E1. Strength and fatigue of the upper limb in children with Unilateral Spastic Cerebral Palsy. New insights in measurement and training
E2. Sexual Health Care in physical rehabilitation medicine: pitfalls and challenges
E3. Value Based Health Care in Rehabilitation: From Hype to Reality
E4. Measuring cognitive functioning in rehabilitation: brief screening and outcome measurement
E5. The application of sensors to objectively monitor orthopaedic footwear adherence in research and clinical practice
E6. Rehabilitation, Sport & Active Lifestyle: now and in the future
E7. Patient Participation in Research: Challenges and Opportunities
E8. PROFITS: opportunities to improve prediction and services early post stroke.
E1. Mini-symposium: Strength and fatigue of the upper limb in children with Unilateral Spastic Cerebral Palsy. New insights in measurement and training
Clear evidence and well performed research related to strength measurement and training of the upper limb in children with Unilateral Spastic Cerebral Palsy (USCP) are still lacking. Untill now no clear answers can be given on the following questions:
- Which tests should be used: grip strength tests or task-oriented strength tests?
- Is grip strength of the Non-Affected Hand diminished compared to typically developing children?
- Is strength and/or muscle fatigue important in the upper limb in children with USCP?
- What type of training should be performed, task-oriented strength or muscle related strength?
In this mini-symposium we will address above mentioned questions. The need of strength testing and training in children with USCP as well as the results of grip strength measurement and task-oriented strength measurement studies will be presented. After these presentations the results of the first study on muscle fatigue of the upper limb and the preliminary results of the multi center Dutch RCT of Task-oriented Arm Strength training (TOAST-CP) will be presented. We will end with a panel discussion with the audience regarding the pros and contra’s of the presented results and special focus will be on the translation of these results to clinical practice of rehabilitation in children with USCP.
Chair: Prof. Rob Smeets MD PhD, Maastricht University, The Netherlands
Speakers: Eugene Rameckers, Koen Dekkers, Mellanie Geijen, Lieke Brauers
- Are children with Unilateral CP weak in the non affected upper limb - Koen Dekkers MSc, Revant, Breda, The Netherlands
- Task-oriented strength measurement of the upper limb in children with CP - Mellanie Geijen MSc, Maastricht University, The Netherlands
- Grip fatigue of the upper limb in children with CP and TD, does it exist? - Lieke Brauers MSc, Hasselt University, Belgium
- Effect of Task-oriented arm strength training in children with CP on strength and upper limb skills - Eugene Rameckers PhD, Adelante Rehabilitation, The Netherlands
E2. Mini-symposium: Sexual Health Care in physical rehabilitation medicine: pitfalls and challenges
Sexual health issues are more prevalent among people with a chronic illness or physical disability than among the general population. Although sexual health care in the rehabilitation setting in the Netherlands is a growing field of interest, integrating Sexual Health in the overall care for rehabilitation patients has proven to be a challenge. With this mini-symposium we will introduce you to different levels of the exciting field of Rehabilitation Sexology. On a Macro-level: how does SHC fit into the vision for specialist rehabilitation medicine in the year 2025 - where network-medicine, prevention and self-management will be important? On a Meso-level: how can you organize SHC within your operational interdisciplinary Team? On the Micro-level we will focus on the importance and meaning of SHC for the rehabilitation patients. Special attention will be given for the so-called validation-problems of youngsters in physical rehabilitation who experience a disturbance in their social-sexual development.
Chair: Woet Gianotten, Consultant Rehabilitation Sexology, UHD Medical Sexology UMC, Utrecht and Erasmus MC, Rotterdam
Speakers: Riet Pieters, Egbert Kruijver, Jim Bender, Ans Mellink
- “Sexual Health Care; What’s it all about? Developments in Rehabilitation Sexology; looking towards the year 2025.”: Sexual Health Care is not only important for the quality of life of people with disabilities or chronic illnesses, but is also an essential part of a holistic approach. What are the opportunities and dilemmas to integrate SHC in the modern Rehabilitation Medicine, anno 2025? - Egbert Kruijver, Social Worker MSW Sexologist NVVS - Sophia Rehabilitation, The Hague; De Hoogstraat, Utrecht; Private Practice, Nieuwegein. Chairman of the Dutch NVVS special interest group for rehabilitation sexology.
- “Rehabilitation Sexual Health Care is team work; an interdisciplinary approach”: Jim will base his talk on years of experience, working in and training of rehabilitation teams in sexual health care. The focus is the integration of sexual health care within an operational interdisciplinary team in the rehabilitation setting. Keywords: rehabilitation sexology is teamwork, ‘sexuality aware attitude’, and professional communication. Background literature: “Training rehabilitation teams in sexual health care: a description and evaluation of a multidisciplinary intervention”, in: Disability & Rehabilitation, January 12th 2017. - Jim Bender, Health Psychologist Sexologist NVVS - Sophia Rehabilitation. The Hague; Private Practice, The Hague. Trainer and consultant at Bender & Pieters, Training & Consultancy in Rehabilitation Sexology, Woerden. Has had a pioneering role in the Dutch rehabilitation sexology since 1995.
- “Sexuality reborn; Sexual Health Care for adults in physical rehabilitation”: This talk will provide insight into the work of a rehabilitation sexologist treating adult patients in the Dutch rehabilitation setting. What are the sexual health issues that patients have and how are they addressed? What are helpful interventions? Special topics: intimacy, incontinency and pelvic physiotherapy, problems with intimacy & sex requires rehabilitation work within a relationship. - Riet Pieters, MD Sexologist NVVS - Heliomare, Wijk aan Zee, Private Practice, Woerden. Works with people with SCI, Chronic Pain, brain injury and CP. Trainer and consultant at Bender & Pieters, Training & Consultancy in Rehabilitation Sexology, Woerden.
- “An ounce of prevention is worth a pound of cure; sexual forming for youngsters with disabilities”: Youngsters with physical disabilities often experience a disturbance in their social-sexual development. Need for medical attention, dependence on caregivers and little privacy influences the way they develop in relation to their (sexual) body and their (sexual) autonomy. These youngsters often have difficulties integrating intimate relations in their lives and are especially vulnerable for sexual abuse and other negative aspects of sexuality. Key word is ‘awareness about sexual health issues’ among children and adolescents with disabilities as well as their parents, teachers and caregivers. - Ans Mellink, Social Worker MSW, Sexual health consultant - Merem Rehabilitation, Hilversum. As a member of MDT she works with children, adolescents and adults, as contextual therapist also works with families and couples.
E3. Mini-symposium: Value Based Health Care in Rehabilitation: From Hype to Reality
The principles of Value Based Health Care (VBHC) are increasingly adopted in health care, including medical specialist rehabilitation. Its main concept concerns the improvement of the value for the patient of the health care delivered. This not only requires the redesign of health care processes, e.g. by means of patient-centred care pathways and structural involvement of the patient in decision making. It also implies the appropriate measurement of outcomes in such a way that the value for the patient can indeed by demonstrated. Regarding the measurement of the value of rehabilitation for the patient, comprehensive sets of recommended outcomes are being developed or launched on both the national and international level. However, experiences with extensive outcome measurements based on the principles of VBHC from rehabilitation practice are very much needed, in order to further develop this field.
Participants in this mini-symposium:
-Are familiar with the principles of VBHC and its application in rehabilitation medicine
-Are aware of activities of the International Consortium for Health Outcomes Measurement (ICHOM) and parallel national and international initiatives regarding outcome assessment within the field of rehabilitation medicine
-Can apply the principles of shared decision making in stroke rehabilitation
-Have insight into potential success and failure factors of measuring the outcomes of stroke rehabilitation based on the VBHC principles
Chair: Paulien Goossens
Speakers: Felici van Vree, Thea Vliet Vlielan, Markus Wijffels, Helene Voogdt, Iris Groeneveld, Marieke de Jonge
- General introduction - Paulien Goossens, physiatrist MD PhD, Rijnlands Rehabilitation Center, Leiden, Netherlands
- Value Based Health Care (VBHC) in Rehabilitation - Prof. Thea Vliet Vlieland MD PhD - Professor of rehabilitation processes and physical therapy at the Department of Orthopaedics, Rehabilitation and Physical Therapy of the LUMC
- The challenge of VBHC and bundle payment for ischaemic stroke in Rotterdam Stroke Service. Did we succeed? – Markus Wijffels, physiatrist MD, Rijndam Rehabilitation center, Rotterdam, Netherlands
- Patient-centred rehabilitation: Shared decision making in stroke rehabilitation - Helene Voogdt, PhD, MSc, projectleader Shared decision making in stroke rehabilitation, Dutch Knowledge Network Stroke services, Utrecht, Netherlands
- VBHC: From theory to practice! - Felicie van Vree MSc MA researcher / Marieke de Jonge, quality consultant, Rijnlands Rehabilitation Center, Leiden, Netherlands/ Iris Groeneveld PhD, researcher, Sophia rehabilitation Center, Den Haag, Netherlands
- Plenary discussion
E4. Mini-symposium: Measuring cognitive functioning in rehabilitation: brief screening and outcome measurement
This mini-symposium will highlight the use of brief screening and outcome measures in medical rehabilitation, in particular the Montreal Cognitive Assessment (MoCa; a test to measure objective cognitive functioning), the Checklist of Cognitive and Emotional complaints (CLCE-24) (a questionnaire to measure subjective cognitive functioning) and the cognition scale of the Utrecht Scale for Evaluation of Rehabilitation (USER-cognition; an observational instrument). Measurement of cognitive dysfunction is well-developed and many validated tests for specific cognitive functions are available and commonly used for diagnostic purposes. Less evidence exists on the use of brief screening measures such as MoCA and the CLCE-24 for use in research and clinical practice. Measurement of cognition outcomes of rehabilitation is even less developed. The physical independence score of the USER is commonly used to measure outcomes of stroke rehabilitation in the Netherlands, but the USER-cognition score is not used and its validity is largely unclear to date. Based on results from recent cohort studies, clinical trials, routine outcome measurement, and clinical experience, the speakers will discuss the possibilities and limitations of these measures.
Chair: Marcel Post
Speakers: Marcel Post, Coen van Bennekom, Caroline van Heugten
- Introduction to the workshop - prof. Marcel Post, PhD, professor of spinal cord injury rehabilitation, Center of Excellence for Rehabilitation Medicine Utrecht, Netherlands
- Cognitive functioning based on the MoCA and CLCE-24 in brain injury research - Prof. Caroline van Heugten PhD, professor of clinical neuropsychology, Maastricht University Medical Center, Maastricht, Netherlands
- The USER-cognition as outcome measure of rehabilitation - Marcel Post
- Validity of cognitive screening measures in research and clinical practice - Prof. Coen van Bennekom, MD, PhD, professor of rehabilitation and labour, Heliomare Rehabilitation Center, Wijk aan Zee, Netherlands
- General discussion
E5. Mini-symposium: The application of sensors to objectively monitor orthopaedic footwear adherence in research and clinical practice
For orthopaedic footwear to be effective, it is essential that patients adhere to wearing them. After decades of subjective monitoring of footwear adherence, new technology has found its way to research and clinical practice. Sensors based on recording temperature are available that can be placed in the footwear, for accurate and objective adherence measurements. During this symposium, the latest research insights obtained from using these sensors will be presented from clinical trials at AMC and UMCG. Presentations from the AMC focus on people with diabetes at high-risk for foot ulceration, for whom adherence is essential to prevent ulcers. This includes not only insight in their adherence patterns, but also interventions to improve adherence via motivational interviewing and the provision of “orthopedic-home-shoes”. The UMCG coordinates the SOFA-trial, in which more than 250 patients have already been included, with an adherence sensor placed in their first pair of orthopedic shoes. This sensor will register adherence continuously for 12 months, providing unique insights into long-term adherence patterns and potential seasonal changes. Finally, several orthopaedic shoe companies use these sensors in daily clinical practice. The last presentation of this symposium will focus on the challenges and benefits when implementing these sensors in footwear practice.
Chair: Jaap van Netten en Klaas Postema
Speakers: Jaap van Netten, Sicco Bus, Juha Hijmans, Tessa Busch-Westbroek, Thijs Lutjeboer, Rob Verwaard
- Introduction - Jaap van Netten PhD, Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- The first steps – development of the @monitor and insights in adherence patterns of diabetes patients at high-risk of foot ulceration - Sicco Bus, AMC Amsterdam
- The next step – validation of the Orthotimer and its application in the SOFA trial - Juha Hijmans, UMCG Groningen
- The longest step – results of 12 months continuous monitoring of orthopedic footwear - Thijs Lutjeboer, UMCG Groningen
- The adherent step – increasing orthopedic footwear adherence in people with diabetes via objective monitoring, motivational interviewing and “orthopaedic-home-shoes” - Tessa Busch-Westbroek, AMC Amsterdam
- The real-life steps – implementing adherence sensors in clinical practice - Rob Verwaard, Wittepoel. Rotterdam
- General discussion with the audience and closing remarks - Klaas Postema MD PhD, Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, the Netherlands
E6. Mini-symposium: Rehabilitation, Sport & Active Lifestyle: now and in the future
During the last two decades much has changed in rehabilitation practice. Rehabilitation and human movement sciences have bridged many gaps between theory and a more evidence-based practice. Gait labs, instrumented treadmills, robotics and exercise testing facilities have taken a place in rehabilitation institutes and have in many ways become elementary to institutional rehabilitation. The importance of exercise physiology and it’s notions of testing, (de-)conditioning, physical activity, sedentariness, stress-strain-capacity and economy/efficiency of human mobility has evolved into daily rehab practice and the rehabilitation paradigm, and is viewed being essential ingredients for an active and participating individual after rehabilitation. Apart from exercise testing becoming an integral part of patient monitoring, patient-specific training and training guidelines have consequently evolved. With the worldwide outreach of ‘Exercise=medicine’, the stimulation of a physically active lifestyle within and beyond the doors of the rehabilitation centers has become key: to daily functioning, participation, health and well-being over the lifespan. Yet, are we doing a sufficiently decent job, what should and can be done better in a future of shorter clinical rehabilitation and more distant rehabilitation programs? How do persons with a disability pick up this challenge, which professional skills are required, where and when, what motivational elements can be laid out, what limiting factors play a role, what is the role of self-management, social economic status, a personal orientation towards sports and active lifestyle? How can we combine this with more personalized programs and advanced technologies? Many questions lay ahead, some can be answered now, but a future collaborative research agenda needs to evolve to help tackle this multifaceted challenge.
Chair: Lucas van der Woude
Speakers: Lucas van der Woude, Rienk Dekker, Trynke Hoekstra, Femke Hoekstra, Bregje Seves, Floor Hettinga, Leonie Krops
- Rehabilitation, Sport & Active Lifestyle: now and in the future - Prof Lucas van der Woude PhD, Rienk Dekker MD PhD Center for Rehabilitation, UMCG, University of Groningen
- ReSpAct, a prospective cohort study in and beyond Dutch Rehabilitation - Trynke Hoekstra PhD Health Sciences, VU University, Amsterdam / Femke Hoekstra PhD - University of British Columbia, Canada
- Fatigue and physical activity behavior in stroke patients - Bregje Seves MSc, Center for Human Movement Sciences, UMCG, University of Groningen
- Is ‘learning to pace’ the linking pin in an active lifestyle after rehab? - Floor Hettinga PhD - University of Essex, UK
- Stimulating physical activity in hard-to-reach physically disabled people - Leonie Krops PhD, Center for Rehabilitation, UMCG, University of Groningen
- General discussion
E7. Workshop: Patient Participation in Research: Challenges and Opportunities
We believe that research should not be ‘about’ or ‘for’ patients, it must be ‘with’ patients. Engaging patients and families in all stages of research, from ideas and research questions to implementation, increases relevance and impact of projects. Interest in patient involvement in research has been growing in recent years. However, patients’ active participation in research is not self-evident. Special efforts are necessary to enable partnerships in research and to make it work. In several research projects we have used various ways to engage patients and parents. In this journey we found that true participation may be different for individual patients/parents, and may be different in various stages of a project. Discussing preferences and expectations highly supports patient engagement. We therefore developed the ‘Participation Matrix’, a tool aiming to promote and facilitate collaboration of patients and researchers. In this workshop we will present and discuss examples, experiences and tools supporting active involvement of patients and families in research.
Objectives of this workshop:
1) raising awareness why patient engagement in research is important
2) demonstrating examples of ways of making patient engagement happen
3) introducing the participation matrix, a tool to guide patient engagement
Chair: Marjolein Ketelaar
Speakers: Marjolijn Ketelaar, Martijn Klem, Dirk-Wouter Smits, Jan Willem Gorter, Mattijs Alsem
- Introduction and background – Marjolijn Ketelaar, senior researcher, Center of Excellence for Rehabilitation Medicine Utrecht; De Hoogstraat Rehabilitation and UMC Utrecht
- From subject to partner and back: shifting roles in patient participation – Martijn Klem, director BOSK
- About various roles in research: the Participation Matrix as a tool to enable engagement – Dirk-Wouter Smits, post-doc researcher, Center of Excellence for Rehabilitation Medicine Utrecht
- The use of social media in engaging families in research - Jan Willem Gorter, director of CanChild, McMaster University, Hamilton, Canada
- Experiences and examples of active involvement by parents in a research project – Mattijs Alsem, rehabilitation physiatrist, AMC
- Interactive discussion: Active engagement of patients and parents in research: Next steps!
E8. Workshop: PROFITS: opportunities to improve prediction and services early post stroke
There is a dire need for transparent, predictable referral policies and adequate follow-up of stroke rehabilitation services to improve quality of care based on evidence based and individually tailored rehabilitation plans (Langhorne et al, 2011). The PROFITS project (Precision profiling to improve long-term outcome after stroke) develops and implements a standardized initial and follow- up assessment of motor recovery post stroke in terms of behavioral restitution (primary neurological repair) and compensation strategies in line with the recommendations of the international stroke recovery and rehabilitation research group (SRRR, Bernhardt et al, 2017; Kwakkel et al, 2017). PROFITS serves both a clinical goal i.e. building a clinimetric backbone- clinical infrastructure for standardized evaluation of referral policies and interventions early after stroke as well as research purposes, i.e. optimization of prediction models and fundamental understanding of motor recovery. A key feature of PROFITS is its clinimetric core set based on current guidelines (KNGF) in which education and training of proper assessment is considered crucial for obtaining reliable and valid outcome. A second feature is the possibility of multicenter data- aggregation by using a tailor- made web-based data-entry, storage facility and computerized prognosis (GEMSTRACKER- Pulse). This workshop discusses the clinical potential of aforementioned approach.
Chair: Gert Kwakkel & Carel Meskers
Speakers: Carel Meskers, Gert Kwakkel, Aukje Andringa, Ruud Selles
- The base: understanding neurobiological and functional recovery post stroke - Prof. Gert Kwakkel PhD, Chair Neurorehabilitation, VU University Medical Center, Amsterdam, The Netherlands
- Clinical consequences & implementation - Carel Meskers MD PhD, Rehabilitation Physician, Associate Professor, VU University Medical Center, Amsterdam, The Netherlands
- How to implement a clinimetric core-set - Aukje Andringa, Physiotherapist, PhD student, VU University Medical Center, Amsterdam, The Netherlands
- ICT infrastructure: design, implementation and perspectives - Ruud Selles PhD, Associate Professor, Erasmus Medical Center, Rotterdam, The Netherlands
- How to move forward: bringing early rehabilitation post stroke to a higher level - Gert Kwakkel & Carel Meskers