INNOVATION From creation to implementation VRA Annual Congress 2012 NH Conference Centre Leeuwenhorst, Noordwijkerhout,The Netherlands Thursday November 1 st and Friday November 2 nd, 2012 PROGRAMME THURSDAY
Sponsors The VRA Annual Congress 2012 has been made possible by many exhibitors. Therefore they deserve your attention and appreciation. Congress Venue NH Conference Centre Leeuwenhorst Langelaan 3 2211 XT Noordwijkerhout The Netherlands T +31.25.2378888 Organizing Society Netherlands Society of Physical and Rehabilitation Medicine Ipsen Farmaceutica VIR e-care Solutions Allergan Ambroise Basko Healthcare Bewegingsvisie Bioness Careways International Endolite Federatie PAS FIOR & GENTZ ForceLink Frank Jol Orthopedische Dienstverlening Hankamp Rehab Loth Fabenim Medi Nederland Motek Medical Ortho Europe Ortho-Medico Orthowel Groep Össur Prompt Healthcare Rembrandt Schoenen Secma Thuasne Vihome Postal address Postbus 9696 3506 GR Utrecht The Netherlands T +31 (0)30-27 39 696 www.revalidatiegeneeskunde.nl vra@revalidatiegeneeskunde.nl Congress registration and acquisition sponsoring T +31 (0)6-14 47 52 82 T +31 (0)6-42 43 07 99 F +31 (0)182-63 43 42 www.janssensenvandeutekom.nl info@janssensenvandeutekom.nl 2
Innovation: from creation to implementation With this theme of the upcoming international annual congress of the Netherlands Society of Physical and Rehabilitation Medicine, the scientific committee wants to highlight the utmost importance for our profession not to stand still but to look for new avenues to face the several current and future challenges. For example, the expected increase of the mean age of the general population, the higher prevalence of co-morbidity and the consequences of advanced medical technology will result in a tremendous growth of patients with disability and restrictions in participation. Furthermore, a lack of sufficient health care workers is foreseen, which will make it impossible to take care of all these demands, and even more important, we seem to have reached the limits of the budget for health care and disability management. So we will have to disappoint many of our patients, unless we are able to come up with new concepts how to attract and educate new colleagues, find innovative solutions to enhance collaboration with other health care professionals, increase the effectiveness and efficiency of our interventions by incorporating knowledge from other medical specialists and other fields like technology such as IT and Virtual Reality. As chair of the scientific committee, I want to thank my colleagues of the committee for putting together a very exciting programme with five excellent and renowned keynote speakers who will share their point of view on the opportunities, challenges and pitfalls of innovation. This year the scientific committee also decided to innovate, as we will "Innovation distinguishes between a leader and a follower" Steve Jobs gather at a new venue in order to host even more participants and provide a better floor for colleagues to share their scientific work and ideas. Especially, a better display and more time will be provided to researchers to present and discuss their posters. And last but not least, the highest number of symposia/workshops (19) ever, including 3 sessions with in total 24 excellent free paper presentations are scheduled. I do hope that we all will have a high quality and very interactive congress, which will boost our energy to create and innovate! Professor Rob Smeets MD PhD Chair Scientific Committee 3PREFACE
Bij Pom staat de cliënt centraal. Iedere cliënt kan bij ons rekenen op deskundig en persoonlijk advies. De oplossingen zijn uniek omdat ieder mens uniek is. Wij blijven zoeken totdat we de beste oplossing gevonden hebben. Optimaal samenwerken met medische professionals en zorgverzekeraars vinden wij vanzelfsprekend. Goede communicatie en afstemming, afspraken over aanmeet- en levertijden en naadloze overdracht zijn voor ons belangrijke elementen om een goede dienstverlening te kunnen garanderen. Pom is een erkend second opinion bedrijf Pom BV Hengstdal 3 Postbus 9011 6500 GM Nijmegen T 024-3659210 F 024-3659205 info@pomnijmegen.nl www.pomnijmegen.nl
Thursday November 1 st 09.00 10.00 Registration of the participants 10.00 10.10 Opening congress 10.10 10.40 The art of possibility S.H. Berdenis van Berlekom MBA 10.40 11.10 Challenges in knowledge transfer Professor T. van der Weijden MD PhD 11.10 11.35 Poster presentations 11.35 13.15 Visiting posters and commercial exhibition Lunch 13.15 15.15 Parallel session 1 1a. Free Papers 1b. Mini-symposium: Rehabilitation and virtual environments: a love affair or just a one night stand? 1c. Mini-symposium: SCI: innovation in sitting, standing and walking 1d. Workshop: Problems and pitfalls in the vocational training of specialists are there to be solved 1e. Mini-symposium: Evaluation, prediction and treatment of walking ability in children with Spina Bifida 1f. Mini-symposium: It s my life. Innovation of care for young adults with childhood onset disabilities 1g. Workshop: Rehabilitation Medicine: Rehab is fun! 15.15 16.00 Tea break and visiting commercial exhibition 16.00 18.00 General Assembly VRA 18.00 19.30 Free time 19.30 24.00 Dinner and music entertainment PROGRAMME OVERVIEW 5
Eén met Genium Baanbrekende nieuwe technologie en decennia aan praktijkervaring; de nieuwe Genium is de eerste van een nieuwe generatie intuïtieve prothesen. De functies gebeuren in real time en soms zelfs anticiperend op de situatie. De techniek van de Genium geeft de loper een ongeëvenaard fysiologisch gangbeeld, met een schat aan functies die andere systemen achter zich laat. www.ottobock.com/genium ottobock.nl info.benelux@ottobock.com T +31 (0)499 474 585
Friday November 2 nd 8.30 10.30 Parallel session 2 2a. Free Papers 2b. Workshop: Effective Exercises in Rehabilitation Medicine: How does it work? 2c. Mini-symposium: From innovation to implementation in pediatric rehabilitation: playfulness and flow 2d. Workshop: Changes in Educational program VRA for residents in PM&R. 2e. Mini-symposium: Physician Assistants in rehabilitation: from innovation to implementation 2f. Workshop: Clinical assessment of walking energy cost and fitness in children and adolescents with cerebral palsy or other motor impairments: Application in pediatric rehabilitation 10.30 11.15 Coffee break and visiting commercial exhibition 11.15 11.45 Force and position feedback mechanisms in neuromuscular control Professor F.C.T. van der Helm PhD 11.45 12.10 Poster presentations 12.10 13.15 Visiting posters and commercial exhibition Lunch 13.15 15.15 Parallel session 3 3a. Free Papers 3b. Mini-symposium: Rehabilitation Robotics: a promise for the near future? 3c. Mini-symposium: RCT s and alternative study designs in Rehabilitation Medicine; From design to implementation and all the bumps on the way 3d. Mini-symposium: Wheeled mobility: an ergonomics perspective 3e. Workshop: Introduction of IFMS in a medical staff of rehabilitation physicians 3f. Mini-symposium: Lifespan expectations for individuals with cerebral palsy 15.15 15.45 Tea break and visiting commercial exhibition 15.45 16.00 Awarding: best presentation and best poster PhD Award Rehabilitation Medicine 16.00 16.30 Clinical Movement Analysis in Rehabilitation Medicine: the road to implementation Professor J. Harlaar PhD 16.30 17.00 Healthcare new style: a different role for healthcare professionals and patients Professor B.R. Bloem MD PhD 17.00 Closing of the VRA Annual Congress PROGRAMME OVERVIEW 7
PROGRAMME THURSDAY 8 Programme Thursday November 1 st 10.00 10.10 Opening congress Chair: Prof. R.J.E.M. Smeets MD PhD, Chair Scientific Committee 10.10 10.40 S.H. Berdenis van Berlekom MBA The art of possibility While professionals in rehabilitation medicine are busy implementing the current best practice, they always have to be aware of signals indicating that a néxt practice is at hand. Innovators have a nose for this next trend, but do our organisations and their rehabilitation specialists have a nose for innovators? In his presentation, Steven van Berlekom will state that innovation is performing the art of possibility, a positive attitude towards ideas eventually changing the rules of the game (or not). He will reflect on a variety of topics, such as the difference between solving a problem and accomplishing an ambition, the manageability of the weather and the importance of passing. He will wander through questions as: How can we ensure improvements and innovations in the increasingly production-based environment of a rehabilitation centre? What organisational and cultural conditions invite professionals to become innovators? What kind of leaders and, as important, followers do we need to build an innovational environment? Which part can patients play in the search of the next practice? And last but not least, are rehabilitation specialists equipped for performing the art of possibilities and if not, what can be done to support them? Steven Berdenis van Berlekom is member of the executive board of De Hoogstraat Revalidatie in Utrecht. His focus in the board is on quality and safety, innovation and scientific research. 10.40 11.10 Professor T. van der Weijden MD PhD Challenges in knowledge transfer Research evidence on the effectiveness of medical interventions is published in large quantities every year. This does not automatically lead to improvements in patient care. Unwarranted inter-doctor variation that has been documented since the 1940 s, continues to persist in many health care settings. Systematic implementation efforts are needed to achieve and sustain high quality of care. Clinical practice guidelines are seen as a strategy of first choice in this field. The development of guidelines is a challenge; evidence-based information regarding effectiveness, efficiency, patient preferences, and safety has to be appraised, and subsequently related to national or local experiences on best practices to assure feasibility, timeliness and equity. Research is therefore needed on the preferred methods for development of multidisciplinary guidelines and quality of care indicators.
Dissemination of guidelines does not lead to significant improvements in quality of care. Physicians may experience a conflict between the adherence to guidelines (with populationbased recommendations) and patient-centred work (applying the guideline to a unique patient). Health care should be delivered according to accepted professional guidelines, with specific benchmarks for the quality indicators. However, health care should also meet objective and subjective needs of individual patients. Trudy van der Weijden is professor in Implementation of Clinical Practice Guidelines at Caphri, school for public health and primary care, Maastricht University. 11.10 11.35 Poster presentations Chair: A. Mert MD PhD, scientific committee The scientist will announce the poster in a 1 minute presentation. They have been requested to introduce themselves and to present the main message of the poster. During the lunch participants of the congress will visit the posters which are placed in the hall. Each scientist prepares a 2-3 minute presentation to inform interested participants. 1. Osseointegrated Prosthetic Fitting, First experiences with the Swedish method in the Netherlands. J.H. Arendzen 2. Musculoskeletal complaints of conservatory students: preliminary results of a cross-sectional study in 8 Dutch conservatories. V.A.E. Baadjou 3. Robot-assisted treadmill training in spinal cord injury: a pilot study on bowel, bladder and sexual function. N.E. Bouma-Kollerie 4. Dynamic assessment: useful for assessing learning potential in patients with ABI? Preliminary results of an ongoing study. H. Boosman 5. Cognitive complaints after Out-Of-Hospital Cardiac arrest. L.W. Boyce 6. Muscle fatigue during repetitive voluntary maximal contractions; a comparison between children with cerebral palsy, typical developing children and young adults. M.M. Eken 7. Effectiveness of booster mcimt-bit for children and adolescents with unilateral upperlimb paresis: preliminary results. Y. Geerdink 8. Feasibility of a home-based training programme in adolescents and young adults with Cerebral Palsy. L.E. Haffmans 9. Absolute and relative flexor tendon excursions in zone II and V of the hand measured by ultrasound. S.G. Heemskerk, E. Pirard 9
a 10. High prevalence of hand and wrist impairments in juvenile idiopathic arthritis (JIA). A.F. Hoeksma The right steps thanks to reliable information Which treatment did I prescribe in comparable cases? Which medical interventions are evidence based? These are just some of the many questions you will be able to answer using the the Revalidatie EPD (EMR). In addition, the EPD provides access to other hospital systems that contain up-to-the-minute information on patients. This enables you to always take the right steps in the treatment process. Visit our stand to see the latest innovations on the Revalidatie EPD. e-care Solutions VIR e-care Solutions Wekeromseweg 8a 6816 vs Arnhem www.vir.nl 11. Assessment of upper-limb capacity, performance and developmental disregard with the VOAA-DDD-R in children with unilateral spastic cerebral palsy. A. Houwink 12. Changes in fitness, wellbeing and rehabilitation goals during a process-guided cardiac rehabilitation program. N. Huizenga 13. Learning to live and move with chronic neuropathic pain in diabetes. I.M. Kanera 14. Promoting gain versus preventing loss in chronic pain: does it matter what patients focus on? H.P.J. Kindermans 15. Knee Joint Stabilization Therapy in Patients with Osteoarthritis of the Knee: A Randomized, Controlled Trial. J. Knoop 16. Long-term functioning of caregivers of survivors of a cardiac arrest. V.R.M. Moulaert 17. Feasibility of an early intervention service for survivors of a cardiac arrest: a process evaluation. V.R.M. Moulaert 18. Transfer of motor learning in (robotic) task-oriented armhand training after stroke. R.J.M. Lemmens 10
11.35 13.15 Visiting posters and commercial exhibition Lunch 13.15 15.15 Parallel session 1 1a. Free Papers Chair: M. Andela MD, scientific committee 1. Does case management improve quality of ALS care in the Netherlands? H.W.J. Creemers 2. Recovery of Motor Imagery Ability (MIA) in stroke patients. W. Feenstra 3. The influence of balance support on the metabolic cost of walking in stroke patients during overground and treadmill walking. T. IJmker 4. Selective activity of flexor and extensor wrist muscles is reduced in post-stroke patients. I. Kouwijzer 5. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial. G. Kwakkel 6. Functional gait training using an instrumented treadmill with visual context improves gait adaptability and associated attentional demands in the chronic phase after stroke: a proof of concept. M.W. van Ooijen 7. Course of mood over time and its predictors following moderate to severe traumatic brain injury: a prospective cohort study. L. Valk-Kleibeuker 8. A longitudinal study of locus of control and healthrelated quality of life after traumatic brain injury. J.E. Wielenga-Boiten 11PROGRAMME THURSDAY
PROGRAMME THURSDAY 1b. Minisymposium: Rehabilitation and virtual environments: a love affair or just a one night stand? Chair: A. Mert MD PhD W. Bles PhD, W.J. Renger MSc, M. Roerdink PhD, M.P. Schijven MD PhD, W. Wertheim MD Games are fun. Serious games are serious fun. The use of serious games and virtual reality is becoming more and more commonplace in rehabilitation practices, but therapeutic results vary and implementation of these innovative techniques is fragmented. Medical curricula, both in basic and specialist training have little room, if at all, for application of VR and serious gaming. Moreover, expertise in the medical community about this subject is sparse. Nevertheless, there is increasing emerging knowledge on good game design, the military have more than 50 years of experience with virtual reality, the technological advances are such that it is more and more possible to do in-game measurements on performance. Also some rehabilitation centers have already successfully implemented serious gaming/vr as part of their therapeutic arsenal. To start to close the gap that is created during medical training with regard to medical gaming, this mini-symposium will introduce the audience to fundamental aspects of virtual reality and gaming, and offer a basic understanding of the possibilities and pitfalls these techniques have in therapeutic rehabilitation environments, but also as an educational tool in medical specialist training. 1c. Mini- symposium: SCI: innovation in sitting, standing and walking Chair: J.M. Stolwijk-Swuste MD PhD C. Smit MD, S. van Langeveld PT PhD, H. van de Meent MD PhD, H.A.F.M. Rijken PT, B. Fleerkotte PT, prof. T.W.J. Janssen PhD In this mini-symposium innovations in sitting, standing and walking in spinal cord injury will be presented. First the application of electrostimulation of gluteal and hamstring muscles in order to reduce the risk of pressure ulcers will be presented. Next, the contribution of an ipad in independence of tetraplegics in communication, mobility, and self-care activities will be reported. Also a newly developed prediction rule to assess a patient s chances of walking independently after traumatic spinal cord injury will be explained. Furthermore, clinical experiences with the robot-assisted treadmill training with rehabilitation robots Lokomat and LOPES will be shared. Also the results of the first Dutch study into the effects of robot-assisted treadmill training using the Lokomat will be addressed. Finally the possibilities of future collaborative multicenter research of robot-assisted treadmill training in different patient groups will be discussed. 12
1d. Workshop: Problems and pitfalls in the vocational training of specialists are there to be solved Chair: H. Hacking MD W. Bakx MD, A. van Kuijk MD PhD, C. Meskers MD PhD, M. Maas MD, C. den Rooyen MSc The workshop focuses on the problems that evolve from the implementation of modern training of medical specialists. Problems are translated to practical solutions. Targeted analysis of problems may help to find those solutions as well as create support by the members of the training group. During the workshop we make use of an analysis model that was developed within the project Modernisering Medische Vervolgopleidingen. Finally, we will discuss the application of quality instruments for training evaluation and how instruments can be used to increase active participation by your colleagues. An interactive approach during the workshop will guarantee the easy exchange of tips and trics. 1e. Mini-symposium: Evaluation, prediction and treatment of walking ability in children with Spina Bifida Presentation of the first multidisciplinary guideline Chair: B. Ivanyi MD PhD H.J.G. van den Berg-Emons PhD, J.F. de Groot PhD, M.J. Nederhand MD PhD, M.A.G.C. Schoenmakers PhD, J.A. van der Sluijs MD PhD Children and adolescents with spina bifida (SB) are at risk of a sedentary life. To make independent walking possible they need a combination of physiotherapy, orthotic management and surgical treatment. An optimal tuning of such a multidisciplinary treatment is essential but to date multidisciplinary guidelines were missing. A first multidisciplinary evidence based guideline on evaluation, prediction and treatment of walking ability in children with SB is being established in the Netherlands. During the minisymposium the main aspects of the guideline will be presented; the outcome measures and prognostic factors of walking ability in children with SB and the recommended conservative and surgical practice to enhance their walking ability. 13
PROGRAMME THURSDAY 1f. Mini-symposium: It s my life. Innovation of care for young adults with childhood onset disabilities Chair: M.E. Roebroeck PhD W.M.A. van der Slot MD, M.S.G. Floothuis OT, E. Kruijver, C.G.B. Maathuis MD PhD, S.R. Hilberink MSc, on behalf of TransitieNet In their transition to adulthood, young people with childhood onset disabilities may experience problems to regulate their own life and take responsibility for their health. Since 2007 rehabilitation centers cooperate in the Dutch network TransitieNet to innovate care for young people (16-25 years). In this mini-symposium clinicians from several rehabilitation centers will share their experiences with young adult teams and age-appropriate interventions. These innovations aim to improve the young people s autonomy in several life areas. We will particularly focus on the goals and methods of a young adult team, and on interventions to improve work participation, emerging romantic relationships and sexuality and Skills for Growing Up (Groei-wijzer, for youth and their parents). With the use of practical examples and discussion on feasibility and preliminary effectiveness of the interventions we encourage interaction with participants of the symposium. 1g. Workshop: Rehabiltation Medicine: Rehab is fun! (only for medical students) Chair: G.M. Rommers MD PhD M. Tepper MD, R. Dahmen MD, W.G.M. Bakx MD, Prof. F. Nollet MD PhD Rehabilitation medicine is all about function and participation. In this workshop we present patient cases with a variety of diagnoses well known to rehabilitation medicine. We present cases about stroke, spinal cord, amputation and orthotics devices to speed up the mobilisation process. To learn about cognitive limitations in everyday life and how to deal with it. Share the expertise and challenges ahead together with experienced staff to learn what rehabilitation medicine is all about! We will highlight the pleasure of everyday practise and what to learn from it for medical students. Information about clerkships and training posts will be available and specialist registrars tell you all about: rehab is fun! 14
15.15 16.00 Tea break and visiting commercial exhibition 16.00 18.00 General Assembly VRA During the General Assembly, the Board will present the updated strategic plan including the proposal for the budget 2013. Several Sections will report on their activities and developments during this year. In addition, progress on specific items like DBC and Inzicht in Revalidatie will be presented. 18.00 19.30 Free time 19.30 24.00 Dinner and musical entertainment Registration for the social programme is required. We invite you to join us for a predinner drink and buffet dinner. This will be accompanied by music entertainment. 15
Be you Verkorte productinformatie Dysport poeder voor injectievloeistof 500 E. Samenstelling Per injectieflacon 500 E Clostridium botulinum type A toxine-hemagglutininecomplex (E = eenheid van activiteit). Indicaties Behandeling van blefarospasme, hemifacialisspasmen, spasmodische torticollis, symptomatische behandeling van axillaire hyperhidrose en spasticiteit van de arm volgend op een CVA bij volwassenen. Niet te gebruiken bij kinderen onder 12 jaar. Dosering en wijze van toediening De aanduiding voor de eenheid is specifiek voor Dysport en is niet gelijk aan de eenheid van andere botuline toxine type A bevattende producten. Het zichtbare midden van de rubber sluiting dient met alcohol te worden gereinigd, direct vóórdat er door heen wordt gestoken. Een steriele naald van 23 of 25 Gauge dient te worden gebruikt. Het gereconstitueerde product is fysisch-chemisch stabiel gedurende 8 uur bij 2-8 C. Axillaire hyperhidrose: Dysport wordt met 2,5 ml natriumchloride (0,9%) aangemaakt tot een oplossing, die 200 eenheden per ml bevat. De werkzaamheid is aangetoond bij een dosering van 100-200 E. Aanbevolen startdosis 200 E per axilla, verspreid via 10 intradermale injecties en met 20 E per injectieplaats. Het maximaal effect dient zichtbaar te zijn bij week 2 na injectie. In het merendeel van de gevallen geeft de aanbevolen dosis een voldoende onderdrukking van de zweetsecretie voor ongeveer 48 weken. Injecties worden niet frequenter dan iedere 12 weken toegediend. Blefarospasme en hemifacialisspasmen: Dysport wordt met 2,5 ml natriumchloride (0,9%) aangemaakt tot een oplossing, die 200 eenheden/ml bevat. De minimale effectieve dosis is 40 eenheden per oog. De maximale dosis van 120 eenheden per oog mag niet overschreden worden. Dysport wordt mediaal en lateraal subcutaan toegediend op de overgang van de pars palpebralis en pars orbitalis van zowel het bovenste als onderste deel van de musculus orbicularis oculi van de ogen. Verlichting van de symptomen kan binnen 2 tot 4 dagen worden verwacht en de maximale werking binnen 2 weken. Om te voorkomen dat de symptomen terugkomen, worden de injecties om de 12 weken herhaald of wanneer nodig, afhankelijk van de respons van de individuele patiënt, maar niet vaker dan om de 12 weken. Spasmodische torticollis: Dysport wordt met 1 ml natriumchloride (0,9%) aangemaakt tot een oplossing, die 500 eenheden per ml bevat. Initiële dosering is 500 E per patiënt, die verspreid in de twee of drie meest actieve nekspieren worden toegediend. Injecties worden het meest toegepast in de musculus sternocleidomastoideus, de musculus splenius capitis en de musculus trapezius. Bij herhalingsinjecties dient de dosering te worden aangepast aan het klinische effect en de waargenomen bijwerkingen. Aanbevolen worden doseringen tussen 250-1.000 E. Doseringen hoger dan 1.000 E zijn niet aanbevolen. Een verbetering van de torticollis symptomen kan binnen een week worden verwacht. Om te voorkomen dat de symptomen terugkomen, worden de injecties om de 8-12 weken herhaald, afhankelijk van de respons van individuele patiënt. Spasticiteit van de arm na een CVA: Dysport wordt met 1 ml natriumchloride (0,9%) aangemaakt tot een oplossing, die 500 eenheden per ml bevat. De aanbevolen dosis bedraagt 1.000 eenheden, verdeeld over vijf spieren: musculus flexor digitorum profundus, musculus flexor digitorum superficialis, musculus flexor carpi ulnaris, musculus flexor carpi radialis en musculus biceps brachii. Klinische verbetering mag worden verwacht binnen 2 weken na injectie. De injecties kunnen worden herhaald ongeveer iedere 16 weken, of zo vaak als nodig is om de respons te handhaven, doch niet vaker dan iedere 12 weken. Contra-indicaties Niet gebruiken bij overgevoeligheid voor één van de componenten van Dysport. Bijzondere waarschuwingen en voorzorgen bij gebruik Er zijn bijwerkingen gemeld die verband houden met de verspreiding van het toxine op afstand van de toedieningsplaats, wat soms heeft geresulteerd in overlijden van de patiënt, wat in sommige gevallen gepaard ging met dysfagie, pneumonie en/of significant krachtverlies. Patiënten die met therapeutische doses werden behandeld, kunnen een verergerde spierzwakte ervaren. Patiënten met onderliggende neurologische aandoeningen inclusief slikproblemen lopen een verhoogd risico op deze bijwerkingen. Het botulinetoxineproduct moet bij deze patiënten onder supervisie van een specialist worden gebruikt en mag alleen worden gebruikt als wordt aangenomen dat de voordelen van behandeling zwaarder wegen dan de risico s ervan. Patiënten met dysfagie en aspiratie in de voorgeschiedenis moeten met uiterste voorzichtigheid worden behandeld. Aan patiënten of zorgverleners moet worden geadviseerd om onmiddellijk medische hulp in te roepen als er problemen met slikken, met praten of met de ademhaling ontstaan. De behandelend arts dient ervaring te hebben met de diagnostiek van de aandoening en met de toepassing van botulinum toxine hierbij. Bij het overschakelen van het ene botulinum toxine bevattende product naar het andere dient opnieuw naar de optimale dosering te worden gezocht met inachtneming van de instructies in de bijsluiter. Patiënten met (preëxistente) stoornissen in de neuromusculaire prikkeloverdracht, zoals myasthenia gravis, hebben mogelijk een verhoogde gevoeligheid voor het botulinum toxine. Bij een gering aantal patiënten behandeld met Dysport is vorming van antilichamen geconstateerd. Interacties Het effect van botulinum toxine kan worden gepotentieerd door antibiotica of andere geneesmiddelen, die de neuromusculaire transmissie beïnvloeden, zoals lithiumzouten, benzodiazepines, 4-aminopyridine, guanidines, corticosteroïden, aminoglycosiden en cholinesteraseremmers. Polymyxine, tetracycline en lincomycine dienen met voorzichtigheid aan de patiënt te worden gegeven. Ook bij gebruik van spierrelaxantia met een langdurige werking moet men bedacht zijn op een mogelijke wisselwerking door de begindosis hiervan te verminderen of door een spierrelaxans te gebruiken met een onmiddellijk effect (zoals vencuronium of atracurium). Gebruik bij zwangerschap en het geven van borstvoeding Er is onvoldoende experimenteel onderzoek bij dieren gedaan naar de effecten op zwangerschap. Dysport dient niet tijdens de zwangerschap te worden gebruikt, tenzij strikt noodzakelijk. Het is niet bekend of Dysport in de moedermelk overgaat. Bij de beslissing om de borstvoeding voort te zetten/te staken of om de behandeling van Dysport voort te zetten/te staken dienen het voordeel van borstvoeding voor het kind en het voordeel van de behandeling met Dysport voor de moeder te worden overwogen. Belangrijkste bijwerkingen Algemeen: gegeneraliseerde zwakte, vermoeidheid, griepachtige symptomen, pijn/buil op plaats van toediening. In zeer zeldzame gevallen zijn bijwerkingen als gevolg van de verspreiding van toxine op afstand van de toedieningsplaats gemeld (verergerde spierzwakte, dysfagie, aspiratiepneumonie met in sommige gevallen een fatale afloop). Axillaire hyperhidrose: een verhoogd zweten in andere huidgebieden. Blefarospasme en hemifacialisspasmen: ptosis, diplopie, zwakte van de aangezichtspieren, oedeem van de oogleden. Spasmodische torticollis: dysphagia, verslapping van de nekspieren, dysfonie. Spasticiteit van de arm na CVA: dysphagia, ongevalletsels/val. Afleverstatus U.R. Voor prijzen wordt verwezen naar de Z-index taxe. Voor de volledige productinformatie wordt verwezen naar de geregistreerde SPC (oktober 2011). Registratienummer RVG 17505. Ipsen Farmaceutica B.V., Taurusavenue 33b, 2132 LS Hoofddorp. Telefoon: 023 554 16 00 - E-mail: ipsen.nl@ipsen.com - Websites: www.dysport.nl en www.ipsen.nl Oktober 2011
Programme Friday November 2 nd 6. Percutaneous nerve stimulation in severe neuropathic pain patients due to spinal cord injury: a pilot study. J.M. Stolwijk-Swuste 8.30 10.30 Parallel session 2 2a. Free Papers Chair: J.H. de Groot PhD, scientific committee 1. The effect of robot-assisted gait training on cardiopulmonary fitness in motor incomplete spinal cord injury: a training study. F. Hoekstra 2. Health related quality of life, body functions and activities; satisfied boys, worrying parents. S.L.S. van Houwen-Opstal 3. Electrical activation of paralyzed muscles increases resting energy expenditure in individuals with spinal cord injuries. T.W.J. Janssen 4. Trajectories in wheelchair exercise capacity after spinal cord injury. C.F. van Koppenhagen 5. Cognitive Mechanisms of Change in Multidisciplinary Treatment of Patients with Chronic Wide Spread Pain: A Prospective Cohort Study. A. de Rooij 7. Implementation of Acceptance & Commitment Therapy (ACT) in Dutch pain rehabilitation. H.R. Trompetter 8. Fatigue resistance of the knee extensor muscles in patients with post-polio syndrome. E.L. Voorn PROGRAMME FRIDAY 17
2b. Workshop: Effective Exercises in Rehabilitation Medicine: How does it work? Chair: P. van Aanholt MD 2c. Mini-symposium: From innovation to implementation in pediatric rehabilitation: playfulness and flow Chair: Prof. A.C.H. Geurts MD PhD PROGRAMME FRIDAY R. Dekker MD PhD, F. Hettinga PhD, on behalf of National project group VRA physical activity and sports It is well known that an active lifestyle is important for a healthy life. A lot of diseases are cured or at least have a less significant impact by an active lifestyle. The intention of the workshop is to promote the need of an active lifestyle for everybody and more specific for our patients and for people with a disability. We want to advocate the need of expertise of Exercise Physiology for Rehabilitation Physicians. We also show why knowledge of Exercise Physiology is of great importance to make the right Rehabilitation Program and to give an adequate advise for an active lifestyle. We show that the aim of the treatment should guide the selection of type of training program, which is specific for each individual. We will have an active workshop. All participants will have to exercise physical activities with a different energy level. That is why it is advised to wear sportswear. Prof. M.W.G. Nijhuis-Van der Sanden PhD, P.B.M. Aarts OT PhD, Y.A. Geerdink OT MSc, A. Houwink PT PhD, J. Munster MD In order for children to remain motivated during intensive and task-specific training, interventions need to be both playful and generate a positive flow during which children want to continue training. This mini-symposium presents two, state of the art, playful training interventions for children with writing disabilities ( Juf in a Box ) and children with unilateral spastic cerebral palsy ( the Pirate concept ). Juf in a Box is a recently developed computer game that uses an interactive tablet to train writing skills. The Pirate concept consists of modified Constraint-Induced Movement Therapy combined with Bimanual Training. The first steps of implementing a new innovation will be discussed with regards to Juf in a Box: theoretical background, development and pilot results. Then, the following steps for implementation will be presented with regards to the Pirate concept: current state of the Pirate concept, nationwide implementation and the role of the rehabilitation physician, and follow up interventions. 18
2d. Workshop: Changes in Educational program VRA for residents in PM&R Chair: M. Tepper MD H. Arwert MD, M. van Beugen MD, R. Dahmen MD, L. Kruisheer MD, D. Jägers MD Educational programme BETER describes the competencies of a Medical Specialist in Physical and Rehabilitation Medicine according to the CANMEDS. In the current educational programme of the VRA most courses are dedicated to specific themes or diagnoses. In 2014 a new, four year course will be introduced; focusing on the themes Communication and Management and Clinical Reasoning. Each year will have its own subjects related to these themes as the course intensity and complexity increases with each passing year. Education in smaller groups is more effective and beneficial to the attitude of active learning. In the near future e-learning will play a more prominent role. In an interactive workshop we will introduce the VRA 2014 educational programme. A guest speaker will introduce the concept of e-learning and there will be room to exchange experiences. The consequences for the role of course coordinator and organizing committee will also be discussed. 2e. Mini-symposium: Physician Assistants in rehabilitation: from innovation to implementation Chair: J.F. Braam MPA W.H. van Unen MPA, J.P.M. Berkvens MD, A.M. ter Steeg MD MHA, B.F. Weitenberg MPA At present the Dutch health care system is changing in several areas. One of the new developments is task redesign. The master physician assistant (MPA) is a relative new care professional. Currently, in the Netherlands, approximately 800 PAs work within all medical specialties. Nearly 30 PAs are deployed in physical and rehabilitation medicine. This number steadily increases. Does the PA empower chances for rehabilitation medicine, both in the short and long term? Given the central congress theme 'Innovation' the speakers will reveal what opportunities the deployment of PAs in rehabilitation medicine entail. This symposium starts by exposing the position of PAs from a broader perspective, opportunities in task redesign, current legislation and reimbursement. Next, the contents of the Dutch PA medical training programme will be highlighted. The last part focuses on the process of implementation and collaboration between a rehabilitation specialist and PA. 19
PROGRAMME FRIDAY 20 2f. Workshop: Clinical assessment of walking energy cost and fitness in children and adolescents with cerebral palsy or other motor impairments: Application in pediatric rehabilitation Chair: A. Dallmeijer PhD A. Balemans MSc, E. Bolster MPPT, A. Buizer MD PhD Assessment of walking energy cost and fitness is becoming increasingly important in the treatment of mobility limitations in children and adolescents with child-onset disabilities. Common complaints in these patient groups include reduced walking distance and early fatigue during daily life activities. These complaints may be associated with an increased walking energy cost or a reduced fitness level. Appropriate assessment of these outcomes are therefore essential for clinical decision making. This workshop provides a background in exercise physiology that is required to understand and interpret test results. Test protocols, test interpretation and clinical cases will be presented and discussed with the audience. 10.30 11.15 Coffee break and visiting commercial exhibition Chair: A.H. Vrieling MD PhD, scientific committee 11.15 11.45 Professor F.C.T. van der Helm PhD Force and position feedback mechanisms in neuromuscular control The simultaneously modulation of the strength of the force and position feedback loops determines the postural control of the human limbs. Force feedback originates from the Golgi tendon organs, and position feedback from the muscle spindles. Position tasks require a high stiffness of the human limb ( resist ), whereas force tasks require a low stiffness ( give way ). Using closed-loop system identification mechanisms in combination with force perturbations, the quantitative contribution of the various feedback loops can be determined. In force tasks, the stiffness becomes lower than in passive conditions showing that the reflexive feedback is actively giving way. Remarkedly, experimental results show a switch of the sign of position and force feedback gains between position and force tasks. A theoretical model was developed which can explain the symptoms of dystonia, like preferred position and high resistance against displacement. The model assumes a-symmetric feedback gains between flexors and extensors, and the lack of positive force feedback gains settings. Experiments with CRPS patients with dystonia showed that they could
significantly less modulate their force feedback strength. It is concluded that Golgi tendon feedback has a similar important role for the stiffness behaviour of the human limbs as muscle spindles, and they should be simultaneously quantified in order to understand neuromuscular control. Frans van der Helm is professor in Biomechatronics and Bio-robotics, Delft University of Technology, and also adjunct-professor at the University of Twente, LUMC, Northwestern University (Chicago) and Case Western Reserve University (Cleveland). 11.45 12.10 Poster presentations 19. Event-Related Potentials from the EEG in children with unilateral Cerebral Palsy: Differences between children with and without Developmental Disregard. M.L.A. Jongsma 20. Nebula': the concept of playful learning. A.A. van Kuijk 21. Tarsal coalitions in seven dancers: presentation, treatment and outcome. A.E. van Loon-Felter 22. Process evaluation of the treatment program Oncological spinal cord injury : Experiences and needs of patients and experts. L.H. van Orsouw 23. Goal Attainment Scaling in outpatient rehabilitation of mobility after stroke. D.I. van Riet-Paap 24. Blended learning in Residency Training in PM&R: Fashion or Value? G.M. Rommers 25. Sexual functioning before and after multidisciplinary pain rehabilitation in patients with chronic musculoskeletal pain. J.L. Swaan 26. Measures and procedures utilized to determine the added value of microprocessor-controlled prosthetic knee joints: a systematic review. P.J.R. Theeven 27. Learning curves of Southampton Hand Assessment Procedure tasks in novice prosthetic users. E. Vasluian 28. The psychometric qualities of the PHODA-Youth for adolescents with chronic musculoskeletal pain. J.A. Verbunt 29. The difference in physical functioning between relatively active and inactive patients with Chronic Fatigue Syndrome. D.C.W.M. Vos-Vromans 30. Cognitive and emotional problems in patients surgically treated for a cerebral meningioma. S. van der Vossen 31. Adherence to wearing prescribed custom-made footwear in diabetic patients with a history of plantar ulceration. R. Waaijman 32. Complications following traumatic spinal cord injury during the acute phase. K.C.M. van Weert 21
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33. School absence in adolescents with nonspecific chronic pain and/or fatigue. T. Westendorp 34. Akathisia, a rare cause of psychomotor agitation in patients with traumatic brain injury: a case report and review of the literature. J.E. Wielenga-Boiten 12.10 13.15 Visiting posters and commercial exhibition Lunch 13.15 15.15 Parallel session 3 3a. Free Papers Chair: J. Fleuren MD PhD, scientific committee 1. Perceived usability of therapeutic footwear in diabetic patients with neuropathy and prior foot ulceration. M.J.L. Arts 2. School performance of children with Obstetric Brachial Plexus Palsy. L. Corsel 3. Walking in an unstable environment: The response of people with a transitibial amputation to balance perturbations during gait. L. Hak 4. Safety and efficacy of the osseointegrated prosthesis for lower limb amputees: Preliminary results of the first 24 patients in the Netherlands. H. van de Meent 5. Body structures and physical complaints in Upper Limb Reduction Deficiency: a 24 year follow up study. S.G. Postema 6. Intermanual Transfer in Upper-Limb Myoelectric Prosthetic Training. S. Romkema 7. Birth prevalence and possible risk factors for congenital limb defects in the Northern Netherlands. E. Vasluian 8. Prognostic factors in the causation of recurrent plantar ulceration in patients with diabetes. R. Waaijman 23PROGRAMME FRIDAY
Buchrnhornen Hanssen Footcare OIM Orthopedie Penders Voetzorg Samenwerkende producenten van orthopedische maatschoenen en voethulpmiddelen www.federatie-pas.nl PAS altijd een passend antwoord 3b. Minisymposium: Rehabilitation Robotics: a promise for the near future? Chair: prof. H. Rietman MD PhD E. van Asseldonk PhD, J.H. Buurke PT PhD, A. Stienen PhD, G. Prange PhD, A. Kottink PhD The incidence of people suffering from a stroke in the Netherlands is 1.6 per 1000 inhabitants. Because of demographic changes (aging) the expectance is that this will increase with 50% in 2025. One of the consequences of a disturbed generation of neural commands in the sensorimotor cortex is impaired motor function of the upper and lower extremities. Intensive and task-specific treatment, consisting of active, highly repetitive movements, is regarded one of the most effective approaches in neural rehabilitation. Recent development in robot-mediated rehabilitation has revealed the great potential of robotic devices for delivering repetitive training, thus facilitating a high frequency and/or duration of task-specific training during sub-acute and chronic phases of stroke rehabilitation. Motivation can be increased through combination with virtual reality game environments. While there is growing evidence that such technologies are beneficial to patients recovery of functional and motor outcome, the uptake of these technologies has been slow. 24
3c. Mini-symposium: RCT s and alternative study designs in Rehabilitation Medicine; From design to implementation and all the bumps on the way Chair: Prof. dr. H.J. Stam MD PhD S. Bus PhD, Prof. G. Kwakkel PhD, Prof. F. Nollet MD PhD, R. Selles PhD Randomized controlled trials (RCTs) represent the study design with the highest level of evidence to determine the effectiveness of an intervention. The design is therefore the state of the art in different fields of medicine and allied health sciences, including rehabilitation medicine and physical therapy. However, RCTs can be difficult to setup, mostly require large numbers of patients, and often encounter many bumps on the way during their execution. Despite of this, many RCTs are conducted, or have been completed, in the field of rehabilitation medicine in the Netherlands. In this minisymposium, some of the state-of-the-art trials in the field will be presented, with a focus on the challenges that the project groups faced in setting-up and executing these trials. Solutions to these challenges and possible alternative study designs, such as cluster randomized trials and propensitymatching in observational studies, will be discussed. 3d. Mini-symposium: Wheeled mobility: an ergonomics perspective Chair: Prof. L.H.V. van der Woude PhD S. de Groot PhD, R.J.K. Vegter MSc, M.G.M. Kloosterman MSc, F. Hettinga PhD, L.J.M. Valent PhD Since more than 30 years manual wheelchair propulsion is subject of study in the Netherlands. Optimization of performance and functioning in daily life and sports has been the key ergonomics focus point. Social range of action and freedom of mobility of the wheelchair-user combination in this context is the central outcome. This implies an accurate balance between stress, strain and capacity (of the upper body), which should lead to the prevention of overuse injuries, as well as prevent an inactive lifestyle. Indeed exercise is medicine, and a physically active lifestyle is suggested to be key to well-being and health, while supporting participation. Optimal quality wheelchairs (or assistive technology for that matter), wheelchair fitting as well as individual work capacity and skill are key to that. The current state of the art will be presented by a group of (young) researchers, currently active in research on wheeled mobility, work that is exemplified in 6 short yet, complementary presentations and a combined discussion. 25PROGRAMME FRIDAY
PROGRAMME FRIDAY 26 3e. Workshop: Introduction of IFMS in a medical staff of rehabilitation physicians Chair: A. Kap MD E. van Loon MD, E. Turlings MSc, N. van Vemde MA on behalf of the VRA Quality Committee Individual functioning medical specialists (IFMS) is a method to improve the individual professionalism of medical specialists. This workshop will give you theoretical background about several methods. Practical information is given on questions such as: which aspects are necessary for a good feedback conversation; how to have a constructive but critical dialogue with your colleagues? Personal experiences are shared on working with the IFMS. The workshop is led by Elma Turlings and Nathalie van Vemde, experienced trainers on this subject at Q-Academy and consultants at Q-Consult, bedrijfskundige adviseurs in Arnhem. 3f. Mini-symposium: Lifespan expectations for individuals with cerebral palsy Chair: A.J. Dallmeijer PhD D.W. Smits PhD, S.S. Tan PhD, R.C. Vos PhD Growth curves empirically model the evolution of an outcome variable over time. Using growth curves in clinical practice has gained attention in many developed countries. As part of the longitudinal PERRIN+ study, developmental trajectories were determined for gross motor function, daily activities and social participation based on 424 individuals with cerebral palsy (CP) recruited in the Netherlands. The study is the first to cover toddlers, children, adolescents and young adults with CP aged. By means of an interactive discussion, we will discuss (1) the value of developmental trajectories in the context of lifespan expectations for the treatment of CP and (2) the applications of developmental trajectories in daily practice. As developmental trajectories support individuals with CP, their families and professionals in setting realistic lifespan expectations at an early age, this course encourages the use of growth curves in the treatment of CP. 15.15 15.45 Tea break and visiting commercial exhibition 15.45 16.00 Awarding: best presentation and best poster PhD Award of Rehabilitation Medicine
Chair: G.M. Ribbers MD PhD, scientific committee 16.00 16.30 Professor J. Harlaar PhD Clinical Movement Analysis in Rehabilitation Medicine: the road to implementation Human movement analysis is the scientific analytical method to reduce human motion to the mechanical behaviour of the (neuro-)musculoskeletal system. Whether or not application of such methods is useful in the clinical practise of Rehabilitation Medicine, requires a close interaction of application designers and physiatrist. It is obvious that the complexity of the human movement system in action, cannot be understood from observation and physical examination alone. However, simply measuring all information that can be acquired, is not automatically meaningful. The road behind: over the last 20 years the introduction of clinical movement analysis in The Netherlands has been governed by this interaction and has evaluated into an unique concept. Adapted technologies for clinical feasible solutions were developed and a network of clinical gait labs and multidisciplinary courses is now established. The road ahead: short-term developments will include even closer national collaborations involving datasharing, and the conception of guidelines for sensible clinical use. Technological developments will contribute to cost effectiveness, while computational biomechanical modelling will support the physiatrist in informed decision making. The challenge of this road ahead is not to get lost in technological opportunities, but to stay critically focused on the need to provide better care for our patients. Jaap Harlaar is biomedical engineer and professor in clinical movement analysis. He is heading the laboratory of clinical movement analysis at the Department of Rehabilitation Medicine at the VU University Medical Center. He is also co-heading the musculoskeletal biomechanics research group of the MOVE research institute Amsterdam. He is also lecturer at the faculty of human science of VU University Amsterdam. 16.30 17.00 Professor B.R. Bloem MD PhD Healthcare new style: a different role for healthcare professionals and patients The world around us is changing. Healthcare is no exception to this phenomenon. The role of both healthcare professionals and that of patients will change due to social changes such as individualism, globalization and technology. In my presentation I will address these new roles. Healthcare professionals need to develop from omnipotent Gods into a coach or a guide, who supports the patient in making the right decisions. Moreover, healthcare professionals have to specialize on a limited number of disorders and integrated care should be provided during the entire disease process of patients. The new role of the healthcare professionals has resulted in the development of ParkinsonNet. In my presentation I will elaborate on the creation of ParkinsonNet, the current state of affairs, and on some important developments for the near future. I will also discuss the important role, played by the rehabilitation specialists within the ParkinsonNet. Patients will 27