Prize of The European Academy of Rehabilitation Medicine

The European Academy of Rehabilitation Medicine has created an annual prize: The Prize of European Academy of Rehabilitaiton Medicine.

This is funded by the Journal of Rehabilitation Medicine and the non-profit Foundation for Rehabilitation Information (Sweden).

The prize is 1200 Euros plus up to 450 Euros for registration, travelling and accommodation at the occasion when the prize is presented.

A submission should be on a rehabilitation, physical medicine or medico-social topic relating to the (re-)integration of persons with disabilities It should be the work of a doctor or health professional employed in a Physical and Rehabilitation Department of a country which has an official delegate in the Physical and Rehabilitation Medicine Section of European Union of Medical Specialists.(www.euro-prm.org). The work should be written in one of the two official languages of the Academy (English or French). A summary of the work should be presented in the other official language .It should be typed or printed and may be a finished work or set of works that is part of a thesis or consist of at least one publication in a peer-reviewed journal. Candidates should submit their work at the latest by 31 July of the year in question to all members of the Prize Committee (see www.aemr.eu) It should be accompanied by a signed letter in one of the two languages, asking for the enclosed submission to be considered for the prize, and countersigned by the head of the department A copy (with the letter )should be sent to each member of the prize committee(see below and see website of Academy for full addresses ).

The prize will be awarded at a major scientific meeting. All candidates will be informed of the result of the competition. The decision of the Prize Commission is final. The announcement of the prize will be sent each year to the national societies of PRM, and to rehabilitation journals. It will also be on the Academy website. The successful candidate will be asked to send a photo to the secretary. If only one submission is sent in then the jury may decide to postpone the award to the next year.

Further information can be found at the Academy website www.aemr.eu
M. A. Chamberlain
Chair, Prize Committee,
Dec 2011

Winner 2014: Manoj Sivan

Summary of the thesis: home-based Computer Assisted Arm Rehabilitation (hCAAR) device for upper limb exercises in stroke. This thesis was awarded the European Academy of Rehabilitation Medicine prize 2014. Dr Sivan received his prize during the congress of Baltic and North Sea Forum on PRM in Riga, September 2015.

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation therapy. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to develop and evaluate a robotic device (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. The project had two stages: Stage 1, hCAAR development using a user-centred design process; Stage 2, a feasibility clinical study in the home setting.

Stage 1: Nine stroke survivors with upper limb weakness and 6 healthcare professionals were involved in the concept and design stages of device development. hCAAR consists of a powered joystick with a computer interface, which is used to direct the movement of the upper limb to perform therapeutic movements as directed by tasks on the screen. hCAAR also provides controlled assistance when the user’s voluntary upper limb movement is insufficient to complete the prescribed task. Stage 2: In the feasibility study, 19 participants (stroke survivors with upper limb weakness) were recruited. Clinical outcomes performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and one month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) muscle strength scale and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI), ABILHAND and participant/carer/therapist qualitative feedback.

No serious adverse events were reported. Two participants were unable to use hCAAR: one due to severe paresis (FM 6/66); and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. The median usage time was 433 min (IQR 250–791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. Five participants reported improvement in functional ability in daily activities. Participants, family members and therapists were satisfied with the usability of hCAAR in the home setting. The research project also demonstrated that the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for stroke provides a useful basis to structure interviews to gather feedback from end-users and healthcare professionals in different stages (concept, design and testing) of the rehabilitation device development.

In conclusion, a home-based restorative rehabilitation robotic device has been developed using a user-centred design process that involved stroke survivors and healthcare professionals. The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for 8 weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study.

Dr Manoj Sivan, MD, works as a Consultant in Rehabilitation Medicine, Salford Royal Hospital and Honorary Senior Lecturer, University of Manchester. E-mail: Manoj.Sivan@manchester.ac.uk.

References
1. Sivan M, Gallagher J, Makower S, Keeling D, Bhakta B, O’Connor RJ, Levesley M. Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting. J Neuroeng Rehabil 2014; 11: 163.
2. Sivan M, Gallagher J, Holt R, Weightman A, Levesley M, Bhakta B. Investigating the International Classification of Functioning, Disability and Health (ICF) framework to capture user needs in the concept stage of rehabilitation technology development for stroke patients. Assist Technol 2014; 26: 164–173.
3. Sivan M, O’Connor RJ, Makower S, Levesley M, Bhakta B. Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke. J Rehabil Med 2011; 43: 181–189.

 

 

 

Winner 2013: Eric J.K. Boldingh

Summary of the thesis: Pain and disabilities related to hip disorders in adults with severe cerebral palsy. This thesis was awarded with the European Academy of Rehabilitation Medicine prize 2013. Dr Boldingh received his prize during the ESPRM congress in Marseille, France, 2014.

Research considered the question: Are patients with cerebral palsy (CP) and hip disorders bothered by this disorder, in their youth, adolescence or later? And if so, how can we help these people by preventing or curing this problem?

First part of the thesis is on the development of an instrument to measure pain in patients with severe cerebral palsy. The pain assessment instrument (PAICP) uses drawings of everyday situations. Patients score pain on a faces pain scale (1).

Secondly, a cross-sectional study was carried out to investigate the relationship between hip X-ray findings (migration, deformity and osteoarthritis) and pain in 160 patients with severe CP (2).

We conclude that there is a high prevalence of hip pain after unsuccessful femoral bone surgery in patients with severe CP. Migration and deformity of the femoral head are closely inter-related, and are associated with pain (2). Patients frequently need a special molded chair and suffer from adduction contractures of the hip (3).

Third part is a systematic review of the literature about preventive, curative and palliative surgery in hip disorders in patients with severe cerebral palsy (4, 5).

Last part is the design of a decision tree for the surveillance and intervention of hip disorders in spastic CP. The algorithm is based on our research and on the literature assessed in our reviews.

Dr Eric Boldingh (1951) is working as a physiatrist for multiple impaired children in the Hague, the Netherlands. His current research is aimed at establishing a CP registration system in the Netherlands. E-mail: e.boldingh@casema.nl.

References
Boldingh EJ, et al. Assessing pain in patients with severe cerebral palsy: development, reliability, and validity of a pain assessment instrument for cerebral palsy. Arch Phys Med Rehabil 2004; 85: 758–766.
Boldingh EJ, et al. Determinants of hip pain in adult patients with severe cerebral palsy. J Pediatr Orthop B 2005; 14: 120–125
Boldingh EJ, et al. Radiographic hip disorders and associated complications in severe cerebral palsy. J Pediatr Orthop B 2007; 16: 31–34.
Boldingh EJ, et al. Palliative hip surgery in severe cerebral palsy: a systematic review. J Pediatr Orthop B 2014; 23: 86–92.
Bouwhuis CB, el al. Effectiveness of preventive and corrective surgical intervention on hip disorders in severe cerebral palsy: a systematic review. Disabil Rehabil 2014 Apr 14 [Epub ahead of print].
Shore BJ, et al. Adductor surgery to prevent hip displacement in children with cerebral palsy: the predictive role of the Gross Motor Function Classification System. J Bone Joint Surg Am 2012; 94: 326–334.

 

 

 

 

The following theses were considered to be of very high level and deserve to be shown even though they did not manage to reach the level of getting the award

 

Thesis: Health issues and participation in adults with cerebral palsy. Wilma van der Slot

The permanent and complex nature of cerebral palsy (CP) and the risk of developing secondary conditions imply that persons with CP will face health issues and participation restrictions throughout life.

The main aim of this thesis was to improve our insight into health issues and participation amongst adults with spastic CP, and to identify targets for prevention and treatment of both health problems and participation restrictions.

In two cross-sectional studies we studied 72 adults with spastic unilateral and bilateral CP (aged 25–45 years) without severe cognitive impairment. Health issues, e.g., chronic pain, fatigue and depressive symptoms, were assessed. Furthermore, aerobic fitness (progressive maximal exercise test), physical activity level (activity monitor) and cardiovascular disease (CVD) risk factors (e.g., non-fasting blood sample, blood pressure, body fat, and smoking) and clustered 10-year CVD risk (Systematic Coronary Risk Evaluation) were measured. In addition, participation and health-related quality of life (HRQoL) were assessed.

Compared to Dutch healthy reference samples, adults with bilateral CP had a significantly higher prevalence of chronic pain (75% vs 39%) and depressive symptoms (25% vs 12%) (p < 0.005), higher severity of fatigue (4.4 vs 2.9; p < 0.0001) (1), and reduced aerobic fitness and physical activity (mean 77% and 85% of ref. values, respectively).

The 10-year fatal CVD clustered risk was low (≤ 1%). However, several single CVD risk factors were present, e.g. higher blood pressure levels. A high risk waist circumference was found in about one-fifth of the study sample. Lipid profile, smoking and alcohol consumption were more favourable amongst adults with bilateral CP than in a reference sample (2).

Regarding participation, at least 60% of adults with bilateral CP had difficulty in mobility, recreation and housing, and 44% in personal care and employment. Adults with bilateral CP perceived a low HRQoL for physical functions, but not for mental functions (3).
In adults with unilateral CP, physical activity levels were normal and they had in most life areas a comparable level of participation as healthy age and gender matched persons. However, they spent more time on non-intensive leisure activities (4).

In conclusion, this study on relatively young adults with spastic CP without severe cognitive impairment, showed that persons with bilateral CP were severely affected by secondary conditions, in addition to their spastic paresis. A substantial number of them experienced participation restrictions. Relevant modifiable factors in bilateral CP seem aerobic fitness, body fat and self-efficacy. Adults with unilateral CP functioned relatively well, but were less extensively studied. These findings underscore the necessity for future research to disentangle underlying mechanisms of health issues and to refine targets for both prevention and treatment of adults with CP.

Wilma van der Slot works as a rehabilitation physician and researcher at the Department of Neurorehabilitation of Rijndam rehabilitation institute and within the research themes ‘Transition and Lifespan Research’ and ‘MoveFit’ of the Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands. Her works involves neurorehabilitation, specialised rehabilitation care during the transition into adulthood and lifespan care for persons with a disabling condition since childhood. E-mail: w.vanderslot@erasmusmc.nl

References
van der Slot WMA, et al. Chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy. Dev Med Child Neurol 2012; 54: 836–842.
van der Slot WMA, et al. Cardiovascular disease risk in adults with spastic bilateral cerebral palsy. J Rehabil Med 2013; 45: 866–872.
van der Slot WMA, et al. Participation and health-related quality of life in adults with spastic bilateral cerebral palsy and the role of self-efficacy. J Rehabil Med 2010; 42: 528–535.
van der Slot WMA, et al. Everyday physical activity and community participation of adults with hemiplegic cerebral palsy. Dis Rehabil 2007; 29: 179–189.

 

 

 

Thesis: A roundtrip between the rehabilitation department and the gait lab: Interest of the tibial nerve neurotomy and of the long-range autocorrelations analysis. Benjamin Bollens

The Physical and Rehabilitation Medicine department and the gait lab are complementary. Evidence-based rehabilitation requires the development of reliable assessment tools and efficient rehabilitative procedures, whereas clinical practice contextualizes the observations made in the gait lab. Hence, the efficacy of the tibial nerve neurotomy and the interest of the long-range autocorrelations analysis were studied in a complementary way throughout the same PhD thesis.

The spastic equinovarus foot (SEF) is a common impairment that interferes with ambulation, limits achievement of daily activities and negatively affects participation and quality of life in hemiparetic patients. Selective neurotomy is an option of treatment when SEF results from overactivity of the calf muscles. This surgery consists of a partial and selective section of the motor nerve branches innervating the spastic muscles. Only several non-randomized, uncontrolled case-series studies had suggested that tibial nerve neurotomy was a safe and long-lasting treatment of SEF (1). Based on the International Classification of Functioning, Disability and Health, we performed a randomized, assessor-blinded, controlled trial comparing the tibial nerve neurotomy with botulinum toxin injections in the calf muscles (2). This study validated with a higher level of evidence the use of the tibial nerve neurotomy as a treatment of choice for chronic stroke patients presenting with SEF.
In the 2nd part of the project, we explored the long-range autocorrelations characterizing the stride duration variability in the normal human gait, using complex mathematical methods (3). Long-range autocorrelations are used to characterize the long-term dynamics of gait variability and are described as a marker of gait balance and fall risk. Their persistence and reproducibility while walking on a treadmill are a reality, which further validates the treadmill as a useful tool for assessing gait fluctuation dynamics (4). The hypothesis that they would be efficient for comparing subjects presenting with different spontaneous speed is supported by their invariance over a large range of gait speeds in different age groups (5). Finally, it was shown that their properties were not affected by biomechanical constraints or cognitive interferences as imposed through backward walking and dual-tasking (6). As a result, these findings suggest that the long-range autocorrelations observed in walking variability are robust and intrinsic to the locomotor system.

The duality between both parts of the thesis is merely theoretical. In reality, neuroscience improves the knowledge of the nervous system functioning, which is the basis for rational approaches to rehabilitation. In parallel, rehabilitation contextualizes the scientific progress and gives meaning to neuroscience. The common presentation of both projects in the same PhD thesis illustrates the interest of an integrated approach combining clinical and scientific activities. Hence, my professional occupation is presently focused on the clinical management of patients, but always with a scientific vision and in close collaboration with the gait lab.

Benjamin Bollens works as a rehabilitation physician and invited lecturer at the Université Catholique de Louvain, Institute of Neuroscience, Avenue Mounier and Université Catholique de Louvain, Cliniques universitaires Saint-Luc, Physical Medicine and Rehabilitation Department, Avenue Hippocrate, Brussels, Belgium. E-mail: benjamin.bollens@uclouvain.be

References
Bollens B, et al. Effects of selective tibial nerve neurotomy as a treatment for adults presenting with spastic equinovarus foot: a systematic review. J Rehabil Med 2011; 43: 277–282.
Bollens B, et al. Comparison of selective neurotomy and botulinum toxin injections as a treatment for spastic equinovarus foot: a randomized, assessor-blinded, controlled trial. Neurorehabil Neural Repair 2013; 27: 695–703.
Crevecoeur F, et al. Towards a “gold-standard” approach to address the presence of long-range auto-correlation in physiological time series. J Neurosci Methods 2010; 192: 163–172.
Bollens B, et al. Does human gait exhibit comparable and reproducible long-range autocorrelations on level ground and on treadmill? Gait Posture 2010; 32: 369–373.
Bollens B, et al. Effects of age and walking speed on long-range autocorrelations and fluctuation magnitude of stride duration. Neuroscience 2012; 210: 234–242.
Bollens B, et al. Variability of human gait: influence of backward walking and dual-tasking on the presence of long-range autocorrelations. Ann Biomed Eng 2014; 42: 742–750.

 

 

 

Thesis: Life satisfaction and wheelchair exercise capacity in the first years after spinal cord injury. Casper Floris van Koppenhagen

In this thesis findings of the Umbrella study (from start of active rehabilitation up to one year after discharge) and SPIQUE study (5 years after discharge), are presented. This thesis focuses on the impact of wheelchair exercise capacity, life satisfaction and their mutual relationships over time from the start of active rehabilitation up to 5 years after discharge of inpatient rehabilitation.

We found a marked decrease in life satisfaction of persons with spinal cord injury at one year after discharge from inpatient rehabilitation, compared to the general population and to their own life satisfaction before spinal cord injury.
Decrease of life satisfaction was strongest for the domains Sexual life, Self care and Vocational situation. Partner relations, Family life and Contacts with friends and acquaintances appeared the least affected life domains. Age, gender and education had little influence on life satisfaction after spinal cord injury or change of life satisfaction. High level of lesion, suffering from pain and from secondary impairments were associated with a decrease of life satisfaction and with low life satisfaction one year after discharge.

Life satisfaction improved during inpatient rehabilitation, especially during the first 3 months of active rehabilitation and remained stable during the first year after discharge. Having few pain sensations and a low number of other secondary impairments and having a better functional status were predictors of a more favourable course of life satisfaction early after spinal cord injury.
No significant changes in mean wheelchair exercise capacity were found between discharge and 5 years later. No significant determinants for the course of wheelchair exercise capacity in the 1–5 year interval were detected. Again age, gender, level and completeness of lesion were determinants for peak oxygen uptake and level of lesion and gender for peak power output, a confirmation of other international studies. The loss to follow-up group was older of age and included more persons with tetraplegia, probably leading to a slight overestimation of the model outcome for wheelchair exercise capacity.

We confirmed that different wheelchair exercise capacity trajectories exist after spinal cord injury. We found 4 different trajectories in the course of peak power output: 1) high progressive scores; 2) deteriorating scores: progressive scores during inpatient rehabilitation with deteriorating figures after discharge; 3) low progressive scores: low scores at start of rehabilitation with relative strong progressive scores after discharge; and 4) low inpatient scores with very strong progressive scores after discharge. Logistic regression of factors that might be distinctive between the trajectories with high progressive scores and low progressive scores, revealed that older age, female gender, tetraplegic lesion and low functional status were associated with the class with low progressive scores.

We examined that wheelchair exercise capacity and life satisfaction in spinal cord injury population are longitudinally associated up to 5 years after discharge of inpatient rehabilitation. Further analyses revealed that the relationship between exercise capacity and life satisfaction was mainly based on the within-subject variance, suggesting that improvement of physical fitness might lead to improvement of life satisfaction.

Casper Floris van Koppenhagen works as a Physical Medicine and Rehabilitation Specialist at a Spinal Cord Injury Unit, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands. E-mail: casper.koppenhagen@planet.nl


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