Adelante Rehabilitation Center

Hoensbroek, Netherlands

Adelante Rehabilitation Center

Hoensbroek, Netherlands
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Franck J.A.,Adelante Rehabilitation Center | Smeets R.J.E.M.,Maastricht University
PLoS ONE | Year: 2017

Background: Arm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated. Method: This single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge. Results: Eighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation. Conclusions: A majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies. © 2017 Franck et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Vanmulken D.A.M.M.,Adelante Rehabilitation Center | Bongers H.M.H.,Adelante Rehabilitation Center | Seelen H.A.M.,Maastricht University
Spinal Cord | Year: 2015

Study design:Prospective multiple case study.Objectives:To test (1) the feasibility of haptic robot technology (Haptic Master (HM)) use to improve arm-hand function (AHF) and arm-hand skill performance (AHSP) in persons with a cervical spinal cord injury (C-SCI), (2) inventory participants' motivation and expectation to work with the robot technology used and (3) to descriptively report the results in individual cases.Setting:Rehabilitation Centre.Methods:Five C-SCI patients were trained for 6 weeks, 3 days per week, 60 min per day. Therapists filled out the Usefulness, Satisfaction and Ease-of-use questionnaire (USE). The Intrinsic Motivational Inventory (IMI) and credibility and expectancy questionnaire (CEQ) were filled out by participants. Performance at activity level was gauged using the Van Lieshout test for AHF in Tetraplegia and the Spinal Cord Independence Measure. Function level was gauged using muscle strength testing and the International Classification for Surgery of the Hand in Tetraplegia.Results:As to the feasibility of the application of haptic robot technology, the mean USE score was 65%. Mean IMI and CEQ results were 67% and 60%, respectively. Participants were motivated to train with the HM. All participants rated credibility higher than expectations regarding the improvement. In the current patients, little progress was demonstrated at the International Classification of Functioning, Disability and Health function and the activity level.Conclusion:It is feasible to train C-SCI persons with the HM. Therapists report that working with the HM is easy to learn and easy to perform. Usability of the HM may be improved. Further research is needed to assess in which group of C-SCI and at which stage of rehabilitation HM training may be most beneficial. © 2015 International Spinal Cord Society. All rights reserved.

Timmermans A.A.A.,Maastricht University | Verbunt J.A.,Maastricht University | van Woerden R.,Atrium Medical | Moennekens M.,Adelante Rehabilitation Center | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2013

Objectives: More than 50% of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life. This study aims to evaluate the effectiveness of a task-oriented mental practice (MP) approach as an addition to regular arm-hand therapy in patients with subacute stroke. Methods: A multicenter, prospective, single-blind, randomized clinical trial was performed. Patients trained for 6 weeks, at least 3 times per day. In the experimental group, patients performed video-instructed MP. In the control group, patients performed neurodevelopmental therapy-based exercise therapy. The primary outcome measures are Fugl-Meyer test, Frenchay arm test, Wolf motor function test, and accelerometry. Results: The patients did improve over time on Fugl-Meyer test and Wolf motor function test in both the control and the experimental group. A significant improvement on the Frenchay arm test was found after training (which was maintained at 12-month follow-up) only in the experimental group. However, no difference in training effects between groups was demonstrated. Conclusions: Training effects were demonstrated after MP training in patients with subacute stroke. However, the results of this study do not corroborate the hypothesis that the use of MP in addition to therapy as usual in patients with subacute stroke has an additional effect over neurodevelopmental therapy in addition to therapy as usual. © 2013.

De Groot S.,Duyvensz Nagel Research Laboratory | De Groot S.,University of Groningen | Post M.W.M.,University Utrecht | Bongers-Janssen H.M.H.,Adelante Rehabilitation Center | And 2 more authors.
Spinal Cord | Year: 2011

Study design: Cross-sectional study. Objectives: To describe the satisfaction of the manual wheelchair user with hand rim wheelchair-related aspects (for example, dimensions, weight and comfort) and wheelchair service-related aspects and to determine the relationship between wheelchair users' satisfaction, personal and lesion characteristics, and active lifestyle and participation in persons with a spinal cord injury (SCI). Setting: Eight Dutch rehabilitation centers with a specialized SCI unit. Methods: The Dutch version of the Quebec user evaluation of satisfaction with assistive technology (D-QUEST) was filled out by 109 participants 1 year after discharge from inpatient SCI rehabilitation. Relationships between the D-QUEST scores and personal and lesion characteristics, and active lifestyle and participation (physical activity scale for individuals with physical disabilities (PASIPD), Utrecht activity list (UAL), mobility range and social behavior subscales of the SIP68 (SIPSOC)) were determined. Results: A high level of satisfaction was found with wheelchair-related aspects. The participants were less satisfied with the service-related aspects. Participants with an incomplete lesion were slightly more satisfied regarding both aspects than those with a complete lesion. A higher satisfaction regarding wheelchair dimensions and a higher overall satisfaction were related to a more active lifestyle. Persons who were more satisfied with the simplicity of use of the wheelchair had a better participation score. Conclusion: Dutch persons with SCI are in general quite satisfied with their hand rim wheelchair. Some aspects of the wheelchair (dimensions and simplicity of use) are important to optimize as these are related to an active lifestyle and participation. © 2011 International Spinal Cord Society All rights reserved.

Eliasson A.C.,Karolinska Institutet | Krumlinde-Sundholm L.,Karolinska Institutet | Gordon A.M.,Columbia University | Feys H.,Catholic University of Leuven | And 7 more authors.
Developmental Medicine and Child Neurology | Year: 2014

Aim: The aim of this study was to provide an overview of what is known about constraint-induced movement therapy (CIMT) in children with unilateral cerebral palsy (CP), to identify current knowledge gaps, and to provide suggestions for future research. Method: Nine experts participated in a consensus meeting. A comprehensive literature search was conducted and data were summarized before the meeting. The core model produced by the European network for Health Technology Assessment was used as a framework for discussion and to identify critical issues for future research. Results: All models of CIMT have demonstrated improvements in the upper limb abilities of children with unilateral CP. A consensus was reached on 11 important questions to be further explored in future studies. The areas of highest priority included the effect of dosage, the effect of repeated CIMT, and the impact of predictive factors, such as age, on the response to CIMT. Consensus suggestions for future study designs and the use of validated outcome measures were also provided. Interpretation: The CIMT construct is complex, and much remains unknown. It is unclear whether a specific model of CIMT demonstrates superiority over others and whether dosage of training matters. Future research should build upon existing knowledge and aim to provide information that will help implement CIMT in various countries with different health care resources and organizational structures. © 2013 Mac Keith Press.

Smeets S.M.J.,Maastricht University | Ponds R.W.H.M.,Maastricht University | Ponds R.W.H.M.,Adelante Rehabilitation Center | Gregorio G.W.,Maastricht University | And 4 more authors.
Neuropsychology | Year: 2014

Objective: The purpose of this study was to investigate impaired awareness of deficits in relation to treatment motivation and depressive symptoms in patients with neuropsychiatric symptoms after acquired brain injury. Method: The study had a Cross-sectional design with 93 outpatient brain injury patients with neuropsychiatric symptoms in the chronic phase after injury. Awareness was measured by the discrepancy in answers between patients and significant others and/or clinicians. Patients were divided into 3 awareness groups: underestimation, accurate estimation, and overestimation of competencies. Treatment motivation and depressive symptoms were measured with self-report questionnaires. Results: Average discrepancy scores suggested patients had accurate awareness of deficits. However, when dividing patients into 3 awareness groups, 30% underestimated, 38% accurately estimated, and 32% overestimated their competencies. Linear regression analysis with discrepancy scores showed overestimation of competencies (positive discrepancy scores) was associated with less depressive symptoms, whereas underestimation (negative discrepancy scores) was associated with more depressive symptoms (β = -.28 to -.42, p <.05). Group analysis revealed that the underestimation group reported significantly more depressive symptoms than the overestimation group (β = .43 to.44, p <.05). No significant difference between the accurate estimation and overestimation group was found (p>.05). An association between awareness and treatment motivation was not statistically confirmed. Conclusion: This study demonstrated that when considering awareness groups, more nuanced results arise than when only considering discrepancy scores. From a clinical and scientific standpoint, it is important to distinguish awareness groups in addition to considering mean discrepancy scores. © 2014 American Psychological Association.

Winkens I.,Maastricht University | Ponds R.,Maastricht University | Ponds R.,Adelante Rehabilitation Center | Pouwels C.,GGZ Oost Brabant | And 2 more authors.
Neuropsychological Rehabilitation | Year: 2014

The ABC method is a basic and simplified form of behavioural modification therapy for use by nurses. ABC refers to the identification of Antecedent events, target Behaviours, and Consequent events. A single-case experimental AB design was used to evaluate the effects of the ABC method on a woman diagnosed with olivo-ponto-cerebellar ataxia. Target behaviour was verbal aggressive behaviour during ADL care, assessed at 9 time points immediately before implementation of the ABC method and at 36 time points after implementation. A randomisation test showed a significant treatment effect between the baseline and intervention phases (t 1/4 .58, p 1/4 .03; ES [Nonoverlap All Pairs] 1/4 .62). Visual analysis, however, showed that the target behaviour was still present after implementation of the method and that on some days the nurses even judged the behaviour to be more severe than at baseline. Although the target behaviour was still present after treatment, the ABC method seems to be a promising tool for decreasing problem behaviour in patients with acquired brain injury. It is worth investigating the effects of this method in future studies. When interpreting single-subject data, both visual inspection and statistical analysis are needed to determine whether treatment is effective and whether the effects lead to clinically desirable results. © 2013 Taylor & Francis.

PubMed | Adelante Rehabilitation Center and Maastricht University
Type: Journal Article | Journal: Journal of orthopaedic case reports | Year: 2017

Non-or partial weight bearing is frequently the standard treatment after peri-articular lower extremity fractures. Displaced talar neck fractures are severe injuries compromising vascularity of the corpus and consequently are at risk for non-union and avascular necrosis, the main reason to restrict weight bearing for up to three months according to most literature.We report a case of a 31-year old male with a high impact car accident. His pelvic ring and Hawkins II talar fracture were treated by open reduction and internal fixation. Rehabilitation was based on permissive weight bearing following wound healing. His fractures healed uneventfully and he was able to run freely, without any discomfort within 8 weeks. Radiological evaluation of the talus showed complete bone healing without signs of avascular necrosis. At one year follow-up, the patient is free of the symptoms.We might consider changing the restricted or non-weight bearing protocol in surgically treated talar neck fractures at our centre and allow early weight bearing, based on body awareness and the creation of a safe environment during the rehabilitation phase.

Nooijen C.F.J.,Erasmus Medical Center | Vogels S.,Rijndam Rehabilitation Institute | Bongers-Janssen H.M.H.,Adelante Rehabilitation Center | Bergen M.P.,Rijndam Rehabilitation Institute | And 2 more authors.
Spinal Cord | Year: 2015

Study design:Cross-sectional.Objectives:To determine the prevalence and severity of fatigue in persons with subacute spinal cord injury (SCI), assess whether demographic and lesion characteristics are related to fatigue and determine the relationship with physical fitness and physical behavior.Setting:Measurements were performed 2 months before discharge from inpatient rehabilitation.Methods:Thirty-six persons with subacute SCI, dependent on a manual wheelchair, mean age 43±15 and 83% men, completed the Fatigue Severity Scale (FSS). FSS scores >4 indicated fatigue. We recorded age and lesion characteristics, measured body mass index, measured peak power output and peak oxygen uptake during a maximal handcycling test and determined physical behavior using an accelerometer-based activity monitor. T-tests were used to test for differences in fatigue between subgroups based on age and lesion characteristics, and regression analyses to assess the relationship with physical fitness and physical behavior.Results:Mean FSS was 3.3±1.3. Fatigue, including severe fatigue, was prevalent in 31% (95% confidence interval: 16-46) of participants compared with 18% in the general population. Furthermore, mean fatigue was significantly higher in persons with incomplete compared with complete lesions (t=2.22, P=0.03). Mean scores between other subgroups did not differ significantly. Of the physical fitness and physical behavior measures, only peak oxygen uptake tended to be related to more fatigue (B=-1.47, P=0.05).Conclusion:Fatigue was prevalent and is of concern in persons with subacute SCI. Those with incomplete lesions seem to be at higher risk. Because fatigue is known to persist among persons with SCI, interventions to reduce fatigue seem necessary. © 2015 International Spinal Cord Society All rights reserved.

Jaspers Focks-Feenstra J.H.,Het Roessingh Rehabilitation Center | Snoek G.J.,Het Roessingh Rehabilitation Center | Bongers-Janssen H.M.H.,Adelante Rehabilitation Center | Nene A.V.,Het Roessingh Rehabilitation Center
Spinal Cord | Year: 2011

Study design: There is a paucity of literature about satisfaction after reconstructive surgery to improve upper limb function in persons with tetraplegia. The present literature describes mainly functional outcomes. Objectives: To evaluate long-term satisfaction after reconstructive upper extremity surgery in persons with tetraplegia. Setting: Two rehabilitation centers in the Netherlands. Method: A three-part questionnaire consisting questions regarding satisfaction, activities, occupation, changes in functional ability and willingness to undergo the surgeries again was used. Internal reliability of the questionnaire was verified by factor analysis and calculation of Cronbach's alpha. Results: In total, 39 out of 55 persons (70.9%) participated in the study. The participants responses to questions about satisfaction, activities and occupation were positive in 73.5, 67.6 and 35.0%, respectively. Nearly 81% improved their functional ability. Approximately 65% of the participants were willing to undergo elbow extension surgery again and 77.1% expressed their willingness to undergo hand/wrist surgery again. Significant positive correlation was found between willingness to have surgery again and improvement in activities and occupation: Spearman's correlation coefficients: activities-elbow extension 0.63 (P=0.003), activities-hand/wrist 0.57 (P<0.001), occupation-elbow extension 0.53 (P=0.025), occupation-hand/wrist 0.57 (P<0.001). Differences between the subgroups who would have surgery again and those who would refrain were also significant; one-way analysis of variance for activities (F=9.54, P<0.01) and for occupation (F=6.60, P<0.02). Conclusion: In the Netherlands, the majority of persons with tetraplegia who underwent reconstructive upper extremity surgery were satisfied with the results. This was related to improvement in activities and occupation. © 2011 International Spinal Cord Society All rights reserved.

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