ACHTERGROND EN ONDERZOEK

ACHTERGROND EN ONDERZOEK 1 ste editie

| januari 2013

Tanja Ivanovski edema / oncology physiotherapist

Plezier tijdens oefenen motiveert! Augmented reality in de oefenzaal? Volgens de KNGF richtlijn beroerte heeft oefentherapie als doel het verbeteren van de zitbalans het reiken in zit, het gaan staan en het kunnen blijven staan een evidentie op het eerste niveau. Meerdere malen per dag oefenen wordt geadviseerd. Het is daarbij van belang om gebruik te kunnen maken van robottechnologie, exergaming, balanstraining en/of virtual reality vanwege de noodzakelijke kostenbesparing in de zorg.

ACHTERGROND EN ONDERZOEK 1 ste editie

| januari 2013

SAMENVATTING

INHOUD

SAMENVATTING INTRODUCTIE

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5

1

SERIOUS EXERGAMING

2

HIPPOTHERAPIE

3

FYSIOTHERAPIE & NEURO REVALIDATIE

4

PROPRIOCEPTION

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SPIEGELNEURONEN

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MUZIEKTHERAPIE & PSYCHIATRIE

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FELDENKRAIS & PILATES

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WHOLE BODY VIBRATION

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SNOEZELEN

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E-HEALTH

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29

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INDEX MEDISCHE PUBLICATIES

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49

EPILOOG

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COLOFON

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inhoud

Therapeutic Motion Simulation (TMS) is een moderne tool voor fysiotherapeuten. TMS is inzetbaar voor neuro revalidatie en het verbeteren van de kwaliteit van leven van chronisch zieken met ernstige bewegingsstoornissen zonder dat het saai wordt voor de patiënt. TMS focust op zelfmanagement van de gebruikers. De TMS (robot)technologie is veelomvattend omdat het geïnspireerd is door een aantal bestaande behandelmethoden en -technieken zoals: • • • • • • •

serious (exer)gaming fysiotherapie en andere oefenmethoden hippotherapie muziektherapie whole body vibration snoezelen e-health

De multidisciplinaire aanpak waarbij uitsluitend gebruik wordt gemaakt van gevalideerde elementen uit bestaande behandelmethoden is uniek en kan alleen gerealiseerd worden dankzij de TMS mechatronica die geavanceerde audio-visuele technologie combineert met low cost robotics en e-health. In dit stuk wordt nader ingegaan op het ontstaan van TMS en de daarop volgende ontwikkeling. Tevens wordt een aantal gevalideerde methoden waar TMS gebruik van maakt nader toegelicht. TMS online wil de kwaliteit van leven en dus de zelfredzaamheid van de patiënten optimaal stimuleren en streeft er naar om deze technologie ook bij patiënten thuis te kunnen aanbieden.

samenvatting

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INTRODUCTIE

Ko Blaas - partiële dwarsleasie

‘Ik voel nu spieren waarvan ik het bestaan niet meer kende’ Door TMS: • Betere houding en core stability ▪ • Lopen met rolator verbetert ▪ • Transfers verbetert • Wervelkolom is soepeler ▪ • Kan zelfstandig uit bed en de deur openen ▪ • Slaapt beter ▪ • Zelf management toegenomen

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testimonial

Therapeutic Motion Simulation™. De naam zegt het al; bij TMS gaat het om bewegingssimulatie door middel van robotfysio, die in een multisensorische - virtuele - omgeving wordt geplaatst om het realistisch te maken. In eerste instantie was het de bedoeling om een simulatie paard te bouwen teneinde Hippotherapie veiliger, goedkoper en dus toegankelijker te maken voor Ernstig Meervoudig Gehandicapten. Die opzet is geslaagd. De kwaliteit van de bewegingen van het Vita paard staat buiten kijf volgens ervaren ruiters en ook zonder de “smell and touch” van het echte paard wordt het Vita paard geassocieerd met paardrijden. De ritmische beweging van het bekken van de ruiter heeft net als op een echt paard een ontspannend effect op spasticiteit. Tevens wordt net als op een echt paard de balans proprioceptief gestimuleerd wat de sensomotoriek ten goede komt zoals blijkt uit onderzoeken naar Hippotherapie. Tijdens een proefperiode bij Stichting Philadelphia te Vierhouten bleek dat de doelgroep niet alleen goed reageerde op het Vita paard, maar ook op het Vita rolstoel podium en het Vita loungbed voor liggende patiënten. Er traden geen contra-indicaties op. Philadelphia schafte de proefopstelling aan en bestelde extra platforms voor een andere locatie. In totaal zijn ultimo 2012 >35 systemen in gebruik en blijkt dat TMS veilig en storingsvrij werkt. De volgende uitdaging die Vita op zich nam was om andere bewegings bronnen dan paardrijden te bedenken waarbij men zowel ritmische als aritmische bewegingen zou kunnen gebruiken, die tenminste dezelfde effecten als het paardrijden zouden opleveren en bij voorkeur deze effecten zouden overtreffen. In deze opzet werd gebruik gemaakt van het gegeven dat de moderne fysiotherapie evidence based is, dat wil zeggen dat de therapeut protocollen gebruikt die wetenschappelijk zijn getoetst in clinical trials. Vita ontwikkelt dus op basis van gevalideerde oefeningen bewegingschoreografieën voor de beweegplatforms die synchroon aan beeld en geluid deze bewegingen overbrengen op patiënten die deze bewegingen niet of met moeite zelf standig kunnen uitvoeren. Ook deze opzet blijkt aan te slaan. Niet alleen bij EMG’ers, maar ook bij NAH patiënten zoals bleek in een proef in een 1ste lijn fysiopraktijk. introductie

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De redenen dat met TMS dikwijls snel resultaten worden geboekt en dat patiënten het als prettig ervaren zijn door Vita onderzocht. Uit een literatuuronderzoek blijkt dat TMS een aantal belangrijke gevalideerde inzichten en kennis toepast op neurologisch gebied die effect hebben op de functies, activiteiten en participatie van patiënten. TMS ontleent inspiratie aan en gebruikt feitelijk elementen uit de onderstaande wetenschappelijke inzichten en respectievelijke behandelmethoden:

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Therapeutic Motion Simulation is uniek en wordt gekenmerkt door:

• Serious gaming • Hippotherapie • Fysiotherapie & neuro revalidatie • Propriocepsis • Spiegelneuronen • Psychiatrie/psychologie • Muziektherapie • Whole Body Vibration • Feldenkrais & Pilates • Snoezelen • E-health

• Beweging te bieden aan mensen die (gedeeltelijk) niet meer kunnen of willen bewegen en zo hun kwaliteit van leven te verbeteren • De toepassing van lowcost en eenvoudig te bedienen robotfysio • De synchronisatie van de robot met virtual reality • Het gebruik van “echte videobeelden” en geen animaties waardoor men zich identificeert met de virtual reality • De mogelijkheid om persoonlijke beweegprogramma’s samen te stellen • De combinatie van enerzijds mentale en fysieke ontspanning te bieden en anderzijds fysieke stimulatie op te roepen • De therapietrouwheid te stimuleren door oefenen (weer) leuk te maken • Er eindeloos veel mogelijkheden zijn om het oefenen ook leuk te houden door het aanbieden van nieuwe content • De kwaliteit van leven door de patient dagelijks te laten bijhouden met behulp van een app en die informatie te linken aan de oefeningen die zijn gedaan • De mogelijkheid om de huidige lage kostprijs van 5,- per ½ uur te reduceren.

Door de intensiteit en combinatie van deze elementen te variëren kunnen beweegprogramma’s worden samengesteld voor bepaalde neurologische aandoeningen zoals CVA, dwarslaesie, Parkinson, MS, MD, Cerebrale Parese, autisme, postpolio en dementie.

De betekenis van de voornoemde disciplines voor Therapeutic Motion Simulation worden hierna toegelicht aan de hand van medische publicaties op grond waarvan de behaalde resultaten met Therapeutic Motion Simulation verklaard kunnen worden.

Afhankelijk van de aandoening zal het accent meer op ontspanning of op stimulatie liggen. Het verdient aanbeveling een fysio- of ergotherapeut de juiste programmering voor een patiënt te laten bepalen. Bij het bepalen van de beweegprogramma’s moet ook de uitgangshouding van de patiënt worden betrokken, omdat er beweegplatforms zijn voor staande, zittende en liggende patiënten en bij een intake ook de mBBS of BBS kan worden bepaald.

In het hoofdstuk over fysiotherapie en neuro revalidatie wordt ingegaan op het gebruik van tools door fysiotherapeuten en KNGF richtlijnen voor beroerte en Parkinson. Verder wordt de werkwijze van TMS met betrekking tot zelfmanagement en het meten van de kwaliteit van leven van de patiënten uiteengezet.

introductie

introductie

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1 SERIOUS EXERGAMING

Lamoth CJ, Alingh R, Caljouw SR. Exergaming for elderly: effects of different types of game feedback on performance of a balance task. 1. Stud Health Technol Inform. 2012;181:103-7. University Medical Centre Groningen, University of Groningen, the Netherlands. [email protected]

Esmée – probleemgedrag

‘Esmée is nu opener en spontaner, alleen maar positief’ Door TMS: • Stemming beter • Opener en spontaner • Loopt rechter op, betere houding • Betere ademhaling • Alleen maar positief volgens moeder en oma

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testimonial

Balance training to improve postural control in elderly can contribute to the prevention of falls. Video games that require body movements have the potential to improve balance. However, research about the effects of type of visual feedback (i.e. the exergame) on the quality of movement and experienced workout intensity is scarce. In this study twelve healthy older and younger subjects performed anterior-posterior or mediolateral oscillations on a wobble board, in three conditions: no feedback, real-time visual feedback, and real-time visual feedback with a competitive game element. The Elderly moved slower, less accurately and more irregularly than younger people. Both feedback conditions ensured a more controlled movement technique on the wobble-board and increased experienced workout intensity. The participants enjoyed the attention demanding competitive game element, but this game did not improve balance performance more than interacting with a game that incorporated visual feedback. These results show the potential of exergames with visual feedback to enhance postural control. PMID: 22954837 [PubMed - indexed for MEDLINE]

serious exergaming

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Sveistrup; licensee BioMed Central Ltd. Motor rehabilitation using virtual reality Journal of NeuroEngineering and Rehabilitation 2004, 1:10

Maureen K. Holden, Ph.D. Virtual Environments for Motor Rehabilitation: Review Cyberpsychology & Behavior, volume 8, number 3, 2005

ABSTRACT

ABSTRACT

Virtual Reality (VR) provides a unique medium suited to the achievement of several requirements for effective rehabilitation intervention. Specifically, therapy can be provided within a functional, purposeful and motivating context. Many VR applications present opportunities for individuals to participate in experiences, which are engaging and rewarding. In addition to the value of the rehabilitation experience for the user, both therapists and users benefit from the ability to readily grade and document the therapeutic intervention using various systems. In VR, advanced technologies are used to produce simulated, interactive and multi-dimensional environments. Visual interfaces including desktop monitors and head-mounted displays (HMDs), haptic interfaces, and real-time motion tracking devices are used to create environments allowing users to interact with images and virtual objects in real-time through multiple sensory modalities. Opportunities for object manipulation and body movement through virtual space provide frameworks that, in varying degrees, are perceived as comparable to similar opportunities in the real world. This paper reviews current work on motor rehabilitation using virtual environments and virtual reality and where possible, compares outcomes with those achieved in real-world applications.

In this paper, the current “state of the art” for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabili tation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson’s disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of tele rehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n= 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cyber sickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

serious exergaming

serious exergaming

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Anat Mirelman, PT, PhD; Paolo Bonato, PhD; Judith E. Deutsch, PT, PhD Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke Stroke. 2008; 40:169-174

E.D de Bruin, D. Schoene, G. Pichierri, S.T. Smith. Use of virtual reality technique for the training motor control in the elderly Z. Gerontol Geriat 2010 - 43:229-234.

BACKGROUND AND PURPOSE - Training of the lower extremity (LE) using

ABSTRACT

a robot coupled with virtual environments has shown to transfer to improved overground locomotion. The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone. METHODS - A single, blind, randomized clinical trial was conducted. Eighteen individuals poststroke participated in a 4-week training protocol. One group trained with the robot virtual reality (VR) system and the other group trained with the robot alone. Outcome measures were temporal features of gait measured in a laboratory setting and the community. Results - Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone. Similarly, significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR. These differences were maintained at 3 months’ follow-up. CONCLUSIONS - The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone.

Virtual augmented exercise, an emerging technology that can help to promote physical activity and combine the strength of indoor exercise, has recently been proposed as having the potential to increase exercise behavior in older adults. By creating a strong presence in a virtual, interactive environment, distraction can be taken to greater levels while maintaining the benefits of indoor exercises which may result in a shift from negative to positive thoughts about exercise. Recent findings on young participants show that virtual reality training enhances mood, thus, increasing enjoyment and energy. For older adults virtual, interactive environment can influence postural control and fall events by stimulating the sensory cues that are responsible in maintaining balance and orientation. However, the potential of virtual reality training has yet to be explored for older adults. This manuscripot describes the potential of dance pad training protocols in the elederly and reports on the theoretical rationale of combining physical game-like exercise with sensory and cognitive challenges in a virtual environment.

serious exergaming

serious exergaming

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Dori Rosenberg, MPH, MS1, Colin A. Depp, PhD2,3, Ipsit V. Vahia, MD2,3, Jennifer Reichstadt, MS3, Barton W. Palmer, PhD2, Jacqueline Kerr, PhD4, Greg Norman, PhD4, and Dilip V. Jeste, MD2,3 1 Joint Doctoral Program in Clinical Psychology UCSD/SDSU 2 University of California, San Diego, Department of Psychiatry 3 Sam and Rose Stein Institute for Research on Aging, UCSD 4 University of California, San Diego, Department of Family and Preventive Medicine Exergames for Subsyndromal Depression in Older Adults: A Pilot Study of a Novel Intervention Am J Geriatr Psychiatry. 2010 March ; 18(3): 221–226. ABSTRACT OBJECTIVES - Subsyndromal depression (SSD) is several times more common

than major depression in older adults, and is associated with significant negative health outcomes. Physical activity can improve depression, yet adherence is often poor. We assessed the feasibility, acceptability, and short-term efficacy and safety of a novel intervention using exergames (entertaining video games that combine game play with exercise) for SSD in older adults. METHODS - Community-dwelling older adults (N = 19, age 63-94) with SSD participated in a 12- week pilot study (with follow-up at 20 to 24 weeks) of Nintendo’s Wii Sports, with three 35-minute sessions a week. RESULTS - 86% of enrolled participants completed the 12-week intervention. There was a significant improvement in depressive symptoms, mental health-related quality of life, and cognitive performance, but not physical health-related quality of life. There were no major adverse events, and improvement in depression was maintained at follow-up. CONCLUSIONS - The findings provide preliminary indication of the benefits of exergames in seniors with SSD. Randomized controlled trials of exergames for late-life SSD are warranted.

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serious exergaming

Jessica - verschoven ruggenwervel

‘Mijn rug voelde direct beter aan!’ Door TMS: • ▪ Kan weer paardrijden ▪ • ▪ Rug voelt direct beter aan

testimonial

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2 HIPPOTHERAPIE

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HE Lechner*,1, S Feldhaus 2, L Gudmundsen2, D Hegemann2, D Michel 2, GA Zach 2 and H Knecht 1 1 Institute for Clinical Research, Swiss Paraplegic Centre, Nottwil, Switzerland; 2 Swiss Paraplegic Centre, Nottwil, Switzerland The short-term effect of hippotherapy on spasticity in patients with spinal cord injury Spinal Cord (2003) 41, 502 – 505

STUDY DESIGN - Assessment of spasticity before and after hippotherapy

treatment. OBJECTIVE - To evaluate the short-term effect of hippotherapy on spasticity

Philadelphia Vierhouten Gert Wubs – locatie manager

‘Eindelijk iets voor deze doelgroep, waar zo weinig voor is’ Gert is launching customer en is overtuigd van de meerwaarde van TMS voor mensen met een Ernstig Meervoudige Beperking. Bezoekers zijn altijd welkom.

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testimonial

of spinal cord injured patients (SCIs). SETTING - Swiss Paraplegic Centre, Nottwil. METHODS - 32 patients with spinal cord injury with various degrees of spasticity had repeated sessions (mean 11) of Hippotherapy-Ks. Spasticity of the lower extremities was scored according to the Ashworth Scale. RESULTS - In primary rehabilitation patients Ashworth values after hippotherapy were significantly lower than before (Wilcoxon’s signed-rank test: Po0.001). Highest improvements were observed in SCIs with very high spasticity. No significant difference between short-termeffect in paraplegic and short-term effect in tetraplegic subjects was found. CONCLUSIONS - Hippotherapy significantly reduces spasticity of lower extremities in SCIs.

hippotherapie

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Margareta Håkanson, PT, MSca, Margareta Möller, PT, PhDb, Ingalill Lindström, PT, PhDc, Bengt Mattsson, MD, PhDa The horse as the healer - A study of riding in patients with back pain. Journal of Bodywork and movement Therapies (2009) 13, 43-52

Pablo Herrero*1,2,3, Ángel Asensio †3, Elena García †2, Álvaro Marco †3, Barbara Oliván† 1,2,4, Alejandro Ibarz †3, Eva M Gómez-Trullén †2,5 and Roberto Casas †3 Study of the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: a randomised controlled trial BMC Musculoskeletal Disorders 2010,11:71

SUMMARY

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A total of 24 patients, considerably disabled in daily activities by back pain, participated in an Equine Assisted Therapy (EAT) programme. The patients also had several health problems in addition to their current pain. The program emphasised the principles of body awareness. The study is aimed at investigating not only whether symptom reduction would be achieved, but also at identifying qualities of EAT that were particularly beneficial for the patients’ wellbeing. The study was performed according to action research principles. The treatment reduced the pain and lessened other symptoms. The EAT also had an influence on the patients’ self-image and a positive chain of effects was observed. The consequences were described according to four dimensions; the dimension of body awareness, competence, emotion and environment. The dimensions were interrelated having the simultaneous influence of a transition process and symptom reduction towards health.

ABSTRACT

hippotherapie

hippotherapie

BACKGROUND - Although hippotherapy treatment has been demonstrated

to have therapeutic effects on children with cerebral palsy, the samples used in research studies have been very small. In the case of hippotherapy simulators, there are no studies that either recommend or advise against their use in the treatment of children with cerebral palsy. The aim of this randomised clinical study is to analyse the therapeutic effects or the contraindications of the use of a commercial hippotherapy simulator on several important factors relating to children with cerebral palsy such as their motor development, balance control in the sitting posture, hip abduction range of motion and electro myographic activity of adductor musculature. METHODS / DESIGN - The study is a randomised controlled trial. It will be carried out with a sample of 37 children with cerebral palsy divided into two treatment groups. Eligible participants will be randomly allocated to receive either (a) Treatment Group with hippotherapy simulator, maintaining sitting posture, with legs in abduction and rhythmic movement of the simulator or (b) Treatment Group maintaining sitting posture, with legs in abduction and without rhythmic movement of the simulator. DATA COLLECTION AND ANALYSIS - all measurements will be carried out by a specially trained blind assessor. To ensure standardization quality of the assessors, an inter-examiner agreement will be worked out at the start of the study. The trial is funded by the Department of Research, Innovation and Development of the Regional Government of Aragon (Official Bulletin of Aragon 23 July 2007), project number PM059/2007. DISCUSSION - Interest in this project is due to the following factors: Clinical originality (there are no previous studies analysing the effect of simulators on the population group of children with CP, nor any studies using as many variables as this project); Clinical impact (infantile cerebral palsy is a chronic multisystemic condition that affects not only the patient but also the patient’s family and their close circle of friends); Practical benefits (the development of an effective treatment is very important for introducing this element into the rehabilitation of these children).

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3 FYSIOTHERAPIE & NEURO REVALIDATIE

Hedendaagse fysiotherapie moet evidence-based zijn (Carr, Shepherd): de therapeut volgt de protocollen die met behulp van clinical trials wetenschappelijk zijn vastgesteld. Daarbij kan de fysiotherapeut gebruik maken van tools zoals bijvoorbeeld een oefentol - die niet gevalideerd is - of van Therapeutic Motion Simulation voor patiënten die niet op een oefentol kunnen en die ook neuro revalidatie nodig hebben en die met behulp van Therapeutic Motion Simulation zelfstandig kunnen oefenen wat hun zelfverzekerdheid vergroot. Als voorbeeld voor het gebruik van Therapeutic Motion Simulation dienen de KNGF richtlijnen beroerte en Parkinson.

Jan Willem Bakker - spierdystrofie

‘Ik kan nu tegelijk bewegen en ademen, fantastisch’ Door TMS: • Kan bewegen en tegelijk ademhalen ▪ • Helpt om recht op te zitten ▪ • Geweldig om continue te bewegen

In de richtlijn beroerte met evidence niveau 1 - de hoogste bewijslast worden onder meer de interventies gericht op loopvaardigheid en mobiteitsgerelateerde vaardigheden met aantoonbare effectiviteit (hoofdstuk II.IV) genoemd: 1 2 3 4 5

De zitbalans Het opstaan en gaan zitten Houdingscontrole tijdens het staan al dan niet m.b.v. forceplates (tool) Spierkracht en uithoudingsvermogen Loopbandtraining

Therapeutic Motion Simulation kan voor de punten 1 t.e.m. 4 worden gebruikt en kan het herstelproces versnellen en daarmee de voorwaarden voor punt 5 - om beter te kunnen lopen - schept. In de richtlijn voor Parkinson worden eveneens behandelstrategieën genoemd voor probleemgebieden (tabel 5, II.IV): 1 2 3 4

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testimonial

Balans Transfers Mobiliteit Vallen

fysiotherapie & neuro revalidatie

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Therapeutic Motion Simulation kan ook voor deze 4 punten gebruikt worden zelfmanagement te bevorderen en daarmee de kwaliteit van leven van patiënten te verbeteren. Om de kwaliteit van leven te kunnen meten maakt TMS gebruik van een app waarmee de patiënten bijvoorbeeld dagelijks een paar door henzelf gekozen persoonlijke doelstellingen kunnen bijhouden. Deze doelstellingen zijn direct gerelateerd aan de door het ICF protocol vastgestelde waarden betreffende de functies, activiteiten en participatie van patiënten. Voor de metingen wordt de PSK (patientspecifieke klachten) methode gebruikt. DISCUSSIE

Moet Therapeutic Motion Simulation - een tool voor de fysiotherapeut die gebruik maakt van gevalideerde bewegingen en oefeningen afzonderlijk gevalideerd worden of volstaat de PSK evaluatie?

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Carr JH, Shepherd RB School of Physiotherapy, Faculty of Health Science, University of Sydney, Lidcombe, Australia The changing face of neurological rehabilitation ©Revista Brasileira de Fisioterapia, Vol. 10, No. 2 (2006), 147-156 ABSTRACT BACKGROUND - Neurological rehabilitation and the contribution of physical

therapy have changed considerably over the past decades as scientific and technological developments have enabled greater understanding of brain reorganization and the mechanisms of motor control, motor performance, impairments and adaptations. OBJECTIVE - This paper presents a historical perspective covering the last half-century. DISCUSSION - Current scientific research, and the subsequent reevaluation of the functional effects of impairments following an upper motor neuron lesion, is leading to a changing focus in clinical interventions, with emphasis on optimizing motor performance through task-oriented exercise and training, strength and fitness training. Findings in both animal and human models suggest that, for rehabilitation to be effective in optimizing neural reorganization and functional recovery, increased emphasis needs to be placed on challenging, engaging and meaningful task training, to promote learning. The issues of the intensity of task training and extent of cardiovascular stress during physical activity are also discussed. Although there is much to become excited about in the findings from clinical research, clinical practice in neurorehabilitation continues to vary widely and depends largely on the preferred approach of the individual therapist and on the continuing dominance of therapeutic methods developed half a century ago. Physiotherapists need to embrace the responsibility of using evidence-based, or at least scientifically acceptable, methods of intervention and objective measurements of outcome.


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Clarissa B. Oliveira,I,II Ítalo R. T. Medeiros,III Mario G. Greters,III Norberto A. F. Frota, IV Leandro Tavares Lucato, VI Milberto Scaff, II and Adriana B. Conforto IIV I AACD - Adult Physiotherapy, São Paulo/SP, Brazil. II Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Neurology Department, São Paulo/SP, Brazil. III Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Otorhinolaryngology Department, São Paulo/SP, Brazil. IV Fortaleza University - School of Medicine, Fortaleza/CE, Brazil. V Instituto Israelita de Ensino e Pesquisa Albert Einstein, São Paulo/SP, Brazil. VI Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Radiology Department, São Paulo/SP, Brazil. Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke Clinics (Sao Paulo). 2011 December; 66(12): 2043–2048 ABSTRACT OBJECTIVE - Impairments in balance can be a consequence of changes in

the motor, sensory, and integrative aspects of motor control. Abnormal sensory reweighting, i.e., the ability to select the most appropriate sensory information to achieve postural stability, may contribute to balance impairment. The Sensory Organization Test is a component of Computerized Dynamic Posturography that evaluates the impact of visual, vestibular, and somatosensory inputs, as well as sensory reweighting, under conditions of sensory conflict. The aim of this study is to compare balance control in hemiparetic patients during the first year post-stroke and in age-matched neurologically normal subjects using the Berg Balance Scale and Computerized Dynamic Posturography. METHODS - We compared the Berg Balance Scale and Sensory Organization Test scores in 21 patients with hemiparesis after first-ever ischemic stroke and in 21 age-matched, neurologically normal subjects. An equilibrium score was defined for each Sensory Organization Test condition. RESULTS - Berg Balance Scale scores were significantly lower in the patients than in the neurologically normal subjects. Equilibrium scores were significantly lower in the patients than in the neurologically normal subjects for those Sensory Organization Test conditions that did not provide appropriate somatosensory information and under conditions of sensory conflict. A history of falls was more frequent in patients with lower equilibrium scores. CONCLUSION - During the first year after a stroke, defective sensory reweighting significantly impacts balance control in hemiparetic patients. These results are important for the planning of effective rehabilitation interventions.

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Shumway-Cook A, Hutchinson S, Kartin D, Price R, Woollacott M. Therapy, Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA 98195-6490, Effect of balance training on recovery of stability in children with cerebral palsy. Division of Physical PMID: 12948326 [PubMed - indexed for MEDLINE] ABSTRACT

This study examined the effect of massed practice in balance recovery of stability in six children (four males, two females; mean age 9 years 2 months, SD 2 years, range 7 years 5 months to 12 years 11 months) with cerebral palsy (CP). Four children were diagnosed with spastic diplegia (Gross Motor Function Classification System [GMFCS] level II) and two with spastic hemiplegia (GMFCS level I). A single-subject, multiple-baseline experimental design involving three pairs of children matched for diagnosis was used. A moveable forceplate system was used to test and train reactive balance control. Area per second (i.e. area covered by the center of pressure over a one second period) and time to stabilization from center of pressure measures were calculated following perturbations. The intervention phase consisted of massed practice on the moving platform (100 perturbations/day for 5 days). Analysis included hierarchical linear modeling and a repeated measures ANOVA. All children demonstrated a significant improvement in their ability to recover stability as demonstrated by reduced center of pressure area and time to stabilization following training. These improvements were still present 30 days following completion of training. Results suggest that postural control mechanisms in school-age children (7 to 13 years) with CP are modifiable.


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Michelle J Johnson*1,2,3,4 1. Medical College of Wisconsin, Dept. of Physical Medicine & Rehabilitation 2. Marquette University, Dept. of Biomedical Engineering, Olin Engineering Center, Milwaukee, WI 3. Clement J. Zablocki VA, Dept. of Physical Medicine & Rehabilitation, Milwaukee, WI 4. The Rehabilitation Robotics Research and Design Lab Recent trends in robot-assisted therapy environments to improve real-life functional performance after stroke Journal of Neuro Engineering and Rehabilitation 2006, 3:29 ABSTRACT

Upper and lower limb robotic tools for neuro-rehabilitation are effective in reducing motor impairment but they are limited in their ability to improve real world function. There is a need to improve functional outcomes after robot-assisted therapy. Improvements in the effectiveness of these environments may be achieved by incorporating into their design and control strategies important elements key to inducing motor learning and cerebral plasticity such as mass-practice, feedback, task-engagement, and complex problem solving. This special issue presents nine articles. Novel strategies covered in this issue encourage more natural movements through the use of virtual reality and real objects and faster motor learning through the use of error feedback to guide acquisition of natural movements that are salient to real activities. In addition, several articles describe novel systems and techniques that use of custom and commercial games combined with new low-cost robot systems and a humanoid robot to embody the “supervisory presence” of the therapy as possible solutions to exercise compliance in under- supervised environments such as the home.

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A. Visker Scriptie begeleiding: Aly Waninge, Annemarie Dijkhuizen Balans verbeteren en plezier bevorderen bij mensen met een (zeer) ernstige verstandelijke en visuele beperking door training op de therapeutic movement simulator balancer Bachelor scriptie Hanzehogeschool Groningen 2012 SAMENVATTING INLEIDING - Bij mensen met een (zeer) ernstige verstandelijke en visuele

beperking is balans onderdeelvan fysieke fitheid en dus van belang voor de gezondheid [1]. Uit onderzoek is gebleken dat de balans van de bewoners van de Brink is afgenomen in de afgelopenvier jaar [2]. Daarom is verbeteren van de balans een belangrijk aandachtspunt bij deze doelgroep. De doelstelling van dit onderzoek is het bepalen of de balans op een voor de deelnemer plezierige wijze verbeterd kan worden aan de hand van de TMS. METHODE - Het quasi experimenteel interventie onderzoek wordt bij de deelnemers (n = 4) uitgevoerd door middel van observatie en interventie. De interventie bestaat uit zes weken trainen op de TMS Balancer. Er worden voor- en nametingen gedaan van de mBBS, en de MIPQ vragenlijst op lange termijn. Tijdens elke trainingssessie wordt de korte MIPQ vragenlijst gescoord. Om verschillen voor en na de interventie te bepalen zijn de data van de mBBS geanalyseerd met de Wilcoxon rangorde toets, terwijl de data van de MIPQ op lange en korte termijn grafisch worden weergegeven. RESULTATEN - De resultaten van de voor- en nameting van de mBBS laten bij alle cliënten een toename van de mediaan van de score zien, deze is echter niet significant (p = 0.06). Bij de MIPQ op korte en lange termijn zijn er stijgende scores te zien, terwijl bij de lange MIPQ de scores per deelnemer een verschillend verloop laten zien. DISCUSSIE - De verschillen van de uitkomstmaat mBBS zijn waarschijnlijk niet significant omdat de onderzoeksgroep klein was. Bij de uitkomstmaten van de MIPQ vragenlijsten moet rekening gehouden worden met de lichamelijke en geestelijke gemoedstoestand per dag, (nieuwe) omgevingsfactoren en de invulling van de vragenlijsten van de begeleiding. CONCLUSIE - Er is een positieve trend te zien wat betreft de effecten van de TMS op de balans bij mensen met een (zeer) ernstige verstandelijke en visuele beperking door training op de TMS Balancer. De training wordt in het algemeen als plezierig ervaren door zowel deelnemers als begeleiders.


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4 PROPRIOCEPTION

Peter Rusbach – spasticiteit in de benen

‘minder last van spasmen’

Awarded with the Nobel Prize in 1932 The term proprioception was coined by Sir Charles Sherrington in 1906 when he introduced the classification of the senses into exteroceptive (cutaneous), interoceptive (visceral) and proprioceptive (deep) fields and postulated proprioception as our “secret sixth sense” (McCloskey and Gandevia 1993:3, Paterson 2009:769, Smetacek and Mechsner 2004:21, Sherrington 1961:132133, 320, Wade 2009:66).1 Sherrington’s identification of proprioception is part of the scientific quest for inwardly oriented senses thought to constitute a world “beneath the five senses”. From the beginning of the nineteenth century onward, developments in physics, anatomy, and physiology allowed researchers to specify and distinguish between the senses by reference to such criteria as the quality of the experience, the nature of the stimulus, the anatomy of the receptor system, and the pathways to, and representation of the modeling on, the cortex. Empirical support was given to the division of touch into a panoply of senses such as the muscle sense, the movement sense and multiple dimensions of cutaneous sensitivity. The fractioning of the sense of touch involved the questioning and reassessment of the number of the senses (Howes 2009:22-23, Paterson 2009:768, Wade 2009:55-57, 60-63, 80).

Door TMS: • Betere houding ▪ • Minder last van spasmen ▪ • Anderen sporten, hij TMS’t

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testimonial

proprioception

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Bryan L. Riemann; Scott M. Lephart University of Pittsburgh, Pittsburgh, PA The Sensorimotor System, Part I: The Physiologic Basis of Functional Joint Stability Journal of Athletic Training 2002;37(1):71–79

Bryan L. Riemann; Scott M. Lephart, University of Pittsburgh, Pittsburgh, PA The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability Journal of Athletic Training , 2002;37(1):80–84

OBJECTIVE - To define the nomenclature and physiologic mechanisms

OBJECTIVE - To discuss the role of proprioception in motor control and in

responsible for functional joint stability. DATA SOURCES - Information was drawn from an extensive MEDLINE search of the scientific literature conducted in the areas of proprioception, neuromuscular control, and mechanisms of functional joint stability for the years 1970 through 1999. An emphasis was placed on defining pertinent nomenclature based on the original references. DATA SYNTHESIS - Afferent proprioceptive input is conveyed to all levels of the central nervous system. They serve fundamental roles in optimal motor control and sensorimotor control over functional joint stability. CONCLUSIONS/APPLICATIONS: Sensorimotor control over the dynamic restraints is a complex process that involves components traditionally associated with motor control. Recognizing and understanding the complexities involved will facilitate the continued development and institution of management strategies based on scientific rationales.

activation of the dynamic restraints for functional joint stability. DATA SOURCES - IInformation was drawn from an extensive MEDLINE search of the scientific literature conducted in the areas of proprioception, motor control, neuromuscular control, and mechanisms of functional joint stability for the years 1970-1999. DATA SYNTHESIS - Proprioception is conveyed to all levels of the central nervous system. It serves fundamental roles for optimal motor control and sensorimotor control over the dynamic restraints. CONCLUSIONS/APPLICATIONS: Although controversy remains over the precise contributions of specific mechanoreceptors, proprioception as a whole is an essential component to con- trolling activation of the dynamic restraints and motor control. Enhanced muscle stiffness, of which muscle spindles are a crucial element, is argued to be an important characteristic for dynamic joint stability. Articular mechanoreceptors are attributed instrumental influence over gamma motor neuron activation, and therefore, serve to indirectly influence muscle stiffness. In addition, articular mechanoreceptors appear to influence higher motor center control over the dynamic restraints. Further research conducted in these areas will continue to assist in providing a scientific basis to the selection and development of clinical procedures.

proprioception

proprioception

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Phil Page, MS,PT,ATC,CSCS Sensorimotor training: A ‘‘global’’ approach for balance training Journal of Bodywork and Movement Therapies (2006) 10, 77-84

5 SPIEGELNEURONEN

SUMMARY

Sensorimotor training was developed by Dr. Vladimir Janda as part of a treatment approach to chronic musculoskeletal pain syndromes. He noted that many of these syndromes exhibited characteristic patterns of muscle imbalance, which were manifested with changes to the central nervous system motor programming. Janda emphasized the importance of proprioception in the rehabilitation process. In order to restore normal muscle firing patterns and reflexive stabilization, he developed a specific proprioceptive exercise progression for patients with chronic musculoskeletal pain. Sensorimotor training emphasizes postural control and progressive challenges to the sensorimotor system to restore normal motor programs in patients with chronic musculoskeletal pain. Patients progress through static, dynamic, and functional phases using simple rehabilitation tools such as balance boards, foam pads, and elastic bands. This paper will describe the scientific rationale for the program and describe the clinical progression of sensorimotor training.

De ontdekking van spiegelneuronen in 1996 door Rizzolatti en Gallese heeft een stroom van neuropsychologisch onderzoek op gang gebracht dat in toenemende mate aantoont dat verbeelden nieuwe neurologische verbindingen in het brein baant en dat verbeelden daarmee een belangrijke rol vervult in leerprocessen (Iacoboni, M. 2008: Koch & Fried, 2000, Markman e.a. 2009, Taal 2011). Voor TMS zijn spiegelneuronen van belang omdat zij de patiënten stimuleren om zich te vereenzelvigen met de filmbeelden die vanuit het perspectief van de beweging zijn gemaakt. Nature Neuroscience van 27 mei 2007 Spiegelneuronen zijn neuronen die actief worden wanneer je waarneemt wat iemand anders doet, op dezelfde plek in de hersenen als bij degene die de actie uitvoert. Onderzoekers van het Nijmegen Institute for Cognition and Information en het FC Donders Centre for Cognitive Neuroimaging van de Radboud Universiteit hebben nu ontdekt dat spiegelneuronen niet alleen actief worden wanneer een waarnemer de waargenomen actie wil imiteren; ze worden nog veel actiever als het de bedoeling is om de actie op een andere manier aan te vullen. Biological Psychiatry, Vol. 69 (9). Onderzoekers van het Universitair Medisch Centrum Groningen (UMCG) en het Nederlands Instituut voor Neurowetenschappen van de KNAW (NIN-KNAW) hebben ontdekt dat het spiegelsysteem in het brein van mensen met de hersenaandoening autisme wel functioneert, maar zich langzamer ontwikkelt dan bij anderen.

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proprioception

spiegelneuronen

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Vittorio Gallese, Lucia Fadiga, Leonardo Fogassi and Giacomo Rizzolatti (Instituto di Fisiologia Umana, Universita di Parma, Italy) Action recognition in the premotor cortex Brain (1996) 119, 593-609

6 MUZIEKTHERAPIE & PSYCHIATRIE

SUMMARY

We recorded electrical activity from 532 neurons in the rostral part of inferior area (area F5) of two macaque monkeys. Previous data had shown that neurons of this area discharge during goal-directed hand and mouth movements. We describe here the properties of a newly discovered set of F5 neurons (‘mirror neurons’, n=92) all of which became active both when the monkey performed a given action and when it observed a similar action performed by the experimenter. Mirror neurons, in order to be visually triggered, required an interaction between the agent of the action and the object of it. The sight of the agent alone or the object alone (three-dimensional objects, food) were ineffective. Hand and mouth were by far the most effective agents. The actions most represented among those activating mirror neurons were grasping, manipulating and placing. In most mirror neurons (92%) there was a clear relation between the visual action they responded to and the motor response they coded. In̴30% of mirror neurons the congruence was very strict and the effective observed and executed actions corresponded both in terms of general action (e.g. grasping) and in terms of the way in which that action was executed (e.g. precision grip). We conclude by proposing that mirror neurons form a system for matching observation and execution of motor actions. We discuss the possible role of this system in action recognition and, given the proposed homology between F5 and human Brocca’s region, we posit that a matching system, similar to that of mirror neurons exists in humans and could be involved in recognition of actions as well as phonetic gestures.

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spiegelneuronen

Therapeutic Motion Simulation maakt gebruik van special voor dat doel geproduceerde (beweeg)films waarbij de audio input een belangrijke rol speelt. Naast authentieke geluiden en muziek als ondersteuning voor bijvoorbeeld sport gerelateerde films wordt muziek ook gebruikt als uitgangspunt voor dans- en natuurfilms omdat muziek een krachtig therapeutische waarde kan hebben.

Oliver Sacks, Clinical Professor of Neurology, Albert Einstein College of Medicine, New York, USA The power of music Brain (2006) 129, 2528-2532 ….. Another passionate musical philosopher, Nietzsche, said “We listen to music with our muscles”. This, at least, is something we can see. It is evident in all of us – we tap our feet, we “keep time”, hum, sing along or “conduct” music, our facial expressions mirroring the rises and falls, the melodic contours and feelings of what we are hearing. Yet all this may occur without our knowledge or volition. …..

muziektherapie & psychiatrie

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Sandra L. Siedliecki PhD RN CNS, Senior Nurse Researcher, Department of Nursing Research and Innovation, Cleveland Clinic Foundation, Cleveland, Ohio, USA Marion Good PhD RN FAAN Prof. Frances Payne, Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA Effect of music on power, pain, depression and disability Journal of Advanced Nursing (2006) 54(5), 553–562 AIM - This paper reports a study testing the effect of music on power,

pain, depression and disability, and comparing the effects of researcherprovided music (standard music) with subject-preferred music (patterning music). BACKGROUND - Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated. METHOD - A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21–65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n ¼ 22), patterning music group (n ¼ 18) or control group (n ¼ 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II). RESULTS - The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported. CONCLUSION - Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.

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muziektherapie & psychiatrie

7 FELDENKRAIS EN PILATES

Therapeutic Motion Simulation laat zich ook inspireren door andere oefenmethodes zoals Feldenkrais en Pilates, die ook wetenschappelijk zijn getoetst. Onderstaand enkele voorbeelden van onderzoeken naar deze methoden, die met name ook oefeningen voor het bekken bevatten.

Karol A. Connors,1, 2 Mary P. Galea,1, 3 and Catherine M. Said 1, 3 1 Rehabilitation Sciences Research Centre, School of Physiotherapy, University of Melbourne, Parkville, VIC 3010, Australia 2 Calvary Health Care Bethlehem, Caulfield South, Australia 3 Austin Health, Heidelberg, Victoria, Australia Feldenkrais Method Balance Classes Improve Balance in Older Hindawi Publishing Corporation, Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 873672, 9 pages SUMMARY

The objective of this study was to investigate the effects of Feldenkrais Method balance classes on balance and mobility in older adults. This was a prospective non-randomized controlled study with pre/post measures. The setting for this study was the general community. A convenience sample of 26 community-dwelling older adults (median age 75 years) attending Feldenkrais Method balance classes formed the Intervention group. Thirty-seven volunteers were recruited for the Control group (median age 76.5 years). A series of Feldenkrais Method balance classes (the “Getting Grounded Gracefully” series), two classes per week for 10 weeks, were conducted. Main outcome measures were Activities-Specific Balance Confidence (ABC) questionnaire, Four Square Step Test (FSST), self-selected gait speed (using GAITRite instrumented gait mat). At re-testing, the Intervention group showed significant improvement on all of the measures (ABC, P = .016, FSST, P = .001, gait speed, P < .001). The Control group improved significantly on one measure (FSST, P < .001). Compared to the Control group, the Intervention group made a significant improvement in their ABC score (P = .005), gait speed (P = .017) and FSST time (P = .022). These findings suggest that Feldenkrais Method balance classes may improve mobility and balance in older adults.

feldenkrais en pilates

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Kloubec JA. Department of Health and Exercise Science, Gustavus Adolphus College, St. Peter, Minnesota, USA. Pilates for improvement of muscle endurance, flexibility, balance, and posture. J Strength Cond Res. 2010 Mar;24(3):661-7 ABSTRACT

Many claims have been made about the effectiveness of Pilates exercise on the basic parameters of fitness. The purpose of this study was to determine the effects of Pilates exercise on abdominal endurance, hamstring flexibility, upper-body muscular endurance, posture, and balance. Fifty subjects were recruited to participate in a 12-week Pilates class, which met for 1 hour 2 times per week. Subjects were randomly assigned to either the experimental (n = 25) or control group (n = 25). Subjects performed the essential (basic) mat routine consisting of approximately 25 separate exercises focusing on muscular endurance and flexibility of the abdomen, low back, and hips each class session. At the end of the 12-week period, a 1-way analysis of covariance showed a significant level of improvement (p < or = 0.05) in all variables except posture and balance. This study demonstrated that in active middle-aged men and women, exposure to Pilates exercise for 12 weeks, for two 60-minute sessions per week, was enough to promote statistically significant increases in abdominal endurance, hamstring flexibility, and upper-body muscular endurance. Participants did not demonstrate improvements in either posture or balance when compared with the control group. Exercise-training programs that address physical inactivity concerns and that are accessible and enjoyable to the general public are a desirable commodity for exercise and fitness trainers. This study suggests that individuals can improve their muscular endurance and flexibility using relatively low-intensity Pilates exercises that do not require equipment or a high degree of skill and are easy to master and use within a personal fitness routine. PMID: 20145572

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whole body vibration

8 WHOLE BODY VIBRATION

Met de door Therapeutic Motion Simulation toegepaste beweegtechnolgie kunnen vibraties tot 100 HZ worden geproduceerd. De meeste trilplaten zoals bijvoorbeeld van Power Plate - toonaangevend op het gebied van WBV - gaan tot ~50 HZ. Uit wetenschappelijk onderzoek blijkt dat WBV een heilzaam effect kan hebben op pijnbestrijding en conditieverbetering voor zowel ouderen als sporters.

Bastian, J., C. Trittel, and W. Franz. Vibrationstraining nach vorderer Kreuzbandplastik Deutsche Zeitschrift fur Sportmedizin. Vol. 56, no. 7/8, pp: 228. 2004. ABSTRACT BACKGROUND - A major problem after reconstruction of the anterior

cruciate ligament of the knee is the weakness of the M. quadriceps femoris. The aim of this study was to examine the effects of an additional whole body vibration (WBV) on a platform training in these patients. Different positive effects of this kind of training are still investigated: Whole body vibration leads to an increased co-activation of lower extremity extensor and flexor muscles, positive effects on joint stabilization, increased blood flow. METHODS AND RESULTS - The WBV group trained two times weekly for ten weeks with beginning in the third week posttreatment. The results show, that the group with additional WBV-training had six weeks postoperative no significant reduction of the muscle thickness 10 and 20 cm proximal the patella as the control group did. As a second effect, these group reached more contentness. CONCLUSION - An additional whole body vibration exercise is an effective training after acl-reconstruction in young patients and sportsmen.


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Bautmans, I., E. van Hees, J. Lemper, and T. Mets. The feasibility of whole body vibration in institutionalized elderly persons and its influence on muscle performance, balance and mobility: a randomized, controlled trial BMC Geriatrics. Dec; 5:17. 2005.

Bogaerts, A., C. Delecluse, A. Claessens, W. Coudyzer, S. Boonen, and S. Verschueren. Impact of Whole-Body Vibration Training Versus Fitness Training on Muscle Strength and Muscle Mass in Older Men: A 1-year Randomized Controlled Trial Journal of Gerontology: Medical Sciences. Vol. 62A, No. 6, pp: 630–635. 2007.

ABSTRACT

ABSTRACT

BACKGROUND - Fatigue or lack of interest can reduce the feasibility of

BACKGROUND - This randomized controlled study investigated the effects of

intensive physical exercise in nursing home residents. Low-volume exercise interventions with similar training effects might be an alternative. The aim of this randomised controlled trial was to investigate the feasibility of Whole Body Vibration (WBV) in institutionalised elderly, and its impact on functional capacity and muscle performance. METHODS - Twenty-four nursing home residents (15 female, 9 male; mean age 77.5 ± 11.0 years) were randomised (stratification for age, gender and ADL-category) to 6 weeks static WBV exercise (WBV+, N = 13) or control (only static exercise; N = 11). Outcome measures were exercise compliance, timed up-and-go, Tinetti-test, back scratch, chair sit-and-reach, handgrip strength and linear isokinetic leg extension. RESULTS - At baseline, WBV+ and control groups were similar for all outcome variables. Twenty-one participants completed the program and attended respectively 96% and 86% of the exercise sessions for the WBV+ and control groups. Training-induced changes in timed up-and-go and Tinetti-test were better for WBV+ compared to control (p = 0.029 for timed up-and-go, p = 0.001 and p = 0.002 for Tinetti body balance and total score respectively). In an alternative analysis (Worst Rank Score & Last Observation Carried Forward) the differences in change remained significant on the Tinetti body balance and total score. No other significant differences in change between both groups were observed. CONCLUSION - In nursing home residents with limited functional dependency, six weeks static WBV exercise is feasible, and is beneficial for balance and mobility. The supplementary benefit of WBV on muscle performance compared to classic exercise remains to be explored further.

1-year whole-body vibration (WBV) training on isometric and explosive muscle strength and muscle mass in community-dwelling men older than 60 years. METHODS - Muscle characteristics of the WBV group (n¼ 31, 67.3 6 0.7 years) were compared with those of a fitness (FIT) group (n ¼ 30, 67.4 6 0.8 years) and a control (CON) group (n ¼ 36, 68.6 6 0.9 years). Isometric strength of the knee extensors was measured using an isokinetic dynamometer, explosive muscle strength was assessed using a counter movement jump, and muscle mass of the upper leg was determined by computed tomography. RESULTS - Isometric muscle strength, explosive muscle strength, and muscle mass increased significantly in the WBV group (9.8%, 10.9%, and 3.4%, respectively) and in the FIT group (13.1%, 9.8%, and 3.8%, respectively) with the training effects not significantly different between the groups. No significant changes in any parameter were found in the CON group. CONCLUSION - WBV training is as efficient as a fitness program to increase isometric and explosive knee extension strength and muscle mass of the upper leg in community- dwelling older men. These findings suggest that WBV training has potential to prevent or reverse the age-related loss in skeletal muscle mass, referred to as sarcopenia.



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Bogaerts, A.C.G., C. Delecluse, A. L. Claessens, T. Troosters, S. Boonen, and S.M.P. Verschueren. Effects of whole body vibration training on cardiorespiratory fitness and muscle strength in older individuals (a 1-year randomised controlled trial) Age and Ageing. Vol. 38(4), pp: 448-454. 2009.

Moezy, A., G. Olyaei, M. Hadian, M. Razi, and S. Faghihzadeh. A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after Anterior Cruciate Ligament reconstruction British Journal of Sports Medicine. Vol. 42(5). pp: 373-378. 2008. ABSTRACT

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ABSTRACT

OBJECTIVE - To determine the effect of whole body vibration training

BACKGROUND - whole body vibration (WBV) training appears to be an

efficient alternative for conventional resistance training in older individuals. So far, no data exist about the vibratory effect on CARDIORESPIRATORY FITNESS. OBJECTIVES: this randomized controlled trial assessed the effects of 1-year WBV training on cardiorespiratory fitness and muscle strength in community-dwelling adults over the age of 60. METHODS - a total of 220 adults (mean age 67.1 years) were randomly assigned to a WBV Fitnessgroup or control group. The WBV group exercised on a vibration platform, and the fitness group performed cardiovascular, resistance, balance and stretching exercises. The control group did not participate in any training. Heart rate was measured during a single WBV session. Peak oxygen uptake (VO2peak) and time-to-peak exercise (TPE) were measured during progressive bicycle ergometry. Muscle strength was assessed by a dynamometer. RESULTS - heart rate increased significantly during WBV training. After 1 year, VO2peak, TPE and muscle strength increased significantly in the WBV and fitness groups. Both training groups improved similarly in VO2peak and muscle strength. The fitness group improved significantly more in TPE than the WBV group. CONCLUSION - WBV training in community-dwelling elderly appears to be efficient to improve cardiorespiratory fitness and muscle strength.

program (WBVT) in comparison with conventional training (CT) program on knee proprioception and postural stability after anterior cruciate ligament (ACL) reconstruction. METHODS - Twenty athletes with unilateral ACL reconstruction were randomly assigned in two groups; WBVT and CT, all participants received 12 sessions of WBVT or conventional training. Absolute error in joint repositioning test in two target angles (30° and 60°) with Biodex dynamometer, bilateral dynamic postural stability (anteroposterior, mediolateral and overall stability indices) with Biodex Stability System were measured pre and post intervention. RESULTS - The improvement of postural stability in the WBVT group was significantly greater than CT group (p = 0.05). The p values of the changing scores of open overall, open anteroposterior, open mediolateral, closed overall, closed anteroposterior and closed mediolateral stability indices were respectively 0.002, 0.010, 0.0001, 0.001, 0.0001, and 0.046. In addition, there were significant differences in all averages of absolute angular error at 60° and 30 º between WBVT and CT groups in both knees ( p values were respectively 0.001, 0.001, 0.0001), with exception, the healthy knees, at 30 º target position which was not significant (p = 0.131). CONCLUSION - Whole body vibration training improved proprioception and balance in ACL reconstructed athletes.



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9 SNOEZELEN

Snoezelen ook bekend als multisensory environment intervention dient ook als inspiratiebron voor Therapeutic Motion Simulation met name op het gebied van ontspanning ten behoeve van bijvoorbeeld Alzheimer patiënten.

Julia van Weert (a), Sandra van Dulmen (a), Ada Kerkstra (a), Peter Spreeuwenberg (a), Miel Ribbe (b), Jozien Bensing (a) a NIVEL, Nederlands instituut voor onderzoek van de gezondheidszorg, Utrecht b Vrije Universiteit/EMGO Instituut, Amsterdam Effecten van snoezelen op demente ouderen en zorgverleners NIVEL 2003

Willy Hemelaar – postpoliosyndroom

‘Het roept herinnering aan paardrijden op’ Door TMS: • Belevenissen die ze anders niet kan ervaren ▪ • Roept herinnering aan paardrijden op ▪ • Betere houding, spieren aanspannen om te blijven zitten tijdens paardrijden ▪ • Activeert ongebruikte spieren

SAMENVATTING

In dit onderzoek is het effect van snoezelen op demente ouderen en op zorgverleners onderzocht in zes Nederlandse verpleeghuizen. Snoezelen is een benaderingswijze om door middel van actieve zintuigprikkeling een ingang te vinden in de belevingswereld van de demente oudere, met als doel het welbevinden te optimaliseren of in stand te houden. De vraagstellingen van het onderzoek luidden: 1. Wat is het effect van snoezelen op het gedrag van dementerende verpleeghuisbewoners? 2. Wat is het effect van snoezelen op de arbeidstevredenheid, burn-out, ervaren werklast en de ervaren problemen in de omgang met demente bewoners van verzorgenden? 3. Hoe verloopt de implementatie en de toepassing van snoezelen op de afdelingen?

>> vervolg samenvatting op de volgende pagina

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testimonial

snoezelen

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10 Het effect is onderzocht door middel van een veldexperiment waarin snoezelen geïmplementeerd werd op zes experimentele afdelingen die vergeleken werden met zes controle afdelingen. In de voormeting is het gedrag van 120 bewoners en 120 verzorgenden in kaart gebracht door middel van video-observaties tijdens de ochtendzorg. Daarnaast gaven de verzorgenden een beoordeling van het gedrag van de bewoners over een langere periode met behulp van gedragsobservatielijsten. Tevens vulden verzorgenden een vragenlijst in over werkbeleving, ervaren werklast, ervaren problemen in de omgang met demente ouderen, arbeidssatisfactie en burn-out. Vervolgens kregen zestig verzorgenden van de experimentele afdelingen de cursus “snoezelen door uitvoerenden” aangeboden door Bernardus. Expertisecentrum / Fontis. Na afloop van de cursus zijn de experimentele afdelingen gestart met het integreren van snoezelen in de 24-uurszorg op de afdeling. Het implementatietraject is nauwkeurig geëvalueerd. Na anderhalf jaar vond een nameting plaats die identiek was aan de voormeting. De resultaten van het onderzoek laten zien dat de integratie van snoezelen in de 24- uurszorg bij een goede implementatie kan leiden tot positieve effecten op de stemming en het gedrag van bewoners en op de werkbeleving van verzorgenden.

E-HEALTH

Therapeutic Motion Simulation is hoofdzakelijk een software driven systeem dat optimaal kan fuctioneren als het online gebruikt wordt. Doordat het online staat kan er op een gestructureerde wijze informatie worden verkregen, die kan worden gebruikt om de functionaliteit van TMS continue te verbeteren. Verder kan de gebruiksinformatie gerelateerd worden aan de door de patient bijgehouden informatie inzake de kwaliteit van leven en ook dit kan weer gebruikt worden om het inzicht op de toepassings mogelijkheden van TMS te vergroten. Tenslotte kan de online verbinding worden gebruikt om TMS bij patient thuis te monitoren en om andere diensten zoals webfysio, beeldtelefonie en andere vormen van e-health aan te bieden resp. te integreren in de firmware van TMS.

Actionplan Europe E-Health, 2012 - 2020 Zorg moet digitale revolutie omarmen De gezondheidszorg moet de digitale revolutie omarmen. Alleen dan kan aan de stijgende zorgvraag voor mensen met chronische aandoeningen beantwoord (blijven) worden. Dat schrijft Neelie Kroes, Europees commissaris digitale agenda, en Tonio Borg, Europees commisaris voor gezondheid en consumentenbescherming op EuropeanVoice.com. ter gelegenheid van het nieuwe Europese e-Health Action Plan, dat deze week wordt gelanceerd. In het stuk wijzen de eurocommissarissen op de angst die veel ouderen hebben over de vraag of zij in de toekomst nog wel voldoende zorg kunnen krijgen. Er is een dilemma: aan de ene kant stijgen de uitgaven voor de zorg enorm en aan de andere kant zullen jongere generaties die kosten niet meer kunnen opbrengen. Kroes en Borg zien de oplossing in digitale hulpmiddelen. Technologie De trend is dat mensen steeds ouder worden en dat chronische patiënten liever thuis wonen. Daar komt bij dat ze de constante, tijdverslindende uitstapjes naar de dokter willen vermijden. Dan komt digitale technologie om de hoek kijken, hetzij door middel van remote monitoring-apparaten die op afstand zaken kunnen meten en bewaken, hetzij door middel van telemedicine die de zorg in staat stelt om specialistische medische hulp te geven. Voorbeelden hiervan zijn de mobile applicaties.

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snoezelen

e-health

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De twee eurocommissarissen wijzen erop dat het niet om science fiction gaat, maar dat veel oplossingen al bestaan. Veel van de digitale oplossingen zijn in Europa bedacht en kunnen, mits goed ingezet, leiden tot lagere kosten en meer efficiëntie.

INDEX MEDISCHE PUBLICATIES

1 Kloof Kroes en Borg constateren nog altijd een kloof tussen e-Health-technologie en traditionele patiëntenzorg.”De sector is huiverig om de digitale revolutie te omarmen. Men houdt liever vast aan traditionele methoden en modellen. Politici hebben ook liever niet dat een systeem dat in het verleden goed heeft gewerkt nu door e-Health wordt verstoord”.

SERIOUS EXERGAMING Lamoth CJ, Alingh R, Caljouw SR - Exergaming for elderly: effects of

pag. 9

different types of game feedback on performance of a balance task.

Sveistrup - Motor rehabilitation using virtual reality

pag. 10

Maureen K. Holden - Virtual Environments for Motor

pag. 11

Rehabilitation: Review

Opheffen In het nieuwe European e-Health Action Plan wordt uiteengezet hoe de gezondheidszorg de digitale voordelen kan benutten.”Alleen zo kunnen een betere zorg voor onze burgers garanderen”, aldus het rapport. De slogan is: barrières opheffen om te komen tot een slimmer, veiliger en patiëntgerichte gezondheidszorg.

Anat Mirelman, Paolo Bonato, Judith E. Deutsch - Effects of Training

pag. 12

With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke

E.D de Bruin, D. Schoene, G. Pichierri, S.T. Smith - Use of virtual reality

pag. 13

technique for the training motor control in the elderly

Dori Rosenberg, Colin A. Depp, Ipsit V. Vahia, Jennifer Reichstadt, Barton W. Palmer, Jacqueline Kerr, Greg Norman and Dilip V. Jeste - Exergames

pag. 14

for Subsyndromal Depression in Older Adults: A Pilot Study of a Novel Intervention

2

HIPPOTHERAPIE HE Lechner, S Feldhaus, L Gudmundsen, D Hegemann, D Michel, GA Zach and H Knecht - The short-term effect of hippotherapy on spasticity in

pag. 17

patients with spinal cord injury

Margareta Håkanson, Margareta Möller, Ingalill Lindström, Bengt Mattsson -

pag. 18

The horse as the healer - A study of riding in patients with back pain

Pablo Herrero, Ángel Asensio, Elena García, Álvaro Marco, Barbara Oliván, Alejandro Ibarz, Eva M Gómez-Trullén and Roberto Casas - Study of

pag. 19

the therapeutic effects of an advanced hippotherapy simulator in children with cerebral palsy: a randomised controlled trial

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e-health

index medische publicaties

49

3

7

FYSIOTHERAPIE & NEURO REVALIDATIE Carr JH, Shepherd RB - The changing face of neurological rehabilitation

pag. 23

FELDENKRAIS EN PILATES Karol A. Connors, Mary P. Galea and Catherine M. Said - Feldenkrais

pag. 37

Method Balance Classes Improve Balance in Older

Clarissa B. Oliveira, Ítalo R. T. Medeiros, Mario G. Greters, Norberto A. F. Frota, Leandro Tavares Lucato, Milberto Scaff and Adriana B. Conforto -

pag. 24 Kloubec JA. - Pilates for improvement of muscle endurance, flexibility,

Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke

Shumway - Cook A, Hutchinson S, Kartin D, Price R, Woollacott M -

pag. 25

8

Effect of balance training on recovery of stability in children with cerebral palsy. Division of Physical

Michelle J Johnson - Recent trends in robot-assisted therapy environ-

pag. 38

balance, and posture

WHOLE BODY VIBRATION Bastian, J., C. Trittel, and W. Franz. - Vibrationstraining nach vorderer

pag. 39

Kreuzbandplastik

pag. 26

Bautmans, I., E. van Hees, J. Lemper, and T. Mets - The feasibility

ments to improve real-life functional performance after stroke

pag. 40

of whole body vibration in institutionalized elderly persons and

A. Visker - Balans verbeteren en plezier bevorderen bij mensen

pag. 27

its influence on muscle performance, balance and mobility:

met een (zeer) ernstige verstandelijke en visuele beperking door training op de Therapeutic Movement Simulator Balancer

4

a randomized, controlled trial

Bogaerts, A., C. Delecluse, A. Claessens, W. Coudyzer, S. Boonen, and S. Verschueren - Impact of Whole-Body Vibration Training Versus

PROPRIOCEPTION Bryan L. Riemann, Scott M. - The Sensorimotor System, Part I:

Fitness Training on Muscle Strength and Muscle Mass in Older Men: A 1-Year Randomized Controlled Trial

pag. 30

The Physiologic Basis of Functional Joint Stability

Bryan L. Riemann; Scott M - The Sensorimotor System, Part II: The Role

pag. 41

Bogaerts, A.C.G., C. Delecluse, A. L. Claessens, T. Troosters, S. Boonen, and S.M.P. Verschueren - Effects of whole body vibration training on

pag. 31

pag. 42

cardiorespiratory fitness and muscle strength in older individuals

of Proprioception in Motor Control and Functional Joint Stability

(a 1-year randomised controlled trial)

Phil Page - Sensorimotor raining: A ‘‘global’’ approach for balance

pag. 32

training

Moezy, A., G. Olyaei, M. Hadian, M. Razi, and S. Faghihzadeh. -

pag. 43

A comparative study of whole body vibration training and

5

Vittorio Gallese, Lucia Fadiga, Leonardo Fogassi and Giacomo Rizzolatti - Action recognition in the premotor cortex

6

conventional training on knee proprioception and postural stability

SPIEGELNEURONEN

after anterior cruciate ligament reconstruction

pag. 34

9

SNOEZELEN Julia van Weert, Sandra van Dulmen, Ada Kerkstra, Peter Spreeuwenberg, Miel Ribbe, Jozien Bensing - Effecten van snoezelen op demente

MUZIEKTHERAPIE & PSYCHIATRIE

pag. 45

ouderen en zorgverleners

Oliver Sacks - The power of music

pag. 35

Sandra L. Siedliecki, Marion Good, Prof. Frances Payne - Effect of music

pag. 36

10 E-HEALTH Actionplan Europe E-Health, 2012 - 2020

pag. 47

on power, pain, depression and disability 50



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EPILOOG

De kracht van technologie gebruiken om het leven van mensen die niet (meer) kunnen of willen bewegen te verbeteren. In slechts drie jaar krijgt TMS internationaal erkenning voor haar bijdrage op het gebied van revalidatie en als een methode om de kwaliteit van leven van chronisch zieken te verbeteren. Het gebruik van low cost robotfysio en gaming technologie in combinatie met e-health neemt exponentieel toe . De TMS technologie biedt enorme kansen. TMS heeft als doelstelling om een belangrijke speler te worden op het gebied van serious gaming en neuro revalidatie. Wilt u meer informatie of uw gedachten met ons delen neemt u dan contact met ons op.

COLOFON hoewel deze uitgave met grote zorgvuldigheid is samengesteld kunnen er geen rechten aan worden ontleend. © Vita Care 2013

auteurs Herbert Krakauer Tanja Ivanovski Julius van de Voort, LLM layout & design Klaassen ontwerp fotografie Carlo Galli website www.vita-care.eu email [email protected] Telefoon +31(0)88 144 12 20 52

epiloog

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website www.vita-care.eu email [email protected] Telefoon +31(0)88 144 12 20

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ACHTERGROND EN ONDERZOEK

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