REHABILITATION: MOBILITY, EXERCISE AND SPORTS Assistive Technology Research Series The Assistive Technology Research Series (ATR) aims to disseminate and archive assistive technology research summaries widely through publishing proceedings, monographs, and edited collective works The series aspires to become the primary world-wide source of information in assistive technology research, through publishing state-of-the-science material across all continents ATR defines assistive technology (AT) as any tool, equipment, system, or service designed to help develop, maintain or improve a person with a disability to function in all aspects of his or her life Assistive technology helps people of all ages who may have a broad range of disabilities or limitations The ATR series will accept manuscripts and proposals for a wide range of relevant topics Editor-in-Chief : Rory A Cooper Editorial Board: Angel Gil Agudo, Geoff Bardsley, Robert Bingham, Christian Buhler, H.S Chhabra, Gerry Craddock, Jin Dewen, Sten Ekman, Martin Ferguson, Shirley G Fitzgerald, Antal (Tony) Huba, Jeffrey Jutai, Kiyomi Matsuo, Mounir Mokhtari, Johan Molenbroek, Hisaichi Ohnabe, Paul F Pasquina, Marcia Scherer, Nigel Shapcott, Richard Simpson, Ronaldo de Souza Moraes Jr., Thijs Soede, Pierre Soto, Eric Tam, Osamu Tanaka, Julian Verkaaik, Howard Wactlar, Hans-Werner Wahl, Lloyd Walker, Jue Wang, Brian Woods, Lucas van der Woude, Yusheng Yang Volume 26 Recently published in this series Vol 25 Vol 24 Vol 23 Vol 22 Vol 21 Vol 20 Vol 19 P.L Emiliani, L Burzagli, A Como, F Gabbanini and A.-L Salminen (Eds.), Assistive Technology from Adapted Equipment to Inclusive Environments – AAATE 2009 P Topo and B Östlund (Eds.), Dementia, Design and Technology – Time to Get Involved M Cabrera and N Malanowski (Eds.), Information and Communication Technologies for Active Ageing – Opportunities and Challenges for the European Union W.C Mann (Ed.), Aging, Disability and Independence – Selected Papers from the 4th International Conference on Aging, Disability and Independence (2008) A Mihailidis, J Boger, H Kautz and L Normie (Eds.), Technology and Aging – Selected Papers from the 2007 International Conference on Technology and Aging G Eizmendi, J.M Azkoitia and G Craddock (Eds.), Challenges for Assistive Technology – AAATE 07 C Nugent and J.C Augusto (Eds.), Smart Homes and Beyond – ICOST2006, 4th International Conference On Smart homes and health Telematics ISSN 1383-813X Rehabilitation: Mobility, Exercise and Sports 4th International State-of-the-Art Congress Edited by L.H.V van der Woude Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, The Netherlands Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen, The Netherlands F Hoekstra Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands S de Groot Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, The Netherlands Rehabilitation Centre Amsterdam, The Netherlands K.E Bijker Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands R Dekker Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen, The Netherlands P.C.T van Aanholt Department of Rehabilitation, Scheperziekenhuis, Emmen, The Netherlands F.J Hettinga Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, The Netherlands T.W.J Janssen Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands Rehabilitation Centre Amsterdam, The Netherlands and J.H.P Houdijk Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands Amsterdam • Berlin • Tokyo ã Washington, DC â 2010 The authors and IOS Press All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without prior written permission from the publisher ISBN 978-1-60750-080-3 Library of Congress Control Number: 2009941383 Publisher IOS Press BV Nieuwe Hemweg 6B 1013 BG Amsterdam Netherlands fax: +31 20 687 0019 e-mail: order@iospress.nl Distributor in the USA and Canada IOS Press, Inc 4502 Rachael Manor Drive Fairfax, VA 22032 USA fax: +1 703 323 3668 e-mail: iosbooks@iospress.com LEGAL NOTICE The publisher is not responsible for the use which might be made of the following information PRINTED IN THE NETHERLANDS Sponsors Hosted by: Research Institute MOVE Faculty of Human Movement Sciences (FBW) Institute for Fundamental and Clinical Human Movement Sciences (IFKB) VU University, Amsterdam, The Netherlands Co-sponsored by: Body@Work Heliomare KNAW RCA UMCG-RUG VRA ZonMw Commercial sponsors: Berkelbike Biometrics Europe BV Cardinal Health Delsys Double Performance ForceLink Human Kinetics Informa Healthcare IOS Press JRRD Max Mobility McRoberts OIM Orthopedie Össur Europe Otto Bock Procare RS Scan Trike - Diamond Semi Conductor Xsens 3W-Infomed This page intentionally left blank Rehabilitation: Mobility, Exercise and Sports L.H.V van der Woude et al (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press All rights reserved vii Introduction to the 4th International Stateof-the-art-Congress ‘Rehabilitation: Mobility, Exercise & Sports’ L.H.V VAN DER WOUDEa,e, S DE GROOTa,c, K.E BIJKERb, R DEKKERe, P.C.T VAN AANHOLTf, F HOEKSTRAb, F.J HETTINGAa, T.W.J JANSSENb,c and J.H.P HOUDIJKb,d a Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, b Research Institute MOVE, Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, VU University Amsterdam, c Rehabilitation Centre Amsterdam, d Rehabilitation Centre Heliomare, Wijk aan Zee, e Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen, f Department of Rehabilitation, Scheperziekenhuis, Emmen, the Netherlands Introduction Rehabilitation medicine in the Netherlands was officially founded as a separate medical profession in 1955 Being a young multidisciplinary area of clinical practice and health care, rehabilitation medicine evolved from an initially clinically-founded discipline towards a more academic-based discipline at the start of this millennium In 2008 clinical rehabilitation care was offered in 24 specialized rehabilitation centers, in university hospitals and in many of the larger general hospitals in the Netherlands Rehabilitation medicine and care is based upon the conceptual framework of the International Classification of Functioning, Disability and Health (ICF [2]), and on an integral, structured and multidisciplinary team approach The rehabilitation medical doctor is trained (in a yr specialization program) largely towards the concepts and aims stated in the ‘Whitebook on Physical and Rehabilitation Medicine in Europe’ [3], published by the governing bodies of European specialists in physical and rehabilitation medicine The rehabilitation medical specialist is a clinical specialist, yet part of the training program is directed towards research methodological content and skills Human Movement Sciences has been intimately linked to rehabilitation from its inception as an academic discipline in Amsterdam in the early seventies As distinct from other Western countries, in the Netherlands the professional training of paramedical and nursing staff is outside the university teaching program and part of a separate system of higher education that primarily offers professional bachelor and www.revalidatie.nl/english viii master programs This is where physio-, occupational, vocational therapists, physical education and sports teachers are trained, also for rehabilitation practice Human movement scientists follow a research-oriented university-based training program, focussed on the study of human movement, both with a fundamental and an applied connotation ‘Human movement sciences’ (HMS) is an interdisciplinary study, encompassing a wide range of disciplines such as (exercise) physiology, psychology, anatomy, biomechanics, motor control & learning etc It is offered as an independent scientific bachelor-master program at two universities (Amsterdam and Groningen3) and as a Master specialization in two other universities (Nijmegen and Maastricht) in the Netherlands today Among the most important applied contexts are the fields of sports, health care, and labor Within the context of health, rehabilitation has from the beginning of HMS been of great interest to staff and students and has led to active collaborations between rehabilitation professionals and human movement scientists from the outset It has generated two professors in human movement sciences and rehabilitation, in Amsterdam and Groningen As such HMS has – together with the technical and social sciences – almost by nature contributed to the continued metamorphosis of rehabilitation from a clinical field of (para)medical care and practice, towards a much more evidence-based academic and clinical-research (multi-) disciplinary environment Today in the Netherlands human movement scientists are in many cases the link between the programs of their schools and those of research institutes on the one hand and the rehabilitation centers/ departments on the other Human movement scientists are often the knowledge managers and/or brokers [4] in multidisciplinary research networks and are trained to be the research-focussed liaison between clinical practice and academia The Dutch rehabilitation–research situation The academic or research performance of the rehabilitation discipline in the Netherlands and Europe has been described briefly by Stam [5] The survey involved the input in key-rehabilitation sciences journals (Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Journal of Rehabilitation Medicine and Disability and Rehabilitation) throughout the year 2004 All publications were ranked to country of origin of the research and authors The Netherlands ranked rd, among a group of 12 countries, and was responsible for 8% of the total number of publications At (31%) the USA headed the list However, the list would be quite different if the population size of each country were taken into account, as is indicated by Coppen and Bailey for a similar ranking on clinical medicine [6], where the USA ranked and the Netherlands on the number of citations per 1000 population The impact of the contribution of the Netherlands to the field of rehabilitation research in an international context is considerable and in part explains the active organization of the current congress With the 4th International congress we also in part celebrate the nd lustrum and the success of the Rehabilitation program of the Netherlands Organization for Health Research and Development (ZonMw) which started some ten years ago This very www.fbw.vu.nl www.umcg.nl www.ZonMw.nl/english ix successful research stimulation program initiated rehabilitation research networks In particular, the national rehabilitation research network ‘Restoration of mobility in SCI rehabilitation’ has benefitted greatly from the research stimulation program, which has also been highly productive in terms of the number and diversity of research projects initiated, as well as in terms of successful PhD projects and publications.5 A continued effort for the implementation of research findings in practice is sought through the joint effort of rehabilitation physicians, paramedical professionals and researchers An important example of this collaboration is the patient monitoring project, where individual patients are monitored both clinically and through regular tests to further structure their individual status, rehabilitation strategy and program, and their prognosis [7] Many rehabilitation centers and university departments, and thus the rehabilitation field and the patients, benefit to this day from the success of the ZonMw funding program It has boosted the scientific infrastructure of rehabilitation centers, both in personel as well as in technical facilities It has – above all – stimulated the academic observation and thinking processes in rehabilitation practice and boosted the number of rehabilitation professionals with a research background This is clearly of crucial importance for the quality of rehabilitation treatment and outcome The importance of such a rehabilitation research and sciences agenda was very clearly stipulated recently by Frontera and colleagues with their analysis of the North American rehabilitation situation [8,9]; the bottom line of their statement being that: “…survival of the (…rehabilitation…) specialty, may depend, among other things on the quality of the knowledge base Very few things could be more important for our patients.” 4th International State-of-the-art-Congress ‘Rehabilitation: mobility, exercise & sports’ It is indeed in the context of this brief history that the th International Congress ‘Rehabilitation: Mobility, Exercise & Sports’ is taking place, as a multidisciplinary event and team effort, and as a natural outcome of the continued collaboration between (local and international) rehabilitation professionals, human movement, social and engineering sciences The current congress program follows the preceding congresses in 1991 [10], 1998 [11] and 2004 [12–14] and the academic evolvement of the organizing team in a very natural way The theme ‘Rehabilitation: Mobility, Exercise & Sports’ of the 4th International Congress has also evolved from the continued research work in recent years in the (inter)national context The program follows the intricate collaboration between human movement sciences and rehabilitation professionals and practice, which among others have evolved in the working group ‘Rehabilitation’ of the Netherlands Society of Human Movement Sciences (VvBN)6 and ‘Human Movement & Sports’ of the Dutch Association of Physical Medicine and Rehabilitation (VRA) The latter stresses the recognition of exercise, active lifestyle and sports, not only as an important part of clinical rehabilitation, but much more also as a lifetime commitment, assumed to increase health and quality of life [15–20] www.scionn.nl www.bewegingswetenschappen.org/english/english.html vra.artsennet.nl 210 Rehabilitation: Mobility, Exercise and Sports L.H.V van der Woude et al (Eds.) IOS Press, 2010 © 2010 The authors and IOS Press All rights reserved doi:10.3233/978-1-60750-080-3-210 The effects of Osteopathic treatment on common femoral artery blood flow in SCI individuals and able-bodied controls G.A.W DENISSENa, D MURRAYb, M.M.T HOPMANa, M.J MACDONALDb Department of Physiology, Radboud University, Nijmegen, The Netherlands b Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada a Abstract: Introduction: Pressure sores have been shown to be the major secondary health complication in spinal cord injured (SCI) individuals, and are associated with decreased blood flow and reduced healing potential The goal of this study was to determine the effect of different sessions of osteopathic treatment on mean leg blood flow (MLBF) in the left common femoral artery (CFA) of SCI individuals compared to able-bodied (AB) individuals Methods: Six individuals (five male, one female; age 44 ± 17.5 years) with chronic SCI (C6-T12; ASIA AB; 3.7 ± 4.6 years post-injury) and six AB individuals (five male, one female, 38.3 ± 9.7 years) participated in our study The protocol consisted of control ‘familiarization’ session of 40 minutes and osteopathic treatment days, where our participants received manual therapy treatment focusing on the cranium (session 1), abdomen (session 2) and the lower extremities (session 3) Doppler ultrasound was used to determine the diameter and mean blood velocity (MBV) in the CFA before, during and after each session Results: Two-way ANOVA statistical analysis revealed no difference in the maximal change in MLBF and leg vascular resistance (LVR) between groups or between the different treatment days However, the maximal change in (MBV) was higher and maximal change of mean diameter was lower in SCI individuals (1.9 ± 2.0 cm/s; 0.03 ± 0.03 cm) compared to AB individuals (0.4 ± 1.3 cm/s; 0.06 ± 0.06 cm) across all treatments There were no differences in absolute MLBF or LVR between treatments Conclusion: Osteopathic treatment did not have an effect on CFA MLBF in either SCI or AB individuals There was, however, a difference in the maximal change in MBV and diameter from rest to during treatment between groups These, were however, so small that absolute flow was not observed to be different from baseline Keywords: osteopathic therapy, spinal cord injuries, blood flow, ultrasound Introduction A decreased blood flow in the paralyzed legs of SCI individuals has been associated with many secondary complications (1-3) Pressure sore development is one of the most common complications associated with a decreased blood flow (1;2) It is hypothesized that in SCI, there is a reduced healing potential due to the decreased blood flow, which contributes to pressure sore development These secondary complications of decreased leg blood flow can lead to an extreme decrease in the quality of life for an individual Therefore reductions in these complications can result in decreased pain and discomfort G.A.W Denissen et al / The Effects of Osteopathic Treatment 211 In our study, we examined the effects of osteopathic therapy on blood flow in the lower extremities of individuals with SCI and age-matched able-bodied (AB) individuals The goal of this osteopathic therapy is to create a balance between and within many of the regulatory systems of the body, including the musculoskeletal, cardiovascular, nervous and digestive systems Most of the manual forces used are very light and should not create any discomfort or pain There has been no research to date examining the effect of osteopathic treatment on lower limb blood flow in individuals with SCI Therefore, the objectives of this study were I) to determine the effects of sessions of osteopathic treatment on blood flow in the left CFA of individuals with chronic, ASIA A-D SCI and able-bodied individuals and II) to determine which of the different osteopathic techniques/treatments may be most effective We hypothesized that the different osteopathic treatments would result in an increase in femoral diameter and mean leg blood flow in SCI individuals compared to AB individuals cause their flow was more impaired at the outset of treatment Methods Six spinal cord Injured individuals (44 ± 17.5 years) with complete and incomplete injuries (C6-T12; ASIA A-B; 3.7 ± 4.6 years post-injury) and six AB individuals (38.3 ± 9.7 years) participated in our study Because the groups were age and sex-matched, there were no significant differences between ages in both groups and both groups composed of males and female The protocol consisted of one control ‘familiarization’ session of 40 minutes and three osteopathic treatment days, each lasting for approximately 50 minutes The three osteopathic treatment days involved manual therapy consisting of different types of osteopathic treatments Of these sessions; first session focused more on the dura, cranium, spinal cord, occiput, sacrum and diaphragm, second session focused on the abdomen and pelvis and the structures in the lower extremities (femoral artery) and the third session focused on the lower extremities, with special attention to the interosseous membrane, fibula and tibia and the femoral artery Each session took place week apart Doppler ultrasound was used to determine the diameter and blood velocity in the CFA and blood pressure was measured in the brachial artery before, during and after the control and treatments days Results Two-way ANOVA statistical analysis revealed no difference in maximal change in mean leg blood flow (MLBF) and leg vascular resistance between both groups and between the different treatment days However, maximal change of mean blood velocity (MBV) was higher and maximal change of mean diameter was lower in SCI individuals (1.9 ± 2.0 cm/s; 0.03 ± 0.03 cm) compared to AB individuals (0.4 ± 1.3 cm/s; 0.06 ± 0.06 cm) One-way repeated measures ANOVA did not show any differences in MLBF or LVR during the different treatments 212 G.A.W Denissen et al / The Effects of Osteopathic Treatment Figure Maximal changes in MBV (a) and mean diameter (b) (mean ± SEM) C= control session; 1,2,3 = number of treatment days