Papers by Jacques van Limbeek
European Journal of Pediatrics, 2006
The impact of salivary flow reduction following medication (scopolamine and botulinum neurotoxin)... more The impact of salivary flow reduction following medication (scopolamine and botulinum neurotoxin) on social interaction and emotional development (self-esteem) was evaluated in a group of 45 children with cerebral palsy who suffered from severe drooling. The children ranged in age from 3 to 16 years (median 9.1 years); 28 were male, 17 female. A questionnaire to document the impact of drooling on social interaction and self-esteem for both the children and their parents was developed and administered during the use of scopolamine and up to 24 weeks after intraglandular botulinum neurotoxin in the submandibular glands. The reduction of drooling was related to increased social contacts with peers. In addition, parents perceived that the impact of drooling on the level of the child's satisfaction on physical appearance, relations within the extended family, and life in general increased. Although medication led to (temporary) positive changes, many social and emotional consequences remained unchanged. Interventions to treat drooling should not only be evaluated using measurements of drooling, but the consequences on social interaction and self-esteem should also be assessed.
Developmental Medicine & Child Neurology, 2010
AIM Botulinum neurotoxin type A (BoNT-A) has been described as an effective intervention for droo... more AIM Botulinum neurotoxin type A (BoNT-A) has been described as an effective intervention for drooling and is being increasingly adopted. However, its effectiveness compared with established treatments is still unknown. We undertook a within-participants observational study to examine this.
PEDIATRICS, 2004
To investigate the clinical effectiveness of botulinum neurotoxin type A (BoNT) to reduce droolin... more To investigate the clinical effectiveness of botulinum neurotoxin type A (BoNT) to reduce drooling in children with cerebral palsy (CP). A controlled clinical trial was performed in which the results of single-dose BoNT injections in the submandibular glands were compared with treatment with scopolamine. Forty-five children who had CP and experienced severe drooling were enrolled. Drooling severity was measured at baseline, during application of scopolamine, and at different intervals after BoNT injections up to 24 weeks, using the Drooling Quotient (DQ), the Teacher Drooling Scale (TDS), and Visual Analog Scales (VAS). Drooling was reduced during scopolamine application as well as after BoNT injections. Compared with baseline, the mean DQ showed a significant decrease throughout the study. Greatest reductions were achieved 2 to 8 weeks after BoNT injection. No significant differences were found between scopolamine measurements and those up to 24 months after BoNT injection. Using VAS, parents recorded the effect on drooling in which significant differences were found between baseline VAS score and all follow-up assessments. According to our definition of "success to therapy," demanding a 2-point decrease on the TDS, 61.5% of patients responded to BoNT injections. Analysis of the DQ demonstrated a response rate of 53% of the patients to scopolamine and 48.7% to BoNT until 24 weeks after BoNT injections, the actual duration of this study. As a reaction to scopolamine, 71.1% of the patients had moderate to severe side effects. Only nonsevere, incidental side effects were reported after BoNT injections. During scopolamine application as well as after intraglandular BoNT injections, a clinically relevant reduction in drooling was achieved in children with CP, demonstrating maximum effect 2 to 8 weeks after injections. This is the first controlled clinical trial that confirmed a significant effect of BoNT injections in the treatment of drooling. General anesthesia was needed for all children. BoNT injections show fewer and less serious side effects than transdermal scopolamine treatment.
Neurology, 2004
OBJECTIVE: To investigate the effectiveness of botulinum neurotoxin (BoNT) type A in reducing sal... more OBJECTIVE: To investigate the effectiveness of botulinum neurotoxin (BoNT) type A in reducing salivary flow rate in children with cerebral palsy (CP) with severe drooling. METHODS: During a controlled clinical trial, single-dose BoNT injections into the submandibular salivary glands were compared with scopolamine treatment. Forty-five school-aged children were included. Salivary flow rates from all major glands were obtained at baseline
Developmental Medicine & Child Neurology, 2010
AIM The aim of this study was to evaluate the rheological properties of saliva after submandibula... more AIM The aim of this study was to evaluate the rheological properties of saliva after submandibular botulinum toxin type A (BoNT-A) injections.
Developmental Medicine & Child Neurology, 2006
The purpose of this study was to investigate the effect of salivary flow reduction on daily life ... more The purpose of this study was to investigate the effect of salivary flow reduction on daily life and provision of care in children with cerebral palsy (CP). Parents of children with CP were asked to fill in a questionnaire on the impact of drooling on the daily life of their children and their families and the data were then analyzed. Forty-five children with severe drooling (28 males, 17 females; mean age 9y 5mo [SD 3y 7mo]; range 3 to 16y) were monitored before and after receiving medication (scopolamine and botulinum toxin) to reduce salivary flow. Type of CP included hypotonia (n = 1), spastic paresis (n = 27), and mixed motor disorders with spastic and dyskinetic paresis (n = 17). Eight children were independently ambulant and 37 children were wheelchair users. Thirty-four children had learning disability with a developmental age of below 6 years. Six participants dropped out of the study; data on 39 children were analyzed. Results showed that anticholinergic agents effectively reduced salivary flow. Drooling diminished substantially and this was accompanied by a significant reduction in care needs, making daily care less demanding. The amount of reported damage to communication devices and computers decreased. In addition to the evaluation of primary variables, such as the salivary flow rate, investigation of impact of drooling on daily life provides useful information about the outcome of treatment for reduction in drooling.
Pediatric Neurology, 2011
PLoS ONE, 2014
Background: In Western Europe, low back pain has the greatest burden of all diseases. When back p... more Background: In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP).
Sports Medicine - Open, 2015
Background: Trunk impairment seems to impact significantly on performance in wheelchair court spo... more Background: Trunk impairment seems to impact significantly on performance in wheelchair court sports, but evidence to support this impression has never been systematically assessed. The objective of this study is to systematically review, describe and synthesise the literature investigating the impact of trunk impairment on wheelchair activities in court sports.
Archives of Physical Medicine and Rehabilitation, 1998
Ribbers GM, Oosterhuis WP, van Limbeek J, de Metz M. Reflex sympathetic dystrophy: is the immune ... more Ribbers GM, Oosterhuis WP, van Limbeek J, de Metz M. Reflex sympathetic dystrophy: is the immune system involved? Arch Phys Med Rehabil 1998;79: 1549-52.
European Spine Journal, 2010
Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results ... more Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen's d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes.
Journal of Substance Abuse Treatment, 1992
We thank the treatment staff of the Bouman Foundation at Rotterdam and the Centrum Zeestraat at T... more We thank the treatment staff of the Bouman Foundation at Rotterdam and the Centrum Zeestraat at The Hague for their cooperation in the research efforts and the management staff for their help in performing the research. We also thank W. Edelbroek for her research assistance.
Journal of Personality Disorders, 2014
A renewed interest in identity as one of the core markers of personality disorders has been intro... more A renewed interest in identity as one of the core markers of personality disorders has been introduced by the DSM-5 Level of Personality Functioning Scale. However, little is known about the utility of the construct of identity in children and adolescents. This study aimed to broaden the knowledge of identity integration as a core component of personality functioning in adolescents. The authors investigated levels of identity integration, as measured by the Severity Indices of Personality Problems (SIPP-118; Verheul et al., 2008), in adolescents in both normal (n = 406) and clinical populations (n = 285). Furthermore, changes in levels of identity integration during treatment were investigated in a clinical subsample (n = 76). Levels of identity integration were not associated with age. They were, however, associated with the absence or presence of personality pathology. Most adolescents receiving inpatient psychotherapy gradually changed toward more healthy levels of identity integration; a significant number, however, remained at maladaptive levels of identity functioning after intensive psychotherapy.
Psychological Medicine
The Center for Epidemiologic Studies Depression scale (CES-D) has been widely used in stu... more The Center for Epidemiologic Studies Depression scale (CES-D) has been widely used in studies of late-life depression. Psychometric properties are generally favourable, but data on the criterion validity of the CES-D in elderly community-based samples are lacking. In a sample of older (55-85 years) inhabitants of the Netherlands, 487 subjects were selected to study criterion validity of the CES-D. Using the 1-month prevalence of major depression derived from the Diagnostic Interview Schedule (DIS) as criterion, the weighted sensitivity of the CES-D was 100 % ; specificity 88 % ; and positive predictive value 13n2 %. False positives were not more likely among elderly with physical illness, cognitive decline or anxiety. We conclude that the criterion validity of the CES-D for major depression was very satisfactory in this sample of older adults.
Lancet, 2005
Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Se... more Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.
Physiology & Behavior, 2015
The aim of this study was to determine the measurement reproducibility for a procedure evaluating... more The aim of this study was to determine the measurement reproducibility for a procedure evaluating the mastication process and to estimate the smallest detectable differences of 3D kinematic and surface electromyography (sEMG) variables. Kinematics of mandible movements and sEMG activity of the masticatory muscles were obtained over two sessions with four conditions: two food textures (biscuit and bread) of two sizes (small and large). Twelve healthy adults (mean age 29.1years) completed the study. The second to the fifth chewing cycle of 5 bites were used for analyses. The reproducibility per outcome variable was calculated with an intraclass correlation coefficient (ICC) and a Bland-Altman analysis was applied to determine the standard error of measurement relative error of measurement and smallest detectable differences of all variables. ICCs ranged from 0.71 to 0.98 for all outcome variables. The outcome variables consisted of four bite and fourteen chewing cycle variables. The relative standard error of measurement of the bite variables was up to 17.3% for 'time-to-swallow', 'time-to-transport' and 'number of chewing cycles', but ranged from 31.5% to 57.0% for 'change of chewing side'. The relative standard error of measurement ranged from 4.1% to 24.7% for chewing cycle variables and was smaller for kinematic variables than sEMG variables. In general, measurements obtained with 3D kinematics and sEMG are reproducible techniques to assess the mastication process. The duration of the chewing cycle and frequency of chewing were the best reproducible measurements. Change of chewing side could not be reproduced. The published measurement error and smallest detectable differences will aid the interpretation of the results of future clinical studies using the same study variables.
Journal of Epidemiology and Biostatistics
It is generally believed that dental caries is an infectious disease. The occurrence of dental ca... more It is generally believed that dental caries is an infectious disease. The occurrence of dental caries is affected by a variety of determinants. In order to estimate the precise extent of the relation between specific determinants and the outcome phenomenon (i.e. the occurrence of dental caries), a coherent disease model is required. This model should also permit multivariate analysis to control for confounders and interactions. Only with such a disease model will it be possible to investigate the relation between the occurrence of a determinant and dental caries, and to estimate the extent of this relation. The known causal models for the explanation of dental caries do not fully meet these requirements. Rothman's 'sufficient cause' model has been used as a starting point for the development of a new coherent disease model, to explain the occurrence of dental caries and allow multivariate analysis. The sufficient cause for dental caries comprises three component causes: sufficient microorganisms with cariogenic potential, easily fermentable carbohydrates and teeth. Whether dental caries actually occurs also depends on the influence of independent risk factors that interact with the component causes in a protective, as well as in a risk-increasing manner. These independent risk factors are saliva, fluoride, oral hygiene and diet. The 'sufficient cause' model for dental caries is a biological model in which distinction between protective and risk-increasing factors has been made, and interaction between factors has been described. With this model, it will now be possible to assess the extent of the relationship between a determinant and dental caries (the outcome phenomenon) using multivariate techniques.
The authors have conducted a prospective cohort study of the efficacy of a 7 days administration ... more The authors have conducted a prospective cohort study of the efficacy of a 7 days administration of Indomethacin (n = 89) versus Meloxicam (n = 92), in the prophylaxis of heterotopic ossification (HO) in primary total hip arthroplasty. To assess the interobserver variability of the Brooker classification, all radiographs were evaluated by three investigators. In the Indomethacin group 25 patients developed HO (grade I : 22 , grade III : 2 and grade IV : 1). In the Meloxicam group 34 developed HO (grade I : 30, grade II : 1 and grade III : 3). We were not able to show any difference between Indomethacin and Meloxicam in preventing heterotopic ossification after primary hip arthroplasty. We found a high interobserver variability in the grading system according to Brooker, in particular for the higher grades(grade II, III and IV).
Research in Developmental Disabilities, 2014
The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective asse... more The Mastication Observation and Evaluation (MOE) instrument was developed to allow objective assessment of a child's mastication process. It contains 14 items and was developed over three Delphi rounds. The present study concerns the further development of the MOE using the COSMIN (Consensus based Standard for the Selection of Measurement Instruments) and investigated the instrument's internal consistency, inter-observer reliability, construct validity and floor and ceiling effects. Consumption of three bites of bread and biscuit was evaluated using the MOE. Data of 59 healthy children (6-48 mths) and 38 children (bread) and 37 children (biscuit) with cerebral palsy (24-72 mths) were used.
Journal of Clinical Neurophysiology, 2003
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Papers by Jacques van Limbeek