Congress on NeuroRehabilitation and Neural Repair

8/17/2019 Congress on NeuroRehabilitation and Neural Repair

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Programme and Proceedings Book

Congress on

NeuroRehabilitation

and Neural Repair

Neurorehabilitation and Neuroscience Connected

21-22 May 2015 | Maastricht, the Netherlands


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Contents

Programme schedule • Thursday 21 May 2015 04• Friday 22 May 2015 06Committee and Keynote speakers 08Sponsors 09General information 10

Floorplan 12

Scientific information 14Keynotes • Thursday 21 May 2015 17• Fridayday 22 May 2015 18Focused symposia • Thursday 21 May 2015 20• Friday 22 May 2015 35Themes • Thursday 21 May 2015 53• Friday 22 May 2015 62Young scientist competition • Thursday 21 May 2015 66• Friday 22 May 2015 71

Best poster competition • Friday 22 May 2015 75Lunch symposia 83Posters 85Authors index first author 166Notes 170


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Congress on NeuroRehabilitationand Neural Repair

Welcome

Dear colleague,

We are proud to announce the International Congress on Neurorehabilitation

and Neural Repair organised by the Dutch and Belgian Societies forNeurorehabilitation that will bridge the gap between neuroscience andpractice. This 2-day meeting is focused on the most recent advances inneurorehabilitation research that are ripe for translation, providingopportun t es to s are now e ge, exper ence, an most recentdevelopments in applying evidence-based practice.

The scientific programme includes the most distinguished invited speakers

in the field of neuroplasticity and neurorehabilitation, and is dedicated to the

management o most common pro ems suc as ga t an a ance contro ,

spasticity, cognitive impairments, including difficulties in implementation of

evidence in the field of stroke, Parkinson’s disease, MS and neuromuscular

disorders. All these topics are engaged in 8 invited key note lectures,focused symposia, oral presentations and by your smashing posters that will

e presente at ot ays. s mu t sc p nary con erence s mportantfor all professionals dedicated to neurorehabilitation such as rehabilitationphysicians, neurologists, physical and occupational therapists, nurses,psychologists, movement scientists, bioengineers as well as those who

are more involved in the management of neurorehabilitation.On behalf of the Congress Committees, we wish you a warm welcome at the

International Congress on Neurorehabilitation and Neural Repair in Maastricht.

Prof. Dr. Gert Kwakkel Prof. Gaétan StoquartPresident DSNR President BSNR

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s s o n N e u r o R e h a b i l i t a t i o n

a n d N e u r a l R e p a i r 2 0 1 5 | M a a s t r i c h t


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Committee

Organizing and Scientific Committee

Prof. Dr. Gert Kwakkel

President of the Dutch Society for NeurorehabilitationProf. Dr. Alexander Geurts

Vice-president of the Dutch Society for Neurorehabilitation

Dr. Erwin van Wegen

Treasurer of the Dutch Society for Neurorehabilitation

Prof. Dr. Geert Verheyden

Treasurer of the Belgian Society for Neurorehabilitation

Invited speakers

Dr. Randolph Nudo

University of Kansas Medical Center, USA

Prof. Dominique Pérennou

Hospital Universitaire de Grenoble, France

Prof. Dr. Jan Mehrholz

Klinik Bavaria Kreischa, Germany

Dr. Rebecca Fishern vers ty o ott ng am, n te ng om

Prof. John Vissing

Neuromuscular Centre Rigshospitalet, Denmark

Prof. Jean-Michel Gracies

Université Paris-Est Créteil, France

Prof. Raymond Anthony Rosales

University of Santotomas, Philippines

Dr. Mark Hirsch

Carolinas Rehabilitation, USA


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Sponsors

The Organising Committee of the International Congress on NeuroRehabilitation

an eura epa r grate u y ac now e ges contr ut ons:

Platinum Sponsor

Gold Sponsors

Silver Sponsors

Exhibitors

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General information

The congress takes place in the MaastrichtExhibition and Congress Centre (MECC Maastricht),Forum 100, 6629 GV Maastricht.

All parallel sessions are organised in the congress centre in the Lobby,t e p enary sess ons are organ se n t e u tor um.The exhibition, lunch and coffee tea breaks take place held at the Trajectum.

Parking

MECC Maastricht provides ample parking around the premises. Parking ticketscan e purc ase n t e entrance a an cost € ,- per ay, regar ess oduration. The maximum vehicle height in the parking garage is 2.05 meters.

Registration desk

The registration area in the congress centre will be open for registration:urs ay ay : . – . rs.

Friday 22 May 2015: 08.00 – 17.30 hrs.

The registration fee includes:

• Admission to all scientific sessions• m ss on to t e ex t on an poster area• Congress bag• Daily lunch• Daily coffee breaks• Programme and Proceedings Book• tten ng t e get toget er- r n

Payment registration fee

You can pay the registration fee on-site by credit card or cash. The officialcurrency at the congress is Euros. Cheques and foreign currency are not accepted.


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You will have WIFI access on-site in the congress cen re.

Network: MECC_CongrescentrePassword: meccmaastricht

a ges

For security reasons, badges must be worn throughout the congress. Be carefulnot to lose your badge, as the Congress Committee cannot be responsible forlost badges, tickets or other valuable items. Entrance to lecture halls, posterand exhibition area will not be allowed to any person without a badge.

Certificate of attendance

All participants will receive a digital certificate of attendance by email after thecongress.

Lunch and coffee breaks

Lunches and coffee breaks on Thursday and Friday take place in the exhibitionarea at the Trajectum.

Anything lost?ease go to t e reg strat on es .

Language

The official language of the congress is English.

Liability

Upon registration, participants agree that neither the Organizing Committee northe Conference Management can be subject to any liability concerning participa-

tion related activity. Participants should, therefore, organize their own (healthand travel) insurance(s).

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Merz Pharma Benelux BV tto Bock Topics

Speaker ready roomMotekforce Link Hankamp

Medtronic Neuromodulation Basko Vigo

IPSEN Allergan BV

ongress areas

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Scientif ic Information

Oral presentationsease ma e sure to r ng your ower o nt presentat on on r ve to t e

congress and hand it in to a technician in the Speaker Preview Room Room 1.3 ,

upon arrival, but at least 3 hours before your presentation. Please note that youwill NOT be able to use your own laptop computer.

Poster presentationsPosters will be displayed throughout the meeting in the exhibition area at theTrajectum. The posters are divided per topic. Participants selected to give aposter presentation are required to attend their poster to answer questionsduring the poster-viewing sessions. All topics, titles and abstract numbers oft e presenters are sp aye on t e poster oar s.

Poster set-up and removal timesPlease mount your poster before Thursday 21 May 2015, 10.00 hrs., and do notdismantle your poster before Friday 22 May 2015, 15.30 hrs. The Congress

ecretar at w remove a posters w c ave not een remove y . rs.


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I P S E N

S Y M P O S I U M

Early treatment of spasticity with botulinum toxin type Apost stroke: pros and cons

Donderdag 21 mei 201513.00 - 14.00 uur

MECC Maastricht - Niveau 0 - Zaal 02-03

Prof. Dr. R. Rosales

Department of Neurology and Psychiatry,

University of Santo Tomas and hospital,

Manilla, Philippijnen

J. Martina MD

Medisch Spectrum Twente,

Enschede

Sprekers


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Prescribe a lasting change that may bring patients from "I wish" to...

Cerebral Palsy • Stroke • Multiple Sclerosis • Spinal Cord Injury • Trau rain Injury atic

ITB Therapy for severe spasticity

‘Innovative technologies for balance and gait rehabilitation’.

De lunch kan in de zaal genuttigd worden.

Het symposium is van12.15 tot13.15 uur in Zaal 0.8.

U kunt binnen lopen zonder zich vooraf aan te melden.

B e zo e k o n s

l u n c h s y m po s i u

m!

www.MotekforceLink.com

Innovative technologies for balance and gait rehabilitation


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Mechanisms of neuroplasticity10.00 - 11.00 Auditorium 2

Randolph J. NudoUniversity of Kansas Medical Center

n t e past two eca es, cons era e ev ence as accumu atedemonstrating that the cerebral cortex of adult mammals possessessubstantial capacity for both functional and structural plasticity. Afterinjury to the cerebral cortex, as might occur after an acquired brain injury,a large portion of the frontal and parietal cortex can be damaged, resultingin deficits in sensory and or motor function in the contralateral limbs.

However, substantial spontaneous recovery occurs in the weeks to monthsfollowing injury. While the basic neural mechanisms underlying corticalplasticity and their role in recovery are still under intense investigationin both human and animal models, the implications for developing novelt erapeut c ntervent ons or max m z ng unct ona recovery a ter centranervous system injury are now inescapable. Therapeutic interventionsaimed at restoring motor, sensory or cognitive function even in the chronicstages after events such as stroke or traumatic brain injury are now basedon assumptions derived from our still nascent understanding of brainp ast c ty processes. n erstan ng ow t e rema n ng sensory-motorapparatus can support the recovery of such functions has been a primarygoal of recent research in this area. Thus, this lecture will review thecurrent theoretical models for functional recovery, and our understandingof the ability of spared tissue to be functionally and structurally altered.

Will any of this change patient care?

The importance of implementation research16.30 - 17.30 Auditorium 2r e ecca s er

University of Nottingham UK

Implementation research investigates why interventions found to beeffective in clinical trials often fail to be translated into the care thatpatients receive. This paper will discuss what implementation’ meansand introduce theoretical frameworks that can be used to investigate this

translational gap. The aim will be to show how implementation researchcan identify ways to facilitate evidence based practice and ensure researchfindings actually improve the care that patients receive.

n ngs rom a programme o stro e mp ementat on researc w e

Keynotes Thursday 21 May 2015


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presented, investigating the implementation of evidence based ‘EarlySupported Discharge’ (ESD) services. ESD is a home-based rehabilitation

ntervent on, e vere y a stro e spec a st mu t sc p nary team.Clinical trials have shown that ESD can reduce length of hospital stay andreduce the risk of death and dependency of stroke survivors. Yet in manycountries, ESD service provision is highly variable or ESD is not provided at all.Four phases of a programme of implementation research will be

scusse . e mportance o e n ng t e core components o t eintervention needed to be implemented, will be highlighted, in this casethe key characteristics of evidence based ESD. The need to qualitativelyinvestigate the context in which the intervention is implemented will also

be addressed. Lastly, findings from a prospective comparative cohort studyw e presente n w c serv ces, a opt ng an ev ence ase mo e ,were shown to be effective, when operating in the context of frontlinehealthcare provision.

Exercise therapy for neuromuscular disorders09.00-10.00 Auditorium 2o n ss ng, ,

Copenhagen Neuromuscular Center, Department of Neurology,Rigshospitalet, University of Copenhagen, Denmark

It was a general notion in the past that physical exertion in patients withmusc e wast ng, ue to neuromuscu ar seases, wou acce erate t e

disease process. However, studies conducted in the past two decades haveshown that aerobic conditioning is safe and improves muscle functionin patients affected by a variety of myopathies. In contrast, aerobicconditioning, although safe, does not have the same effect in patientsa ecte y motorneuron seases. s cou re ate to a neura at guemechanism, involving a higher firing rate and larger motor units in theseconditions. Very little is still known about whether other training modescould be of benefit in neurogenic conditions, whether fuel supplementscan enhance exercise performance, if very weak neuromuscular patients

a so can ene t rom tra n ng an w at ntens ty s ou e t e targetfor training. The talk will discuss new experiments that address thesequestions, and suggest avenues for new developments in the field.

Keynotes Thursday 21 May 2015

Keynotes Friday 22 May 2015


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From Neurons to Dutch Neighborhoods in Parkinson’s Disease15.30 - 16.30 Auditorium 2

Prof. Dr. Mark Hirsch

Carolinas HealthCare System Carolinas Rehabilitation, Charlotte, Unitedtates o mer ca

Individuals living with Parkinson’s disease (PD) very often adopt sedentarylifestyles; at diagnosis they are on average 30 percent less physically activethan healthy age-matched controls. The reasons for being sedentary arepoor y un erstoo . nterest n t e ene ts o exerc se an p ys ot erapy n

PD has increased over the past two decades, yet few trials have evaluatedwhether lifestyle behavior change is possible for individuals with PD.Objective: To present an innovative, transformative model for increasingphysical exercise in people with PD by empowering them to collaboratewith neuroscientists and neurorehabilitation professionals as healthcoaches.” Methods: Within the health care system individuals with PD areoften passive objects” or subjects” of care; rarely do they see themselvesas active partners” or collaborators”. We invoke the concept of socialcapital, and indicate its importance in PD neuroplasticity. We describe a

ata- r ven, co a orat ve, part c patory ea t care mo e or n v ua swith PD that promotes increased exercise in ways that enhance socialcapital. We also identify key factors that could threaten implementationof the model: 1) lack of broad awareness of studies, using both animalmodels of PD and people with PD, that document exercise-induced brainrepair or reorganization neuroplasticity with accompanying behavioralrecovery; 2 conflicting perspectives among neuroscientists, rehabilitationprofessionals, people with PD and other stakeholders; and 3) power

imbalances which preferentially assign voice” and decision making tomedical personnel. Conclusion: We encourage participants to discussopportunities for international Parkinson patient provider neuroscientistcollaboration and future research.


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Neuropsychology in neurorehabilitation11.30 - 13.00 Room 0.6

Introductory lecture: Directions in neurorehabilitation:from concept to clinical implementation

r stop e a osse

RevArte Rehabilitation Hospital, Edegem, Belgium; K.U.Leuven, Belgium;Vrije Universiteit Brussel, Belgium

Specific components involved in neurorehabilitation depend on a variety of

actors nc u ng t e ocat on o t e target o re a tat on treatment w t n

a conceptual framework e.g. International Classification of Functioning,Disability and Health according to the WHO). Treatments can be impairment-

focused, activity-focused and participation-focused. Such an approach

will increase the likelihood of successful interventions, but it will also

ncrease t e pro a ty o esta s ng cause-an -e ect re at ons etween

therapies and outcomes, so that further effective treatment strategies can

be developed. Neuropsychology has a key role to play in this enterprise.

Assessment is clearly critical for determining which aspects of behavioural

functions are compromised and which remain intact. Knowledge of

unct ons assoc ate w t part cu ar ra n networ reg ons s a so mportant

for deciding what cognitive and neural mechanisms might be available to

help solve any particular neurorehabilitation problem. Even more important

is the development of new rehabilitation methodologies that are empirically

and theoretically grounded in the neuroscience of motor-cognitive-affective

e av our. e a so nee to cons er t e unct ona consequences o motor,

cognitive and affective impairments and direct our rehabilitation techniques

toward eliminating or alleviating real problems in everyday life.

The effectiveness of different treatment modalities forthe rehabilitation of unilateral neglect in stroke patients:a systematic reviewLisa Pernet, Anke Jughters and Eric Kerckhofs

Neurological Rehabilitation, Vrije Universiteit Brussel, Jette, Belgium

Patients suffering from unilateral neglect syndrome UNS are not able

to respond to stimuli administered to the side of the body opposite tothe lesion. UNS is most commonly seen after right-hemisphere lesions.Patients with UNS experience more problems with activities of daily living

Focused symposia Thursday 21 May 2015


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and recovery after stroke is delayed. A systematic literature review wasdone to investigate which treatment modalities can alleviate the symptoms

o a ter stro e an to eterm ne t e r e ect veness. ata asesPubMed, Web of knowledge and PEDro have been searched. Qualityassessment was conducted using the 9-item Delphi list. Effect sizes havebeen calculated using Cohen’s d. Fifteen RCT’s have been included. Moststudies used add-on therapies. Almost all studies found improvementsn ot groups, ut on y tr a s s owe stat st ca y s gn cant etween

group differences in favor of the experimental group. Large effectsizes were found in only four studies. It could be concluded that all theinterventions discussed in this review can reduce the symptoms of UNS.However, TENS, optokinetic stimulation, somatosensory electrostimulation,m rror t erapy an v rtua rea ty tra n ng seem to e t e most e ect ve

treatment methods d > 0,80 . Future research should focus on producing

studies of higher methodological quality with larger sample sizes.

Postural control and visuospatial behavior: a specific coherencebetween two systems of space representation in neglect patientswith contraversive pushingNathalie Vaes

University of Ghent, Belgium; RevArte Rehabilitation Hospital, Edegem,e g u m

Contraversive pushing is a neurologic disorder characterized by a lateralpostural imbalance. Although not every patient with contraversive pushingsuffers from spatial neglect, both phenomena are highly correlated inr g t- em sp er c pat ents. ase on two per persona neuropsyc o og ca

measures, new computer-based navigation and classic long line bisection,a modulation of visuospatial functioning is discussed in right-hemisphericneglect patients with contraversive pushing, compared to the ones withoutcontraversive pushing. Finally, some practical implications are considered.

Do I have a problem? Unawareness of deficits after acquired brain injuryCaroline van Heugten

Maastricht University, the NetherlandsUnawareness of deficits occurs frequently after brain injury. In thispresentation practice guidelines for assessment and treatment in clinical


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practice will be given on the basis of state of the art research in clinical

neuropsychology. In particular the following topics will be addressed:

measurement o awareness, st nct on etween mpa re se awarenessand denial, changes in awareness over time and treatment of unawareness.

The treatment of executive deficits: what and howuc ano asott

Donders Institute for Brain, Cognition and Behaviour, Radboud UniversityNijmegen, the Netherlands

Executive deficits in brain-injured subjects are particularly invalidatingan requent y ea to severe pro ems n a y unct on ng. reat ng t eseproblems poses particular challenges. First, in brain-injured patientsexecutive problems may be very diverse. This raises the question ofthe clinical relevance of symptoms and of what should be the target oftreatment. Second, executive problems are not only found in patientsw t ronta amage, ut n a muc arger array o ra n- n ure su ects.Therefore, one can ask if treatments should be aimed at frontally injuredpatients only. Third, executive deficits can be measured at very differentlevels. This raises the question of the aspects of executive (dys)functioningthat have to be measured in order to assess the effects of an intervention.

t ree top cs w e a resse an an examp e o an ntervent on g v nga provisional answer to the questions raised will be given.

Treatments to improve walking ability after stroke11.30 - 13.00 - Room 0.7

Recovery of walking and balance after strokeJ.H. Buurke

Roessingh Research and Development, Enschede, the NetherlandsDepartment of Biomechanical Engineering, University of Twente,Enschede, the Netherlands

Insight into the mechanisms underlying walking and balance recovery isnecessary to improve rehabilitation. Recent literature on this topic mainly

escr es t e resu ts rom a oratory exper ments. e w present t eresults of experiments describing walking and balance in stroke patientsduring (simulated) daily life activities, using wearable sensors.



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Timing of providing ankle-foot orthoses after (sub)acute strokeJ.S. Rietman

Roessingh Research and Development, Enschede, the NetherlandsFaculty of Engineering Technology MIRA institute for BiomedicalTechnology and Technical Medicine, University of Twente, Enschede, the

et er an s Department of Biomedical Signals and Systems, Universityof Twente, Enschede, the Netherlands

Introduction: Scientific evidence about long-term use of ankle-footorthoses (AFOs) after stroke is lacking and no generally accepted guidelineregar ng t e t m ng o -prov s on a ter stro e s ava a e.Objective: Determine the effects of AFO-provision at different moments intime after stroke.Methods: Single-center, randomized controlled trial including strokepatients with hemiparesis and an indication for AFO-use, maximal 6 weekspost-stroke. Subjects were randomly assigned to AFO-provision: 1 atinclusion early group ; or 2 eight weeks later late group . Functionalbalance, walking ability and activities of daily life were assessed bi-weeklyfor 18 weeks, with follow-up at week 26.Results: Thirty-three subjects (16 early, 17 late) were included, 6 droppedout 1 early, 5 late . Both groups showed progress over time, withpredominantly higher scores in the early AFO-group. The progress inBerg Balance Scale, Functional Ambulation Categories and 6m walk testshowed statistically significant differences (p=0.006, p=0.033 and


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Equinovarus foot deformity following stroke or traumatic brain injurycompromises walking capacity, interfering with activities of daily living. In

so t-t ssue surgery t e m a ance musc es respons e or t e ev antposition of the ankle and foot are lengthened, released and or transferred.However, knowledge about the effectiveness of surgical correction islimited. A systematic search of full-length articles in the English, Germanor Dutch languages published from 1965 to March 2011 was performed in

u e , , , oc rane an . e ent e stu eswere analysed following the International Classification of Functioning,Disability and Health criteria.A total of 15 case series, case control and historically controlled studies

(CEBM level 4) were identified, suggesting that surgical correction ofequ novarus oot e orm ty s a sa e proce ure t at s e ect ve n termsof re-obtaining a balanced foot position, improving walking capacity anddiminishing the need for orthotic use.Further validation of surgical correction of equinovarus foot deformityfollowing stroke or traumatic brain injury is required, using higher levelstu y es gns w t va ate assessment too s. ompar ng surg catechniques with other interventions is necessary to generate evidenceupon which treatment algorithms could be based.

Treatment options for stroke survivors with a stiff knee gaitM.J.B. Tenniglo

Sint Maartenskliniek, Nijmegen, the Netherlands

Stiff Knee Gait (SKG) is characterized by a diminished knee flexion duringsw ng an s common y o serve n pat ents w t spast c pares s or a ter

stroke. Problems with foot clearance are one of the consequences of SKG.A possible treatment to improve knee flexion during swing is electricalstimulation of the hamstring muscle.In this presentation the effect of functional hamstring stimulation on knee

nemat cs n c ron c stro e surv vors w t a w e scusse andeterminants of success are explored.Furthermore the results will be compared to other studies of treatmentoptions for SKG. These studies are; calf muscle stimulation, a systematicreview about the effects of rectus chemodenervation and preliminary

resu ts o a a out otu num tox n n ect ons n t e rectus emor s.



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Non-invasive direct current stimulation and its application formotor neurorehabilitation

11.30 - 13.00 Room 0.8

The Cerebellum (Cb): limited potential of non-invasive brainstimulation with tDCS for improving motor learningRick van der Vliet , Eric Avila , Anne Geelhoed , Zeb Jonker , SuzanneLouwen , Suzy Margaretha , Cindy Parisius , Maarten Frens , OpherDonchin , Jos van der Geest and Ruud Selles

Erasmus University Medical Center Rotterdam, Rotterdam the Netherlands

Ben Gurion University of the Negev Be’er Sheva IsraelOver the last decade, transcranial Direct Current Stimulation (tDCS)over the motor cortex (M1) has been discovered as a neuromodulationtechnique that can increase neuronal excitability (Nitsche, 2003) andLTP Fritsch, 2010 , skill learning Lefebvre, 2012; Reis, 2009; Reis, 2013;Waters-Metenier, 2014 and rehabilitation after stroke Khedr et al., 2013 .tDCS over the cerebellum might be similarly useful in acceleratingadaptation of learned motor skills such as reaching and walking andindeed, several pilot studies have shown beneficial effects on reachingadaptation Galea, 2011 , locomotor adapation Jayaram, 2012 andeyeblink conditioning Zuchowski, 2014 .Our lab has focused on replicating these literature results in order tostart developing cerebellar tDCS as a tool for clinical rehabilitation. Nomodulatory effects of cerebellar tDCS were found on reaching adaptationas opposed to Galea, 2011 , saccadic adaptation as opposed to Avila,

2015 , VOR adaptation as opposed to Das, 2015 or eyeblink conditioning(as opposed to Zuchowski, 2014).

We argue that population characteristics and task details might havecontributed to these null results but do not exclude cerebellar tDCS hasno e ect on motor earn ng. uture stu es us ng mu t p e ay cere e ardependent learning paradigms should be undertaken to address this issue.

The primary motor cortex (M1): a key target for non-invasivebrain stimulation with tDCS in neurorehabilitationYves Vandermeeren

When transcranial direct current (tDCS) was “rediscovered” in 2000, thedemonstration that applying tDCS over primary motor cortex (M1) induced


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lasting changes in the excitability of the corticospinal tract triggered thenew era of tDCS research, first as a physiology tool and then as a potential

met o or t erapeut c neuromo u at on. t ncu es ast ng c angesin brain activity called after-effects” and behavioural performances invirtually any motor or cognitive domain, both in healthy individuals andin stroke patients. Since stroke deregulates brain excitability both in thedamaged and undamaged hemispheres, three neuromodulation strategiescan be applied: 1 up-regulating” the excitability of the damagedhemisphere, 2 down-regulating” the excitability of the non-damagedhemisphere or (3) doing both simultaneously. Whereas it is likely thattDCS induces more subtle changes than simple up- and down-regulating

excitability, applying tDCS over M1 with each strategy demonstrateden ancements o t e paret c upper m . s not on y t e ma or gate orthe control of voluntary movements through the corticospinal tract, it isalso a crucial node in the network involved in motor learning. This may beone of the reasons why neuromodulation of M1 by tDCS has the potentialto enhance the functional gains driven by neurorehabilitation.

Potential: Postural feedback therapy combined with non-invasivetranscranial direct current stimulation in patients with stroke.Drs. Sarah Zandvliet and Dr. Erwin van Wegen.

Postural instability, balance problems and subsequent falls are very common

in patients with a stroke and are strongly associated with future functionalrecovery. A combination of cerebellar transcranial direct current stimulation

(tDCS) and postural feedback training (PFT) may improve balance in stroke

patients to a level unattained by PFT alone. During this presentation, the first

results of the cross-sectional study in which chronic stroke patients and age

matched healthy subjects receive tDCS during a balance tracking task, will be

presented. In addition, the outlines of a double blind RCT will be presented,

in which we investigate whether cerebellar tDCS combined with PFT ismore effective than PFT alone when started in the early period after stroke.

Neuromodulation of the spinal circuits by TSDCSfor the Rehabilitation of spinal cord injury

A. Kuck , E. van Asseldonk , D. Stegeman , H. van der Kooij University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands

2 Radboud University, Comeniuslaan 4, 6525 HP Nijmegen, the Netherlands



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Spinal Cord Injury (SCI) is a severe injury to the pathways of the centralnervous system (CNS). Despite a heavy post-injury physical rehabilitation

reg me, pat ents are o ten oun to a w ee c a r or e t w t ot erimpairments diminishing their quality of life. Trans-spinal direct currentstimulation (tsDCS) is a promising new technique for the treatment of SCI.During tsDCS a small direct current is applied to the spinal cord via twoor more stimulation electrodes, placed on the back of the subject. Thetec n que t ere y a ms to a ter t e response o t e neura pat ways n t espinal cord, which is hypothesized to have a positive effect on the recoveryof the damaged spinal cord neurons. In previous studies, it has beenshown that tsDCS is able to induce a polarity-dependent modulation of

reflex and motor unit behavior as well as altering ascending proprioceptiven ormat on an assoc at ve p ast c ty e ects on a cort cosp na eve .

Current work in our laboratory focuses on further understanding andoptimizing the use of tsDCS for the rehabilitation of SCI. We will thereforediscuss the current developments in the field, the work done in ourlaboratory and potential future directions of the application of tsDCS tosp na cor n ury re a tat on.

Body Orientation in space: adaption to repeated challengesof stance and locomotor tasks14.30 - 16.00 Room 0.1

Adaptation of leg muscle activity of healthy subjects standingon a predictably moving platformMarco Schieppati

Fondazione Salvatore Maugeri IRCCS , Scientific Institute of Pavia and

University of Pavia, ItalyStanding on a platform continuously moving in anterior-posterior directionrecruits short- and long-latency reflexes, and anticipatory posturaladjustments to counteract the perturbations.

Sixty back-and-forth 10 cm sinusoidal platform displacement cycles wereadministered eyes closed at 0.6 Hz. Centre of mass and leg muscle lengthwere estimated based on optoelectronic recordings of reflective markers’position. Amplitude and time-distribution of Tibialis Anterior (TA) and

Soleus SOL EMG activity were assessed. Bursts were defined as reflexor anticipatory based on the relationship between their amplitude andvelocity of muscle length change prior to the bursts.


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Muscle activity decreased over time. The time-course was faster for TAthan SOL, reflecting SOL unvarying postural activity. TA double-peak reflex

response, pro uce y orwar p at orm s t, ecrease more rap y t anTA anticipatory responses. Regardless of muscle activity adaptations, thecentre of mass hardly changed its mean position or peak-to-peak antero-posterior displacement.

ot re ex an ant c patory act v ty m n s n amp tu e ur ng

adaptation, the former more than the latter. The findings suggest a protocol

for assessing flexibility of balance strategies and provide a reference for

addressing balance problems in patients with movement disorders.

Balancing responses during predictable perturbation inParkinson’s disease: a way of testing leg muscles responsesand of training balanceAntonio Nardone

Fondazione Salvatore Maugeri IRCCS , Scientific Institute of Veruno,and University of Eastern Piedmont, Novara, Italy

When standing on a platform predictably moving in the anterior-posteriordirection, both reflex responses and anticipatory postural adjustmentsAPAs are operating. Patients with Parkinson’s disease PD are unstable

under this condition. We asked whether a such impairment is connectedwith a difficulty in adapting either or both reflex responses and APAs, b)training on the platform improves adaptation and balance control.PD and age-matched healthy subjects (HS) underwent 45 cycles of a back-and-

forth platform displacement 0.4 Hz, 10 cm , prior to and after training on the

platform 3 times week, 1 hour day, 10 sessions . EMG responses of TibialisAnterior muscle were examined as a function of the successive oscillation

cycles. The effect of training was assessed through balance and gait tests.

mp tu e o ot re ex responses an s was arger n pat entsthan HS, and adaptation rate was slower in PD. This phenomenonwas ameliorated through training with the platform. Improvement ofperformance on the platform extended to daily-life balance and gait tasks.Abnormalities of amplitude and adaptation of reflex responses and

s to pre cta e pertur at ons may account or nsta ty o pat ents.Improvement with training suggests that implicit motor learning is largelypreserved in patients.



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Stepping-in-place on a continuously rotating platform:podokinetic after-rotation and long-term adaptation in PD patients

Marco GodiFondazione Salvatore Maugeri (IRCCS), Scientific Institute of Veruno, Italy

Curved walking is a difficult task for Parkinson’s disease patients PD .Stepping-in-place on a rotating platform produces podokinetic afterrotation (PKAR): when stepping on firm ground without vision, subjectsrotate towards the direction opposite to that of the previous platformrotation. We hypothesized that PKAR may improve curved walking in PD.

pat ents an ea t y su ects per orme stepp ng n p ace at t e centre

of a counter-clockwise CCW or CW rotating platform for 10 min. At theend of each trial, participants stepped in place with eyes closed. In thepatients, two trials (CW and CCW) were repeated every other day for a totalof 10 sessions. Spontaneous curved gait on firm ground was assessed in

pr or to an a ter suc tra n ng.

PKAR was present in all participants. In PD, the intensity of PKAR was

often asymmetric. Duration and angular velocity of PKAR increased across

sessions with the repetition of the task. After training, gait speed during

curve tra ector es ncrease w t respect to ase ne ecause o an

increase of step length. Cadence was unaffected by training. PKAR training

can be exploited in PD patients. Training with the rotating platform can

decrease step hypokinesia without affecting walking rhythm in PD patients.

Somatosensory deficits in the upper limb after stroke: assessment,importance, neural correlates and survivors’ experience

14.30 - 16.00 - Room 0.2/0.3Assessment of somatosensory deficits in a clinical settingGeert VerheydenKU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium

This session will introduce the audience into the assessment of somatosensory

modalities after stroke, including exteroception, proprioception and higher

cort ca sensat on. p ate ev ence o stu es eva uat ng psyc ometr c

properties and clinical utility of measures of somatosensation in a

neurological population will be presented. Standardized clinical assessmentsapplicable for the clinical setting will be demonstrated and the distribution of

impairments across modalities will be presented.


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Importance of somatosensory deficits in unimanual and bimanualmotor performance

Sarah Meyer KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium

otor e c ts n t e upper m post stro e ave een stu e extens ve y, ut

insights into somatosensory impairments are less explored. Nevertheless,

sensorimotor interaction is necessary for learning motor skills. This talk will

therefore present findings from a study evaluating somatosensory deficits

in the upper limb, with a focus on the influence of different somatosensorye c ts n ot un - an manua motor outcome a ter stro e. urt ermore,

the impact of neglect on somatosensory impairments and on the relationbetween somatosensory and motor impairments post stroke will bedescribed. Our study showed that patients with neglect have more combined

and more severe somatosensory deficits compared to patients withoutneg ect. urt ermore, n pat ents w t neg ect, cons stent y strongerassociations exist between somatosensory impairments and both unimanual

and bimanual motor outcome, compared to patients without neglect.It is shown that neglect is associated with more severe somatosensoryimpairments in the upper limb after stroke, which is therefore anmportant actor w en e neat ng sensor motor re a tat on strateg es.

Neural correlates of somatosensory deficits after strokeSimon Kessner University Clinical Center Hamburg-Eppendorf, Department of Neurology,Hamburg, Germany

During the past years, there are increasing research activities onsomatosensory symptoms following stroke. Modern neuroimagingstatistics such as voxel-based lesion-symptom mapping VLSM facilitateto test for significant associations of brain lesions to clinical symptoms.In this study, somatosensory qualities in the upper limb of sub-acutestroke patients were tested. Using VLSM, we investigated the statisticalassociation of lesion localization to somatosensory deficit. Furthermore,structura connect v ty o t e s gn cant pea voxe s was eterm neusing diffusion tensor imaging data. In all tested qualities, distribution

of voxels with significant association to somatosensory deficit showedinvolvement of the parietal white matter, the dorsal internal capsule, andthe secondary somatosensory and insular cortex. Fiber tracking starting



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from the peak voxels demonstrated that these brain regions are part ofthe ascending thalamocortical tract and connect the thalamus with insular

an secon ary somatosensory cortex. ere we prov e ev ence us ngVLSM, that stroke lesions affecting the thalamocortical tract might behighly associated to cause somatosensory deficits. We endorse previousfindings about the contribution of the insula and parietal operculum tosomatosensation. Future research should address the rehabilitativepotent a o somatosensory e c ts w t respect to es on oca zat on.

Funding: This work was supported by the German Research Foundation

(DFG) SFB 936 “Multi-site Communication in the Brain”, project C2, and by

Scientific Research Flanders (FWO) in Belgium

Stroke survivors’ experiences of somatosensory impairmentafter strokeNaoimh McMahon Clinical Practice Research Unit, School of Health, University of CentralLancashire, Preston, UK Somatosensory ability is commonly impaired after stroke. Despite growing

recognition for the need to understand service users’ experiences and

perspect ves n ea t serv ces prov s on, stro e surv vors exper ences

of living with somatosensory impairment is under explored. This talk

will present findings from a qualitative study that aimed to explore these

experiences. Five purposively selected community dwelling stroke survivors

with somatosensory impairment were interviewed and data analysed using

nterpretat ve enomeno og ca na ys s. mergent t emes nc u e

making sense of somatosensory impairment, interplay of somatosensoryimpairment and motor control for executing tasks, and perseverance

versus learned non-use. These themes will be discussed along with

implications for practice and recommendations for future research.

Robot-assisted gait rehabilitation in neurological patients14.30 - 16.00 Room 0.7

Neurological gait training: the influence of body weight supportand robot assistance on the trunkEva Swinnen


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Vrije Universiteit Brussel

ntro uct on: o ot-ass ste ga t re a tat on as een reporte to mprovegait- and balance related outcome measures, but it has not been proven that

its effect is superior to other gait rehabilitation methods. One of the questions

in this context is whether body weight support (BWS) may restrict the trunk

and pelvis movements during robot-assisted treadmill walking (RATW),

consequent y ea ng to nsu c ent tra n ng o t e trun a ance.

Methods: Kinematic analyses Polhemus Liberty 240 Hz of the trunkand pelvis movements were performed (1) during walking on a treadmillwith different levels of BWS and (2) during RATW (Lokomat-system) with

different levels of BWS and GF. Statistical analysis consisted of a repeatedmeasures ANOVA with significance level α at 5%.Results: Globally, 1 as compared with walking without BWS, increasingpercentages of BWS were accompanied by a significant restriction in trunkand pelvis movements; and (2) during RATW complemented with the useof BWS, a decrease in trunk and pelvis kinematics was found as comparedw t trea m wa ng w t out ro ot-ass stance.Conclusions: These results have an influence on the training of trunkbalance during gait rehabilitation and should be taken into account indeveloping gait rehabilitation robots and in gait rehabilitation itself.

Development of a new haptic gait trainer (LOPES II);from basic science to admission in healthcareJaap Buurke

Roessingh Research and Development

The last decade, there is an increasing interest in the use of robotic gaittrainers during the rehabilitation of spinal cord injured patients and

patients who suffered from a stroke. These robotic gait trainers warrant

the intensity of training, and reduce the physical demands on therapists.

esp te t ese potent a ene ts ro ot c ga t tra ners ave not yet

demonstrated clear advantages over conventional gait training approaches.

This might be due to the reduced active participation and limited freedom

of movement. Devices, that allow more freedom of movement and increase

active participation may optimize treatment outcome.

ase on t e ent cat on o user requ rements y t e sta e o erspatients, clinicians, technicians, neurorehabilitation scientists , the

“Lower extremity Powered ExoSkeleton II (LOPES II)” was developed.



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The LOPES II supports movements in all important directions aroundpelvis, hip and knee, allows variability in the execution of movements,

an s equ ppe w t a gor t ms t at prov e ust as muc ro ot cassistance as the individual patient needs to improve selected keyaspects of gait (e.g., stability in stance, foot clearance during swing,foot prepositioning for initial contact, step length, push-off). During thepresentation the first results of these added values will be presented.

Gait-Related Cortical Activity and Its Implications for RehabilitationKristel Knaepen

Vrije Universiteit Brussel, Belgium

t s genera y accepte t at wa ng nvo ves a comp ex nteract onbetween supraspinal centers, central pattern generators and multi-sensory peripheral sources. However, the exact neurophysiologicalmechanisms are still unclear and further research is necessary to advanceneurological gait rehabilitation and to develop supporting technologiessuc as ro ot c ass st ve ev ces. ectroencep a ograp y as t e un queadvantage of giving insight into ongoing brain activity during large body

movements. In a set of experiments EEG was used to study gait-relatedcortical activity during treadmill walking (TW) and robot-assisted treadmill

walking (RATW). The main findings indicate the presence of gait-related

cortical potentials in close temporal relation with the phases of the gait

cycle over different electrocortical sources such as the sensorimotor

and cingulate cortex during TW. Next to that, the mu (8–12 Hz) and beta

(12-30 Hz) rhythms are suppressed in the primary sensory cortex duringTW, indicating a larger involvement of the sensorimotor area during TWcompare to . ese stu es prov e new ns g ts nto ga t-re ate

brain dynamics during walking and robot-assisted walking and can helpshape the future of neurological gait rehabilitation.

Development of the ALTACRO system, a step forward to morenatural gait dynamicsCarlos Rodriguez

Vrije Universiteit Brussel, Belgium

ar os o r guez uerrero, ran o rac x, ctor rosu, ona anHam, Michaël Van Damme, Laura De Rijcke, Bram Vanderborght and DirkLefeber


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The aim of this paper is to introduce the paradigms and strategiesused in the design of an Automated Locomotion Training using an

Actuated Compliant Robotic Orthosis ALTACRO . We have developed anovel gait rehabilitation robot with 11 actuated degrees of freedom toassists patients’ legs and pelvis to walk on a treadmill. Since currentgait rehabilitation robots have not accomplished a clear improvementcompared to conventional therapy, a need exists for devices with newc aracter st cs t at can en ance ro ot-ass ste re a tat on t erapy.Gait training robots have evolved noticeable from pure position controlleddevices to robots that allows a more natural gait pattern by renderingthemselves transparent to the human and acting only when is needed.

Systems that induce external dynamics and constraint natural feedbacksuc as pass ve o y we g t support systems, may n uce unnaturaproprioceptive feedback which plays a big role on motor learning.ALTACRO (Figure 1) is an attempt to give a step forward towards the goal ofinvestigate new rehabilitation paradigms by exploiting its novel design. Webelieve that fueatures like mechanically compliant acuation, active ankleass stance, a contro a e t rea m an u y actuate pe v s p at ormwithout the need of a body weight support system will allow us to researchnovel control paradigms that may lead to a more natural, unhindered gaitpattern while using the device, a more natural load distribution and theinclusion of more inmersive virtual rehabilitation scenarios.

Figure 1. The complete ALTACRO system consists of a dual belt treadmill,a rugged structure for support actuation of the pelvis and exoskeleton leg

structures with compliant actuators for hip-, knee- and ankle flexion extension.



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Cognitive rehabilitation: results of a Dutch comprehensiveresearch program on outcome and factors predicting outcome

10.30 - 12.00 Room 0.2/0.3

Problem Solving Therapy during outpatient rehabilitation for strokear e e . sser , ; a an a . e en ro - a , Adriaan van t Spijker

Jan J.V. Busschbach Gerard M. Ribbers ,

Department of Rehabilitation Medicine, Erasmus University MedicalCenter, Rotterdam, the Netherlands Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam

Rehabilitation Centre, Rotterdam, the Netherlands Department of Psychiatry, Section Medical Psychology and Psychotherapy,Erasmus University Medical Center, Rotterdam, the Netherlands

Background Stroke patients make less use of active problem-oriented coping

strategies, and experience a lower health-related quality of life HR-QoL .Objective To assess whether Problem Solving Therapy PST is an effectivegroup intervention for improving coping strategy and HR-QoL in patientsafter stroke.Methods: This pragmatic randomized controlled trial (RCT) investigates the

effects of PST, measured directly after the intervention period 8 weeks .

The intervention group received PST in addition to standard rehabilitation

treatment. Data were analyzed using independent and paired sample t-tests.

Results: Between the groups there were no statistically significantdifferences. However, within the groups there were; the interventiongroup showed significant improvements in coping strategy decreasedemotion-oriented coping p=.040 ; increased distraction p=.010 , problemsolving skills (decreased avoidant style (p=.006)), HR-QoL (increased

utility (p=.048)), and social participation (increased family role (p=.028)and autonomy outdoors (p=.013)). The control group showed significantimprovements in HR-QoL increased VAS p=.001 , depression scorep=.031 , and social participation increased family role p=.011 .

Conclusion: On the short term, PST has no significant psychosocial effectsin stroke patients compared to standard rehabilitation. The upcoming long-term results may reveal potential late effects of PST on coping strategiesor pro em so v ng s s n pat ents a ter stro e.

Focused symposia Friday 22 May 2015


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Effectiveness of a holistic neuropsychological rehabilitationprogramme

Meike Holleman , Martie Vink , Rinske Nijland , Ben Schmand2,3

Reade, Centre for Rehabilitation and Rheumatology, Amsterdam,the Netherlands Department of Medical Psychology, Academic Medical Centre at

the University of Amsterdam, Amsterdam, the NetherlandsProgrammagroep Brein en Cognitie, Faculty of Social and Behavioural

Sciences, University of Amsterdam, Amsterdam, the Netherlands

ect ve: we exam ne t e e ects o a compre ens ve neuropsyc o og ca

rehabilitation programme Intensive NeuroRehabilitation, INR on theemotional and behavioural consequences of acquired brain injury (ABI).Design: we conducted a randomised, non-blinded, waiting-list controlledtrial. During the waiting-list period no or minimal care was provided.

art c pants: seventy-five adult patients suffering from ABI 33 TBI, 14stroke, 10 tumor, 6 hypoxia, 12 other were included, all of whom wereadmitted to the INR treatment programme.Outcome measures: main outcome measures were general psychologicalwell-being (Symptom-Checklist-90), depression and anxiety (Beck

epress on nventory- , osp ta nx ety an epress on ca e, tate- ra tAnxiety Inventory , and quality of life Quality of Life in Brain Injury .Results: multivariate analysis of the main outcome measures showedlarge effect sizes for psychological well-being (partial η = 0.191, p <0.001), depression (0.168, p < 0.001), and anxiety (0.182, p < 0.001), anda moderate effect size for quality of life 0.130, p = 0.001 . Changes onneuropsychological tests did not differ between the groups.Conclusions The INR programme improved psychological well-being,

depressive symptoms, anxiety, and quality of life. The program does notaffect cognitive functioning.

Predictors of health-related quality of life and participation afterbrain injury rehabilitation: the role of neuropsychological factorsBoosman, H. , Winkens, I. , Van Heugten, C. M. , , Rasquin, S. M. C. , Heijnen,

. . , sser- e y, . . .

Brain Center Rudolf Magnus and Center of Excellence for RehabilitationMedicine, University Medical Center Utrecht and De HoogstraatRehabilitation, Utrecht, the Netherlands.



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Maastricht University, Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht, the Netherlands.

aastr c t n vers ty, epartment o europsyc o ogy anPsychopharmacology, Faculty of Psychology and Neuroscience, Maastricht,the Netherlands. Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek,

the Netherlands, and Maastricht University, Research School CAPHRI,

epartment o e a tat on e c ne, aastr c t, t e et er an s.

De Hoogstraat Rehabilitation, Utrecht, the Netherlands.

Background: Few studies have examined the predictive value of

multiple neuropsychological factors on health-related quality of lifeHRQoL and participation following inpatient acquired brain injury ABI

rehabilitation. Therefore, the aims of this longitudinal study were 1 to

assess associations between neuropsychological factors and HRQoL and

participation three months after discharge from inpatient ABI rehabilitation;

and (2) to determine the best neuropsychological predictor of HRQoL and

part c pat on a ter contro ng or emograp c an n ury-re ate actors.

Methods: Patients with ABI n=100 were assessed within approximatelytwo weeks of enrolment in inpatient rehabilitation. Predictor variablesincluded demographic and injury-related characteristics and the followingneuropsychological factors: active and passive coping (UCL), cognitionattention, executive functioning, verbal memory, learning potential ,

depressive symptoms HADS-D , motivation MOT-Q , extraversion andneuroticism (EPQ-RSS) and self-awareness (PCRS).Results: Approximately three months after discharge from inpatientrehabilitation, patients’ physical and psychosocial HRQoL (SS-QoL-12),and participation restrictions and satisfaction USER-P were assessed.

Bivariate analyses revealed that passive coping, executive functioning,depressive symptoms, extraversion and neuroticism were significantlyassociated with HRQoL and participation. These factors significantlyexplained additional variance in physical (18.6%) and psychosocial21.7% HRQoL, participation restrictions 6.9% , and satisfaction with

participation 21.8% after controlling for demographic and injury-relatedfactors. Across all four outcomes, passive coping was the only significantneuropsychological predictor (beta=-.305 to -.464); a higher tendencytowards passive coping was related to lower HRQoL and participation.

onc us on: s stu y s ows t at neuropsyc o og ca unct on ng,and in particular passive coping, plays a role in predicting HRQoL andparticipation after inpatient ABI rehabilitation


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ReSET (Strategic Executive Training); Effectiveness of a cognitiverehabilitation program for executive dysfunctioning in patients

with Parkinson’s Disease. . agsma , O. Tucha , . oerts , H.T. Dijkstra , A.A. Duits , . van aar

J.M. Spikman ,

University of Groningen, Department of Clinical & DevelopmentalNeuropsychology, Groningen, the Netherlands

Medical Center Nij Smellinghe, Department of medical psychology,Drachten, the Netherlands3 Maastricht University Medical Center, Department of Psychiatry and

Psychology, Maastricht, the NetherlandsUniversity Medical Center Groningen, Department of Neurology,Groningen, the Netherlands

Objective: Impairments in executive functions (EF) are predominant inParkinson’s Disease (PD). However, neuropsychological rehabilitationprograms are not routinely offered to PD patients. Spikman et al. (2010)

ave s owe t at n pat ents strateg c execut ve tra n ng ea s to moreimprovement in daily life executive functioning than computer training.Therefore, we studied whether strategic executive training (ReSET) is alsoeffective in PD patients.Participants and Methods: PD patients were randomized into twogroups: ReSET n=23 or computer training Cogniplus n=20 . All patientsset 3 individual executive goals. Neuropsychological assessment wasadministered at baseline, 1-2 weeks and 3-5 months post treatment.Primary outcome measure: DEX questionnaire. Secondary outcomemeasures: goal improvement, PDQ-39 and BADS.

esu ts: at ents n ot con t ons s owe mprovement on t e

questionnaire and executive goals 1-2 weeks post treatment. However, theReSET group showed more improvement. In both groups no differenceswere found between baseline and post treatment on the PDQ-39 and BADS.

Conclusions: ognitive rehabilitation of executive dysfunctions seems to be

ene c a or pat ents, w t some n cat ons t at strategy tra n ng s more

effective than computer training. Future analyses are focusing on studying

long term effects and answering the question which specific group of PD

patients benefit most from cognitive rehabilitation of executive dysfunctions.



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Effects and predictors of errorless Learning in Goal ManagementTraining after acquired brain-injury

Bertens, Dirk, Fasotti, Luciano,1,2 Boelen, Daniëlle H.,2,3, Kessels, Roy P.C. ,3

Radboud University, Donders Institute for Brain, Cognition and Behaviour,Nijmegen, the Netherlands Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, the

Netherlands Radboud University Medical Center, Department of Medical Psychology,

Nijmegen, the Netherlands

ac groun an a ms: at ents w t acqu re ra n- n ury o ten exper ence

executive deficits. Goal Management Training GMT deals with theseproblems and is traditionally administered in a trial-and-error way, inwhich patients are allowed to make errors during the learning stage.Using an RCT we examined whether brain-injured patients with planningpro ems earn every ay tas s more e ect ve y w en t ey are g venerrorless GMT compared to conventional GMT.Method: Sixty-seven patients with executive impairments due to acquiredbrain injury were randomly allocated to an experimental errorless GMT orconventional GMT in which two individually selected everyday tasks weretra ne . as per ormance an goa atta nment were measure e ore anafter training. In addition, potential outcome moderators and mediatorswere examined.Results: Errorless GMT improved everyday task performance significantlymore than conventional GMT (adjusted difference 15.43, p=.006). Age was

ent e as a mo erator or convent ona an as a mo eratorfor errorless GMT. Executive function mediated performance across therea men arms.

Conclusion: A combination of errorless learning and GMT is effective inpatients with executive deficits, especially in patients with higher estimated

s. er pat ents respon e etter to convent ona . ese n ngs are

highly relevant for the implementation of errorless GMT in clinical practice


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Motor & Cognitive Rehabilitation in MS10.30 - 12.00 - Room 0.6

Peter Feys, Francesco Patti, Ulrik Dalgas, Ilse Lamers

e sem nar w prov e state-o -t e-art n ormat on on ev ence- aserehabilitation for physical and cognitive function in Multiple Sclerosis withfour presentations. The first two presentations will discuss the effectsof physical interventions. The evidence on exercise and physical activitywill be reviewed by Ulrik Dalgas, within a multi-dimensional assessmentramewor a so ta ng nto account mpact on non-motor oma ns as

fatigue, depression and quality of life. Evidence-based recommendationsfor assessment and rehabilitation of upper limb function will be providedby Ilse Lamers based on systematic reviews and experimental work.Francesco Patti will review the evidence on cognitive rehabilitation in MStaking into account the neural correlates of cognitive dys function. PeterFeys will integrate cognitive and motor function within the framework ofassessing cognitive-motor interference applying dual tasking methodology,and dual task training.

Uncovering the neurological mechanisms behind upper limbfunctional recovery after stroke: EXPLICIT-stroke & 4D-EEG10.30 - 12.00 Room 0.7

. wa e , . nters, . o s- sca ante, . otgans

The focused symposium will start by addressing early prognosis of

functional outcome of the upper limb after stroke. The proportionalamount of time-dependent (spontaneous) neurological recovery seen inerent mo a t es, suc as motor an v suospat a neg ect a ter stro e,

will be discussed. In addition, a prognostic model for recovery of upperlimb capacity will be presented.Secondly, key findings from the EXPLICIT-stroke program will bepresented and the time-dependent mechanisms that drive restitutionan su st tut on o upper m recovery post stro e w e scusse .Additionally, focus will be on a proposed phenomenological model for

understanding skill reacquisition after stroke.Thirdly, a novel methodology for relating motor behavior to brain activationpatterns based on system identification and electrophysiological brain



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imaging (EEG) will be discussed as part of the 4D-EEG project. Finally,the practical implementation of the 4D-EEG methodology in a longitudinal

stu y w t repeate measurements n t e rst mont s post stro e wbe presented.

Excercise and cognitive behavioural therapy in neuromusculardiseases: results from the FACTS-2-NMD programme13.30 - 15.00 Room 0.1

Chronic fatigue can be alleviated in patients with FSHD

N.Voet , G. Blijenberg , J. Hendriks , I. de Groot , G. Padberg , B. vannge en , . eurts

Department of Rehabilitation, Radboud University Medical Center,Nijmegen, the Netherlands. Expert Center for Chronic Fatigue, Radboud University Medical Center,

Nijmegen, the Netherlands. Department for Health Evidence, Radboud University Medical Center,

Nijmegen, the Netherlands.

Department of Neurology, Radboud University Medical Center, Nijmegen,the Netherlands.

ac groun : We previously reported that 61% of the patients withfacioscapulohumeral dystrophy FSHD are severely fatigued and thatloss of muscle strength, physical inactivity, sleep disturbances and paincontribute to chronic fatigue.Main objective: To study the effects of aerobic exercise training (AET) andcognitive behaviour therapy CBT on chronic fatigue in patients with FSHD,

as assessed with the subscale fatigue of the Checklist Individual Strength(CIS-fatigue).Methods: a multi-centre, assessor-blinded, randomised controlled trial(RCT) was conducted, including 57 FSHD patients with severe chronicfatigue CIS-fatigue ≥ 35 who were randomly allocated to either 1AET, 2 CBT, or 3 a waiting list, usual care UC group. Outcomes wereassessed at baseline, immediately post intervention (after 16 weeks) andafter 12 weeks follow-up. After a 28-weeks waiting period the patients in

the UC group were randomised to either AET or CBT.esu ts: ot ntervent ons were we to erate . ot ntervent on groupsshowed a significant difference in fatigue score compared to UC: -9·1 for


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AET (95%CI -12·4 to -5·8) and -13·3 for CBT (95%CI -16·5 to -10·2). Thesepositive effects were maintained after 12 weeks of follow-up: -8·2 for AET

95%CI -12·4 to -5·8 and -10·2 for CBT 95%CI -16·5 to -10·1 .Conclusion: This is the first RCT indicating that chronic fatigue can beameliorated in patients with an inherited muscular dystrophy.Sources of funding: The Prinses Beatrix Spierfonds (PBS), the NetherlandsOrganisation for Health Research and Development (ID: ZonMW 89000003)an t e o a esearc oun at on.Conflicts of interest:

Exercise therapy and cognitive behavioral therapy are both noteffective in reducing fatigue in post-polio syndrome: results of an RCTFieke S. Koopman MD , Eric L. Voorn MSc , Anita Beelen PhD , GijsBleijenberg PhD2, Marianne de Visser MD PhD3, Merel A. Brehm PhD ,Frans Nollet MD PhD

Department of Rehabilitation, Academic Medical Center, University ofmster am, mster am, t e et er an s

Expert Centre for Chronic Fatigue, Radboud University Medical Centre,

Nijmegen, the Netherlands Department of Neurology, Academic Medical Centre, University of

Amsterdam, Amsterdam, the Netherlands

Introduction: People with post-polio syndrome PPS commonlyexperience severe fatigue that persists over time and negatively impactsfunctioning and health-related quality of life (HRQoL). This study aimed todetermine the efficacy of exercise therapy (ET) and cognitive behavioraltherapy CBT on reducing fatigue and improving activities and HRQoL in

patients with PPS.Methods: We conducted a multicenter, single-blinded, randomizedcontrolled trial. Over four months, severely fatigued patients with PPSreceived ET, CBT, or usual care (UC). ET aimed at improving physicalcapac ty, cons ste o ome- ase aero c tra n ng an superv se grouptraining. CBT was aimed at changing perpetuating factors for fatigue. Theprimary endpoint (fatigue) was assessed using the Checklist IndividualStrength (CIS20-F). Secondary endpoints included activities and HRQoL.Endpoints were measured at baseline and at 4, 7, and 10 months.

esu ts: xty-e g t pat ents were ran om ze . o ow ng treatment,no differences were observed between the intervention groups and UCgroup for fatigue (mean differences in CIS20-F score: 1.47, 95%CI -2.84 to



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5.79 for ET versus UC; and 1.87, 95%CI -2.24 to 5.98 for CBT versus UC),activities, or HRQoL.

onc us ons: ur resu ts emonstrate t at ne t er nor weresuperior to UC in reducing fatigue in severely fatigued PPS patients.

Self-reported Participation Restrictions in Ambulatory ALSPatients: the Role of Physical Functioning and Personal FactorsAnnerieke C. van Groenestijn, MD, MSc , Carin D. Schröder, PhD , EstherT. Kruitwagen- van Reenen MD, MSc , Leonard H. van den Berg, MD, PhD2,Johanna M. A. Visser-Meily, MD, PhD

u o p agnus nst tute o eurosc ence an entre o xce encefor Rehabilitation Medicine, University Medical Centre Utrecht andRehabilitation Centre De Hoogstraat, Utrecht, the Netherlands;Department of Neurology, Rudolf Magnus Institute of Neuroscience,University Medical Centre Utrecht, Utrecht, the Netherlands

ect ve: o escr e t e eve o part c pat on restr ct ons an to exam nethe determinants of participation restrictions.Methods: Cross-sectional study in which 67 ambulatory patientsdiagnosed with ALS were assessed in the early phase of the disease (timesince onset: 1.1 years). Self-reported participation restrictions: the SIPSOC.

eterm nants: ys ca unct on ng: disease severity ALSFRS-R ; lungcapacity FVC% ; fatigue severity CIS-fatigue ; Hand grip strength hand-held dynamometer); Mobility (TUG); and personal factors age, gender,anxiety (HADS-A), depression (HADS-D); illness cognitions (ICQ); coping(CISS:SSC); dissatisfaction with social support (SSL-D). Correlation andregress on ana yses were per orme .

Results: All ALS patients median ALSFRS-R scores 43.0, mean age 59.5reported participation restrictions (most ‘not doing heavy work’ 71%; least‘not going out to visit people: 2%). Physical functioning (lower score of theALSFRS-R; slower TUG) explained most of the participation restrictions56.1% ; personal factors higher score on the ICQ-subscale helplessness

explained 6.6% of the variance F change=4.60, =.014 .Conclusions: During rehabilitation in the early phase of ambulatory ALSpatients, it is already worthwhile to assess participation restrictions. Physical

functioning and illness cognition play a role in explaining participation

restr ct ons. urt er researc s nee e to eva uate t e ro e o ot erpsychological factors and to monitor participation restrictions over time.


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Patients’ experiences with Cognitive Behavioural Therapy andExercise Therapy

Minne Bakker¹, Karen Schipper¹, Frans Nollet², Tineke Abma¹¹ Department of Medical Humanities, EMGO+ Institute, VU Medical Centre(VUmc), Amsterdam, the Netherlands² Department of Rehabilitation, Academic Medical Centre Amsterdam,the Netherlands

Background: Recently, the effectiveness of Exercise Therapy (ET) andCognitive Behavioural Therapy (CBT) for neuromuscular diseases (NMDs)

has been evaluated in a randomized controlled trial. The RCT was aimed atreducing fatigue and improving the functioning of patients with NMDs. Thequantitative study showed mixed effects. A qualitative study was executedto evaluate patients experiences with both interventions.Methods: Qualitative data were collected through semi-structuredinterviews with 53 patients. The data were audio taped, transcribed andanalysed thematically.Results: The majority of the patients participated for external motivationreasons (scientific progression). Beforehand, patients had reservations

about the CBT. Patients had greater expectations about the ET. Afterwards,t e was exper ence as a very ars an ntense t erapy an onewhich was often difficult to integrate into their daily routines. The CBT wasgenerally experienced as positive. In none of the interventions patientsreported a large reduction of the perceived fatigue. However, patients didoften experience more acceptance of their disabilities and felt they were

etter a e to cope w t t e r p ys ca s tuat on.Conclusion: Patients did experience some effects of both the CBT and theET. However, the experienced effects on fatigue were limited. Experienced

effects in terms of increased acceptance and coping strategies indicatethat patients might value different outcomes than those preordained inthe trail. Patients stressed the importance of interventions ’fitting’’ theirlife-world. Further research should focus on less intense physical trainingprograms or on the combination of behavioural and physical training.



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Restore4stroke: results of a Dutch comprehensive researchprogramme on emotional and personal factors determining

the quality of life of stroke patients and their partners13.30 - 15.00 Room 0.2/0.3

Trajectories of health-related quality of life after stroke:results from a 1-year prospective cohort studyML van Mierlo , CM van Heugten2,3, MWM Post , , T Hoekstra , , JMA Visser-Meily

¹ Brain Center Rudolf Magnus and Center of Excellence for Rehabilitatione c ne, n vers ty e ca enter trec t an e oogstraat

Rehabilitation, Utrecht, the Netherlands² Maastricht University, Department of Psychiatry and Neuropsychology.School for Mental Health and Neuroscience, Maastricht, the Netherlands³ Maastricht University, Department of Neuropsychology and

syc op armaco ogy, aastr c t, t e et er an s Department of Rehabilitation Medicine, Center for Rehabilitation, University of

Groningen, University Medical Center Groningen, Groningen, the Netherlands

Vrije University, Faculty of Earth and Life Sciences, Department ofHealth Sciences and the EMGO Institute for Health and Care Research,

mster am, t e et er an s Vrije University Medical Center, Department of Epidemiology and

Biostatistics, Amsterdam, the Netherlands

Purpose: The aims of this study were to identify trajectories of physicaland psychosocial health-related quality of life (HRQoL) from two months to

one year post stroke and to determine predictors of trajectory membership.

Methods: Multicenter prospective cohort study in which 351 patients

were followed up at two, six, and twelve months post stroke. Physical and

psychosocial HRQoL were measured with the Short Stroke Specific Quality

of Life Scale. Using latent class growth mixture modelling, trajectories of

physical and psychosocial HRQoL were determined. Multinomial regression

analyses were performed to predict trajectory membership. Potential

predictors were demographic, stroke-related, and psychological factors.

Results: Four trajectories were identified for both physical andpsychosocial HRQoL: high, low, recovery and decline of HRQoL. Comparingthe low and recovery physical and psychosocial HRQoL trajectories, the

patient groups with low HRQoL were more likely to have higher scoresfor neuroticism. For the decline compared with the high trajectories thefollowing predictors were found for physical HRQoL: being discharged to a


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rehabilitation setting, less acceptance and more neuroticism, pessimism,helplessness, and passive coping. For psychosocial HRQoL these

pre ctors were: e ng sc arge to a re a tat on sett ng, ess se -efficacy and proactive coping, and more helplessness, and passive copingConclusions: The present study identified four distinct trajectories of physical

and psychosocial HRQoL. The findings indicate that psychological factorsare the most important factors in identifying patients at risk of unfavourable

o tra ector es. s ng t ese pre ctors w e p to ent y vu nera epatients and to guide rehabilitation in the early stages post stroke.

The Restore4Stroke Self-Management intervention study:A randomized controlled trial in stroke patients and partnersNS Tielemans , JMA Visser Meily , VPM Schepers , CM van Heugten ,

School for Mental Health and Neuroscience, Department of Psychiatryand Neuropsychology, Faculty of Health, Medicine and Life Sciences,Maastricht University, Maastricht, the Netherlands Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation

Medicine, University Medical Center Utrecht and De Hoogstraat

Rehabilitation, Utrecht, the Netherlands Department of Neuropsychology and Psychopharmacology, Faculty of

Psychology and Neurosciences, Maastricht University, Maastricht, theet er an s

Aim: Examining the effectiveness of a 10-week group-based, stroke-specific self-management intervention aimed at proactive copingcompared to a 10-week group-based, stroke-specific educationntervent on n stro e pat ents an partners.

Methods: Patients had a stroke ≥6 weeks ago, and experiencedparticipation problems indicated by ≥2 items of the Utrecht Scale forEvaluation of Rehabilitation Participation restriction subscale. Afterbaseline measurement, participants were randomly assigned to one of

ot ntervent ons. t ona measurements were per orme rect yafter the intervention, and at three and nine months follow-up. Primaryoutcomes were proactive coping and participation restriction in patientsand partners. Data were analyzed with linear mixed modelling.Results: Participants were 113 patients (mean age 57.0 years (SD 9.0);

mean of 18.8 months after stroke SD 28.4 , and 57 partners mean age59.2 years SD 8.3 . No differences were found between the conditions inproactive coping and participation restriction levels in both patients and



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partners. Beneficial trends were seen regarding patients’ participationrestrictions at nine months follow-up, and partners’ self-efficacy at three

mont s o ow-up, avor ng t e se -managemen

Documents

Congress on NeuroRehabilitation and Neural Repair