidisciplinary and multimodal treatment programs. Hereby, attention is paid towards the implementation of these methods in clinical care.

Chair(s): Heremans Elke, PhD P.T., Research Expert Faculty of Rehabilitation Sciences, UHasselt

Speakers:

• Fanny Van Geel (PhD researcher Hasselt University) is an expert on walking fatigability and related symptoms in persons with MS.
• Maarten Van Herck (PhD researcher Hasselt University) investigates subjective fatigue in patients with lung diseases and the impact of rehabilitation upon fatigue.
• Kyra Theunissen (PhD researcher Maastricht University & Hasselt University) focuses on the biomechanics and energetics of walking fatigability in persons with MS and RA.
• Lieke Brauers (PhD researcher Maastricht University & Hasselt University) investigates motor fatigability in the upper limbs of children with CP.

Outline session: 
We bring together four experts from different domains, i.e. biomechanics, neuromotor, cardiorespiratory and paediatric rehabilitation. The speakers are experts in research on fatigue and fatigability in patients with multiple sclerosis (MS), rheumatoid arthritis (RA), cerebral palsy (CP), chronic obstructive pulmonary disease, asthma and osteoarthritis.

• Fatigue and fatigability: an updated taxonomy 
   
• Impact and prevalence of fatigue and fatigability in adults and children 
   
• Assessment of fatigue and fatigability: golden standard and innovative methods 
   
• Combining novel methods for understanding the relationship between walking mechanics and fatigue 
   
• Novel interventions for treatment of fatigue and fatigability 
   
• Group discussion 

Learning objective(s):

1. To clarify the definitions of different types of fatigue and fatigability and provide the audience with a clear taxonomy for future use in scientific research and clinical practice;
2. To give an overview of the different assessment methods for fatigue and fatigability and the reliability of the available measurement instruments, including the presentation of novel technological assessment methods;
3. To summarize novel evidence regarding fatigue and fatigability in the field of biomechanics and neuromotor, cardiorespiratory and pediatric rehabilitation;
4. To provide an overview of currently used and investigated treatment methods for fatigue and fatigability and their effectiveness

This workshop will provide an overview of the current state-of-the-art in lower-limb prosthetics as well as an overview of current advancements within research.

Chair(s): Prof Hans Rietman, MD, PhD

Outline session: 

• Introduction symposium and overview of current state-of-the-art, bij chair Prof. Hans Rietman, MD, PhD 
   
• Developments in osseo-integration for lower-limb prosthetics, by Henk van der Meent, MD, PhD 
   
• Development of myolectric control algorithms for a transfemoral prosthesis, by Erik Prinsen, PhD 
   
• Development of control algorithms for a powered tranfemoral prosthesis, by René Fluit, PhD 
   
• General discussion and questions, by chair Prof. Hans Rietman, MD, PhD 

Learning objective(s): 

1. To obtain an overview of the current state-of-the-art in lower-limb prostheses
2. To obtain an overview of the state-of-the-art in osseointegration for lower-limb amputation
3. To understand how the use of myoelectric signals can improve the control of transfemoral prostheses
4. To understand how advanced control algorithm can improve the control of powered transfemoral prostheses

Telehealth models of care involving home-monitoring have shown clear benefits for patients with chronic disease while reducing unnecessary clinic visits. These models of care show promise in empowering patients to better manage their health and to participate in their care, thereby improving compliance with treatment and their satisfaction with care. Furthermore, they enable health care professionals to provide timely intervention and personalized care. Despite the increasing evidence of effectiveness of telehealth technologies obtained from small-scale studies, the adoption of telehealth solutions in rehabilitation remains limited. Benefits of home monitoring may apply to several diagnostic groups in rehabilitation medicine such as neuromuscular diseases, spinal cord injury, cerebral palsy and chronic pain disorder. Barriers that need to be overcome to achieve widespread adoption of telehealth include acceptance of this technology by patients and health care professionals, economically sustainable reimbursement systems and interoperability between electronic patient record systems. In this interactive mini-symposium we will introduce examples of currently used models of rehabilitation care based on home-monitoring with special focus on the scalability and sustainability of these care innovations. The audience will be invited to reflect on the opportunities and challenges of home-monitoring in rehabilitation populations to identify strategies to promote implementation and advance adoption of home-monitoring and coaching in rehabilitation medicine.

Chairs:

• Esther Kruitwagen, MD, Rehabilitation specialist, Dept. of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht
• Anita Beelen, PhD, Senior Researcher Neuromuscular diseases, Dept of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht

Speakers:

• Pearl  van Lonkhuizen MSc, Dept of Public Health and Primary Care, Leiden University Medical Center
• Dr. PhD Manon Dontje,Dept of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht
• Prof. MD PhD Nico Wulffraat, Dept of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht

Program outline:

• Introduction by drs. Esther Kruitwagen and Dr. Anita Beelen
   
• Development of a European eHealth care model to improve quality of life in Huntington’s Disease: a user-centered design study, by Pearl van Lonkhuizen
   
• Nationwide implementation of ALS Home monitoring and Coaching, by Manon Dontje
   
• Home monitoring by juvenile arthritis adolescents or parents using an App Reuma2Go. Can it be used to replace clinical visits? by Prof. Nico Wulffraat, MD PhD
   
• Reflection and discussion 

Learning objectives:
At the end of the mini-symposium participants understand the value of care models based on home monitoring and recognize the challenges of promoting implementation and advancing adoption of home-monitoring in rehabilitation medicine.

Recent research has dramatically changed the insights on Parkinson’s. It used to be seen as a neurodegenerative brain disease with merely motor symptoms due to loss of dopamine production in the substantia nigra with no possibility of functional recovery. Brain Research of Parkinson’s have shown an important role for sensory-motor disorders in the basal ganglia, leading to microkinesia and hypophonia with specific complex impairments. To challenge these the broad multidisciplinary functional insight of Rehabilitation Medicine is needed in conjunction with medication to make the most of the neuroplasticity to fight the neurodegenerative disease.

As pioneer in Parkinson Rehabilitation in the Netherlands, Meander MC has successfully introduced an interdisciplinary short intense treatment aiming in restoring the amplitude affected due to microkinesia and hypophonia. In these treatments patients are taught to nominalize their movement and speech in daily life by increasing their amplitude with specific daily exercises. Research shows that patients not only improve during training, but are able to show improvement with the daily exercise even after the Rehabilitation has stopped. Given all these findings it’s important that the knowledge on Rehabilitation Medicine of Parkinson’s is shared to improve treatment for all patients with Parkinson’s.

Chair(s): Willem Jacob Oudegeest (1974-) is the leading consultant Physical Rehabilitation Medicine in the Netherlands for Parkinson Rehabilitation. He works in Meander Medical Center in Amersfoort the Netherlands, and is also President of the Workgroup Parkinson and related Movement disorders of the Netherlands Society of Rehabilitation Medicine and core member of the Parkinson Advisory Board of the Parkinson Association Netherlands. His aim is to continues improve Parkinson Rehabilitation by implementing the newest treatments and sharing his knowledge with patients and colleagues.

Speakers:

• W.J. Oudegeest, physiast Meander MC, Amersfoort
• B.M. (Tineke) Snoeijer, physiotherapist Meander MC, Amersfoort
• M.G. (Monique) Hermans, Speech therapist Meander MC, Amersfoort

Outline session:

• New insights in Parkinson: basal ganglia and microkinesia by W.J. Oudegeest 
• BIG movements adressing microkinesia, by B.M. (Tineke) Snoeijer 
• LOUD voice adressing hypophonia, by M.G. Hermans

Learning objective(s):
Understanding the new insights of Parkinson with a central role for the basal ganglia and microkinesia and hypophonia and knowing how to adress these in an interdisciplinary intense Rehabilitation treatment toe empower the patient to fight the neurodegenerative disease in their daily life.