Standing Committee Chairmen, Task Officers and Consultants: A full list of Standing Committee Cha... more Standing Committee Chairmen, Task Officers and Consultants: A full list of Standing Committee Chairman, Task Officers and Consultants will appear in the next issue of the Journal.
Contents Editorial 187 Obituary 188 The relationship between prosthetics and orthotics services a... more Contents Editorial 187 Obituary 188 The relationship between prosthetics and orthotics services and community-based rehabilitation 189 Factors affecting wound healing after major amputation for vascular disease: a review 195 M. ENEROTH Relative mortality and long term survival for the non-diabetic lower limb amputee with 209 vascular insufficiency B. EBSKOV Editorial The International Society for Prosthetics and Orthotics now has approximately 3000 members from more than 80 countries and has 33 National Member Societies. Through its activities such as congresses, conferences, seminars and courses it brings people from different economic and cultural backgrounds together where experiences and problems can be shared and openly discussed. Through the Society's consensus conferences different aspects of prosthetics and orthotics have resulted in promoting good practice through publications and courses. The Society is presently running a series of courses in different parts of the wo...
Archives of Physical Medicine and Rehabilitation, 2012
Three-year follow-up results of a residential community reintegration program for patients with c... more Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury.
Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinc... more Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study
The objective of this study was to examine the intervention costs of a residential community rein... more The objective of this study was to examine the intervention costs of a residential community reintegration programme for patients with acquired brain injury and to compare the societal costs before and after treatment. Methods: A cost-analysis was performed identifying costs of healthcare, informal care, and productivity losses. The costs in the year before the Brain Integration Programme (BIP) were compared with the costs in the year after the BIP using the following cost categories: care consumption, caregiver support, productivity losses. Dutch guidelines were used for cost valuation. Results: Thirty-three cases participated (72% response). Mean age was 29.8 years, 59% traumatic brain injury. The BIP costs were €68,400. The informal care and productivity losses reduced significantly after BIP (p < 0.05), while healthcare consumption increased significantly (p < 0.05). The societal costs per patient were €48,449. After BIP these costs were €39,773; a significant reduction (p < 0.05). Assuming a stable situation the break-even point is after 8 years. Conclusion: The reduction in societal costs after the BIP advocates the allocation of resources and, from an economic perspective, favours reimbursement of the BIP costs by healthcare insurance companies. However, this cost-analysis is limited as it does not relate costs to clinical effectiveness.
The objective of this study was to examine the intervention costs of a residential community rein... more The objective of this study was to examine the intervention costs of a residential community reintegration programme for patients with acquired brain injury and to compare the societal costs before and after treatment. Methods: A cost-analysis was performed identifying costs of healthcare, informal care, and productivity losses. The costs in the year before the Brain Integration Programme (BIP) were compared with the costs in the year after the BIP using the following cost categories: care consumption, caregiver support, productivity losses. Dutch guidelines were used for cost valuation. Results: Thirty-three cases participated (72% response). Mean age was 29.8 years, 59% traumatic brain injury. The BIP costs were €68,400. The informal care and productivity losses reduced significantly after BIP (p < 0.05), while healthcare consumption increased significantly (p < 0.05). The societal costs per patient were €48,449. After BIP these costs were €39,773; a significant reduction (p < 0.05). Assuming a stable situation the break-even point is after 8 years. Conclusion: The reduction in societal costs after the BIP advocates the allocation of resources and, from an economic perspective, favours reimbursement of the BIP costs by healthcare insurance companies. However, this cost-analysis is limited as it does not relate costs to clinical effectiveness.
Introduction Ecstasy is a commonly used party drug and is the second most popular drug after mari... more Introduction Ecstasy is a commonly used party drug and is the second most popular drug after marijuana among youngsters. Serious health hazards have been described including cardiac diseases, neurological complications, multi-organ failure, and even death. Spinal cord injury/dysfunction (SCI/D) is rarely described as a result of ecstasy ingestion. Case presentation We present a case of a 19-year-old male patient who was admitted to our rehabilitation center, after developing a T11 AIS B SCI/D following recreational use of ecstasy. Discussion In our case magnetic resonance imaging was inconclusive due to artifacts caused by metallic rods used for surgical scoliosis treatment in the past. This individual received no surgical or pharmacological treatments; however, it is questionable whether any specific treatments would have been beneficial. Ecstasy ingestion leads to a serotonin surge and induces microvascular changes. Neurovascular hemorrhage, subarachnoid hemorrhage, de novo aneurysm formation, and subsequent rupture can occur. 5-hydroxytryptamine, which comes from serotonergic terminals, is a very potent vasoconstrictive amine and can thus lead to prolonged vasoconstriction and ischemia. It is most likely that the SCI/D in our case is the result of an ischemic event following the vasoconstrictive effects of ecstasy ingestion. It is important to stress the possible consequences of recreational ecstasy usage and in unexplained SCI/D, one should consider the possibility of drug-related causes.
Archives of Physical Medicine and Rehabilitation, May 1, 2011
Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to... more Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to evaluate a residential community reintegration program for patients with chronic acquired brain injury. Arch Phys Med Rehabil 2011;92:696-704. Objective: To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design: A prospective cohort study with a 3-month waiting list control period and 1-year follow up. Setting: A tertiary rehabilitation center for acquired brain injury. Participants: Patients (Nϭ70) with acquired brain injury (46 men; mean age, 25.1y; mean time postonset, 5.2y; at follow up nϭ67). Intervention: A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures: Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale. Results: There was an overall significant time effect for all outcome measures (multiple analysis of variance T 2 ϭ26.16; F 36,557 134.9; Pϭ.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial 2 ϭ0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial 2 ϭ0.11-0.20). The WHO-QOL-BREF environment subscale showed a small effect size (partial 2 ϭ0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. Conclusions: This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.
We report three patients who developed transient constipation after receiving therapeutic doses o... more We report three patients who developed transient constipation after receiving therapeutic doses of Botulinum Toxin-A (BTX-A) for spasticity of the lower limbs (two cases) and the upper limb (one case). Constipation was observed within the first week after treatment. In all three cases, this symptom resolved completely almost simultaneously with disappearance of the therapeutic effects of BTX-A on mobility. None of the patients had previously received BTX-A injections. Two patients received a second treatment and both presented the same autonomic cholinergic remote symptoms. The third patient refused a second treatment due to the complication noted earlier. Familiarity with this autonomic systemic side effect of BTX-A is essential for those who treat patients already at risk for gastro-intestinal dysfunction. Because the adverse effects were treatable and transitory, we believe that constipation per se is not an absolute contra-indication, if from a therapeutic point of view view, BTX-A is indicated.
Two patients are described who developed heterotopic ossification after a minor trauma. The clini... more Two patients are described who developed heterotopic ossification after a minor trauma. The clinical symptoms, pathophysiology and treatment are discussed. We conclude that disabilities and handicaps will be limited by rehabilitation, which includes training of still available functions, and compensation for the lost functions by offering adaptive equipment and adjusting the circumstances. The treatment of patients with heterotopic ossification requires a multidisciplinary approach.
Nederlands tijdschrift voor geneeskunde, Jan 2, 1991
Two patients are described who developed heterotopic ossification after a minor trauma. The clini... more Two patients are described who developed heterotopic ossification after a minor trauma. The clinical symptoms, pathophysiology and treatment are discussed. We conclude that disabilities and handicaps will be limited by rehabilitation, which includes training of still available functions, and compensation for the lost functions by offering adaptive equipment and adjusting the circumstances. The treatment of patients with heterotopic ossification requires a multidisciplinary approach.
Journal of Experimental and Clinical Medicine, 2009
We report three patients who developed transient constipation after receiving therapeutic doses o... more We report three patients who developed transient constipation after receiving therapeutic doses of Botulinum Toxin-A (BTX-A) for spasticity of the lower limbs (two cases) and the upper limb (one case). Constipation was observed within the first week after treatment. In all three cases, this symptom resolved completely almost simultaneously with disappearance of the therapeutic effects of BTX-A on mobility. None of the patients had previously received BTX-A injections. Two patients received a second treatment and both presented the same autonomic cholinergic remote symptoms. The third patient refused a second treatment due to the complication noted earlier. Familiarity with this autonomic systemic side effect of BTX-A is essential for those who treat patients already at risk for gastro-intestinal dysfunction. Because the adverse effects were treatable and transitory, we believe that constipation per se is not an absolute contra-indication, if from a therapeutic point of view view, BTX-A is indicated.
Abstract Niet-aangeboren hersenletsel leidt tot een breed scala aan beperkingen. Veel patiënten ... more Abstract Niet-aangeboren hersenletsel leidt tot een breed scala aan beperkingen. Veel patiënten lopen gaandeweg het leven vast, ook al zijn sommigen aanvankelijk wel in revalidatiebehandeling geweest. Een uitgebreide en gedegen behandeling gericht op afstemming van alle levensgebieden kan dan noodzakelijk zijn. Het Brain-Integration-programma biedt dit. Dit programma draagt vaak bij aan het verbeteren van het welbevinden en het sociaal-maatschappelijk functioneren van
Standing Committee Chairmen, Task Officers and Consultants: A full list of Standing Committee Cha... more Standing Committee Chairmen, Task Officers and Consultants: A full list of Standing Committee Chairman, Task Officers and Consultants will appear in the next issue of the Journal.
Contents Editorial 187 Obituary 188 The relationship between prosthetics and orthotics services a... more Contents Editorial 187 Obituary 188 The relationship between prosthetics and orthotics services and community-based rehabilitation 189 Factors affecting wound healing after major amputation for vascular disease: a review 195 M. ENEROTH Relative mortality and long term survival for the non-diabetic lower limb amputee with 209 vascular insufficiency B. EBSKOV Editorial The International Society for Prosthetics and Orthotics now has approximately 3000 members from more than 80 countries and has 33 National Member Societies. Through its activities such as congresses, conferences, seminars and courses it brings people from different economic and cultural backgrounds together where experiences and problems can be shared and openly discussed. Through the Society's consensus conferences different aspects of prosthetics and orthotics have resulted in promoting good practice through publications and courses. The Society is presently running a series of courses in different parts of the wo...
Archives of Physical Medicine and Rehabilitation, 2012
Three-year follow-up results of a residential community reintegration program for patients with c... more Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury.
Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinc... more Markedly impaired bilateral coordination of gait in post-stroke patients: Is this deficit distinct from asymmetry? A cohort study
The objective of this study was to examine the intervention costs of a residential community rein... more The objective of this study was to examine the intervention costs of a residential community reintegration programme for patients with acquired brain injury and to compare the societal costs before and after treatment. Methods: A cost-analysis was performed identifying costs of healthcare, informal care, and productivity losses. The costs in the year before the Brain Integration Programme (BIP) were compared with the costs in the year after the BIP using the following cost categories: care consumption, caregiver support, productivity losses. Dutch guidelines were used for cost valuation. Results: Thirty-three cases participated (72% response). Mean age was 29.8 years, 59% traumatic brain injury. The BIP costs were €68,400. The informal care and productivity losses reduced significantly after BIP (p < 0.05), while healthcare consumption increased significantly (p < 0.05). The societal costs per patient were €48,449. After BIP these costs were €39,773; a significant reduction (p < 0.05). Assuming a stable situation the break-even point is after 8 years. Conclusion: The reduction in societal costs after the BIP advocates the allocation of resources and, from an economic perspective, favours reimbursement of the BIP costs by healthcare insurance companies. However, this cost-analysis is limited as it does not relate costs to clinical effectiveness.
The objective of this study was to examine the intervention costs of a residential community rein... more The objective of this study was to examine the intervention costs of a residential community reintegration programme for patients with acquired brain injury and to compare the societal costs before and after treatment. Methods: A cost-analysis was performed identifying costs of healthcare, informal care, and productivity losses. The costs in the year before the Brain Integration Programme (BIP) were compared with the costs in the year after the BIP using the following cost categories: care consumption, caregiver support, productivity losses. Dutch guidelines were used for cost valuation. Results: Thirty-three cases participated (72% response). Mean age was 29.8 years, 59% traumatic brain injury. The BIP costs were €68,400. The informal care and productivity losses reduced significantly after BIP (p < 0.05), while healthcare consumption increased significantly (p < 0.05). The societal costs per patient were €48,449. After BIP these costs were €39,773; a significant reduction (p < 0.05). Assuming a stable situation the break-even point is after 8 years. Conclusion: The reduction in societal costs after the BIP advocates the allocation of resources and, from an economic perspective, favours reimbursement of the BIP costs by healthcare insurance companies. However, this cost-analysis is limited as it does not relate costs to clinical effectiveness.
Introduction Ecstasy is a commonly used party drug and is the second most popular drug after mari... more Introduction Ecstasy is a commonly used party drug and is the second most popular drug after marijuana among youngsters. Serious health hazards have been described including cardiac diseases, neurological complications, multi-organ failure, and even death. Spinal cord injury/dysfunction (SCI/D) is rarely described as a result of ecstasy ingestion. Case presentation We present a case of a 19-year-old male patient who was admitted to our rehabilitation center, after developing a T11 AIS B SCI/D following recreational use of ecstasy. Discussion In our case magnetic resonance imaging was inconclusive due to artifacts caused by metallic rods used for surgical scoliosis treatment in the past. This individual received no surgical or pharmacological treatments; however, it is questionable whether any specific treatments would have been beneficial. Ecstasy ingestion leads to a serotonin surge and induces microvascular changes. Neurovascular hemorrhage, subarachnoid hemorrhage, de novo aneurysm formation, and subsequent rupture can occur. 5-hydroxytryptamine, which comes from serotonergic terminals, is a very potent vasoconstrictive amine and can thus lead to prolonged vasoconstriction and ischemia. It is most likely that the SCI/D in our case is the result of an ischemic event following the vasoconstrictive effects of ecstasy ingestion. It is important to stress the possible consequences of recreational ecstasy usage and in unexplained SCI/D, one should consider the possibility of drug-related causes.
Archives of Physical Medicine and Rehabilitation, May 1, 2011
Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to... more Geurtsen GJ, van Heugten CM, Martina JD, Rietveld AC, Meijer R, Geurts AC. A prospective study to evaluate a residential community reintegration program for patients with chronic acquired brain injury. Arch Phys Med Rehabil 2011;92:696-704. Objective: To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Design: A prospective cohort study with a 3-month waiting list control period and 1-year follow up. Setting: A tertiary rehabilitation center for acquired brain injury. Participants: Patients (Nϭ70) with acquired brain injury (46 men; mean age, 25.1y; mean time postonset, 5.2y; at follow up nϭ67). Intervention: A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions. Main Outcome Measures: Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale. Results: There was an overall significant time effect for all outcome measures (multiple analysis of variance T 2 ϭ26.16; F 36,557 134.9; Pϭ.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial 2 ϭ0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial 2 ϭ0.11-0.20). The WHO-QOL-BREF environment subscale showed a small effect size (partial 2 ϭ0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. Conclusions: This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation.
We report three patients who developed transient constipation after receiving therapeutic doses o... more We report three patients who developed transient constipation after receiving therapeutic doses of Botulinum Toxin-A (BTX-A) for spasticity of the lower limbs (two cases) and the upper limb (one case). Constipation was observed within the first week after treatment. In all three cases, this symptom resolved completely almost simultaneously with disappearance of the therapeutic effects of BTX-A on mobility. None of the patients had previously received BTX-A injections. Two patients received a second treatment and both presented the same autonomic cholinergic remote symptoms. The third patient refused a second treatment due to the complication noted earlier. Familiarity with this autonomic systemic side effect of BTX-A is essential for those who treat patients already at risk for gastro-intestinal dysfunction. Because the adverse effects were treatable and transitory, we believe that constipation per se is not an absolute contra-indication, if from a therapeutic point of view view, BTX-A is indicated.
Two patients are described who developed heterotopic ossification after a minor trauma. The clini... more Two patients are described who developed heterotopic ossification after a minor trauma. The clinical symptoms, pathophysiology and treatment are discussed. We conclude that disabilities and handicaps will be limited by rehabilitation, which includes training of still available functions, and compensation for the lost functions by offering adaptive equipment and adjusting the circumstances. The treatment of patients with heterotopic ossification requires a multidisciplinary approach.
Nederlands tijdschrift voor geneeskunde, Jan 2, 1991
Two patients are described who developed heterotopic ossification after a minor trauma. The clini... more Two patients are described who developed heterotopic ossification after a minor trauma. The clinical symptoms, pathophysiology and treatment are discussed. We conclude that disabilities and handicaps will be limited by rehabilitation, which includes training of still available functions, and compensation for the lost functions by offering adaptive equipment and adjusting the circumstances. The treatment of patients with heterotopic ossification requires a multidisciplinary approach.
Journal of Experimental and Clinical Medicine, 2009
We report three patients who developed transient constipation after receiving therapeutic doses o... more We report three patients who developed transient constipation after receiving therapeutic doses of Botulinum Toxin-A (BTX-A) for spasticity of the lower limbs (two cases) and the upper limb (one case). Constipation was observed within the first week after treatment. In all three cases, this symptom resolved completely almost simultaneously with disappearance of the therapeutic effects of BTX-A on mobility. None of the patients had previously received BTX-A injections. Two patients received a second treatment and both presented the same autonomic cholinergic remote symptoms. The third patient refused a second treatment due to the complication noted earlier. Familiarity with this autonomic systemic side effect of BTX-A is essential for those who treat patients already at risk for gastro-intestinal dysfunction. Because the adverse effects were treatable and transitory, we believe that constipation per se is not an absolute contra-indication, if from a therapeutic point of view view, BTX-A is indicated.
Abstract Niet-aangeboren hersenletsel leidt tot een breed scala aan beperkingen. Veel patiënten ... more Abstract Niet-aangeboren hersenletsel leidt tot een breed scala aan beperkingen. Veel patiënten lopen gaandeweg het leven vast, ook al zijn sommigen aanvankelijk wel in revalidatiebehandeling geweest. Een uitgebreide en gedegen behandeling gericht op afstemming van alle levensgebieden kan dan noodzakelijk zijn. Het Brain-Integration-programma biedt dit. Dit programma draagt vaak bij aan het verbeteren van het welbevinden en het sociaal-maatschappelijk functioneren van
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