De Hoogstraat Revalidatie

Purpose Brachial plexus injuries (BPI) significantly impact Health-Related Quality of Life (HRQoL) through limb malfunctioning, neuropathic and glenohumeral traction pain. Amputation emerges as a final intervention to alleviate traction pain, or eliminate a flail limb. This scoping review reveals insights on functioning, HRQoL and satisfaction of individuals with BPI and amputation, using the International Classification of Functioning, Disability and Health (ICF). Materials and Methods A literature search was conducted using the Cochrane database, PubMed, EMBASE, CINAHL and Web of Science for articles that reported HRQoL and/or functioning in adults with BPI who underwent amputation. Outcomes reflected ICF-domains body function and structure, activities and participation. Results Twenty articles, mostly case reports and retrospective studies, reported on less pain, no hindrance of a flail limb anymore, less anxiety and depression, more energy and less fatigue post-amputation (ICF body functions/structures), with less limitations in daily activities and more social interaction (ICF activities/participation). Individuals reported being satisfied with their decision to amputate. Downsides were scarcely reported. Conclusions Current literature supports that amputation may improve HRQoL and functioning in individuals with BPI, more research is needed however.

Abstract The present study introduces an automated multidisciplinary optimization (MDO) workflow that, for the first time, couples an explicit dynamic bird strike analysis with a post-impact static stress check. This joint problem is solved during preliminary wing sizing by integrating batch Bayesian optimization on Kriging surrogates with a variance-based variable screening procedure. The optimization problem comprises 19 thickness design variables and two highly non-linear constraints, imposing a maximum leading edge penetration and a maximum post-impact front spar stress while minimizing wing mass. The workflow is demonstrated on a five-bay metallic wing segment, yielding a 43% weight saving over the best-performing design during initial data generation while respecting CS 25.631 crashworthiness limits. Results demonstrated substantial computational savings by variable screening and highlighted the necessity of the stress constraint, as designs satisfying only the penetration depth requirement could still experience critical post-impact stress levels.

Purpose The Self-Regulation Assessment (SeRA) was developed to evaluate levels of self-regulation in rehabilitation populations. To support its integration into routine clinical practice, involving healthcare professionals in the implementation process is crucial. Therefore, we explored rehabilitation professionals’ experiences with the SeRA during treatment. Material and methods In this qualitative pilot study, 14 professionals from six rehabilitation institutions used the SeRA with at least three patients. Afterwards, semi-structured interviews were conducted. Directed content analysis was used, with a deductive approach, to identify main themes and subthemes. Results Twelve professionals participated in the interviews. Identified codes were categorised into three main themes. Perceived usefulness (1) was influenced by the SeRA’s characteristics, patient characteristics, and timing of administration. The value of the SeRa (2) was linked to the relevance of self-regulation and its application as a conversation tool and evaluation instrument. These insights shaped recommendations for implementation (3), concerning integration into workflows and potential modifications to the SeRA. Conclusions The SeRA seems applicable across diagnoses and offers insights into self-regulation from the patient’s perspective. It complements existing patient-reported outcome measures. Further refinement, such as shortening the questionnaire and clarifying the timing of administration and role responsibilities, could enhance its usability and clinical relevance.

ABSTRACTBackgroundParental burnout has been proposed as resulting from a persistent imbalance between stress‐enhancing factors (demands/risk factors) and stress‐alleviating factors (resources/protective factors). Parents of children with complex care needs (CCN) face this imbalance more often than parents in general. To address this, we need to know which factors are considered risky and protective for burnout from the perspectives of parents of children with CCN. To facilitate targeted interventions, this study sought to explore both risk and protective factors associated with burnout as perceived by parents of children with CCN.MethodsWe conducted semi‐structured interviews with 38 parents, who recognized or identified themselves with burnout‐related thoughts and feelings. Parents were selected for maximal variation, based on parental, child and family characteristics. The data was analysed through inductive thematic analysis.ResultsFifteen themes, divided into three categories, were identified: (1) ‘the parent’ encompassing factors intrinsic to the parent, such as emotional factors and internal drivers, and physical health; (2) ‘the environment interacting with the parent’ including organization of care, social support and socio‐economic factors; and (3) ‘the sum of all factors’—themes underscoring the collective impact of the context including the caregiving and parental responsibility, and the perception of no option but to endure. Most factors were identified as both risk and protective factors, underscoring the dynamic nature of burnout.ConclusionParticipating parents ascribed burnout to unique combinations of risk and protective factors. Notably, these factors extended beyond the personal sphere to encompass societal structures that current conceptual models for dealing with burnout often ignore. From the perspective of parents, broad multisystem approaches to address parental burnout would likely appear most relevant.

Non-invasive brain stimulation (NIBS) techniques have emerged as a promising non-pharmacological adjunct to neurorehabilitation. Children with Cerebral Palsy (CP) exhibit altered cortical excitability, and while CP remains incurable, physiotherapy combined with other interventions is essential for managing motor dysfunction. Although some studies have examined NIBS using various stimulation parameters, there is limited evidence regarding its effects on the lower extremities and optimal administration protocols. This review aims to evaluate the effectiveness of NIBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for the treatment of motor function in spastic cerebral palsy, specifically in the lower extremity. A systematic search will be conducted in databases including MEDLINE, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, and the Cochrane Central Register of Controlled Trials. The search strategy will follow the PICO framework (Participants, Intervention, Comparison, Outcomes), focusing on randomized controlled trials (RCTs). Two independent reviewers will manage screening, selection, data extraction, risk of bias assessment, and grading of evidence. This review will provide key insights into the effectiveness of NIBS for lower-extremity function in children with spastic CP, guiding future research and clinical applications.

Background How gait changes during the early stages of stoke rehabilitation, and which patient characteristics are associated with these changes is still largely unknown. Objective he first objective was to describe the changes in gait during stroke rehabilitation. Secondly, we determined how various patient characteristics were associated with the rate of change of gait over time. Methods Participants were measured every 3 weeks during stroke rehabilitation. The assessment consisted of an inertial measurement unit (IMU) based 2-minute walk test (2MWT), 3 IMU-based balance tests, and standard clinical tests. In the 2MWT, participants were equipped with 3 IMUs, from which speed, variability, asymmetry, and smoothness were calculated. The changes in gait were examined from admission to discharge at an individual level. The effect of patient characteristics on the rate of change of the gait features over time was assessed with growth models. Results A total of 81 Trajectories from 72 participants were analyzed. On an individual basis, speed increased in 32 trajectories. Only a few trajectories exhibited significant changes in variability, asymmetry, and smoothness over the clinical rehabilitation period. The growth models revealed a significant increase in speed and decrease in variability and smoothness. Only the Berg Balance Scale and gait speed at onset were (negatively) associated with the rates of change of speed and smoothness, respectively. Conclusion We found a substantial variability in the gait-feature outcomes and their progression in individuals after stroke during clinical rehabilitation. The patient characteristics studied had limited associations with the rate of change of gait features over time.

Conceptual frameworks inform and advance clinical practice, research, and education. The “F-words for child development” is a child/youth/family friendly model that embeds the words fitness, functioning, family, friends, fun, and future into the International Classification of Functioning, Disability and Health (ICF). This perspectives paper explores how the concepts and use of the F-words for child development are conducive to the practice of pediatric oncology rehabilitation and promotion of quality of life of children and their families. Pediatric oncology rehabilitation is explored in the context of the ICF and F-words through a review of relevant literature, clinical expertise, and child/youth/family perspectives. The F-words framework is congruent with recognized rehabilitation strategies, preferences, and best practices during and after treatment for cancer in children and youth. The concepts can be used to promote the engagement, health, well-being, and quality of life of children/youth and their families.

Clinical trials in neurodegenerative diseases often encounter selective enrollment and under-representation of certain patient populations. This delays drug development and substantially limits the generalizability of clinical trial results. To inform recruitment and retention strategies, and to better understand the generalizability of clinical trial populations, we investigated which factors drive participation. We reviewed the literature systematically to identify barriers to and facilitators of trial participation in 4 major neurodegenerative disease areas: Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis, and Huntington disease. Inclusion criteria included original research articles published in a peer-reviewed journal and evaluating barriers to and/or facilitators of participation in a clinical trial with a drug therapy (either symptomatic or disease-modifying). The Critical Appraisal Skills Program checklist for qualitative studies was used to assess and ensure the quality of the studies. Qualitative thematic analyses were employed to identify key enablers of trial participation. Subsequently, we pooled quantitative data of each enabler using meta-analytical models. Overall, we identified 36 studies, enrolling a cumulative sample size of 5,269 patients, caregivers, and health care professionals. In total, the thematic analysis resulted in 31 unique enablers of trial participation; the key factors were patient-related (own health benefit and altruism), study-related (treatment and study burden), and health care professional-related (information availability and patient-physician relationship). When meta-analyzed across studies, responders reported that the reason to participate was mainly driven by (1) the relationship with clinical staff (70% of the respondents; 95% CI 53%-83%), (2) the availability of study information (67%, 95% CI 38%-87%), and (3) the use or absence of a placebo or sham-control arm (53% 95% CI 32%-72%). There was, however, significant heterogeneity between studies (all p < 0.001). We have provided a comprehensive list of reasons why patients participate in clinical trials for neurodegenerative diseases. These results may help to increase participation rates, better inform patients, and facilitate patient-centric approaches, thereby potentially reducing selection mechanisms and improving generalizability of trial results.

BackgroundPatient Reported Outcomes Measures (PROMs) are being used increasingly to measure health problems in stroke clinical practice. However, the implementation of these PROMs in routine stroke care is still in its infancy. To understand the value of PROMs used in ischemic stroke care, we explored the patients’ experience with PROMs and with the consultation at routine post-discharge follow-up after stroke.MethodsIn this prospective mixed methods study, patients with ischemic stroke completed an evaluation questionnaire about the use of PROMs and about their consultation in two Dutch hospitals. Additionally, telephone interviews were held to gain in-depth information about their experience with PROMs.ResultsIn total, 63 patients completed the evaluation questionnaire of which 10 patients were also interviewed. Most patients (82.2–96.6%) found completing the PROMs to be feasible and relevant. Half the patients (49.2–51.6%) considered the PROMs useful for the consultation and most patients (87.3–96.8%) reported the consultation as a positive experience. Completing the PROMs provided 51.6% of the patients with insight into their stroke-related problems. Almost 75% of the patients found the PROMs useful in giving the healthcare provider greater insight, and 60% reported discussing the PROM results during the consultation. Interviewed patients reported the added value of PROMs, particularly when arranging further care, in gaining a broader insight into the problems, and in ensuring all important topics were discussed during the consultation.ConclusionsCompleting PROMs appears to be feasible for patients with stroke attending post-discharge consultation; the vast majority of patients experienced added value for themselves or the healthcare provider. We recommend that healthcare providers discuss the PROM results with their patients to improve the value of PROMs for the patient. This could also improve the willingness to complete PROMs in the future.