An online self-care education program to support patients after total laryngectomy: feasibility and satisfaction.

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An online self-care education program to support patients after total laryngectomy: feasibility and satisfaction.

Support Care Cancer. 2015 Aug 26;

Authors: Cnossen IC, van Uden-Kraan CF, Eerenstein SE, Jansen F, Witte BI, Lacko M, Hardillo JA, Honings J, Halmos GB, Goedhart-Schwandt NL, de Bree R, Leemans CR, Leeuw IM

Abstract

PURPOSE: The purpose of this study was to investigate the feasibility of an online self-care education program supporting early rehabilitation of patients after total laryngectomy (TLPs) and factors associated with satisfaction.

METHODS: Health care professionals (HCPs) were invited to participate and to recruit TLPs. TLPs were informed on the self-care education program “In Tune without Cords” (ITwC) after which they gained access. A study specific survey was used (at baseline T0 and postintervention T1) on TLPs’ uptake. Usage, satisfaction (general impression, willingness to use, user-friendliness, satisfaction with self-care advice and strategies, Net Promoter Score (NPS)), sociodemographic, and clinical factors were analyzed.

RESULTS: HCPs of 6 out of 9 centers (67 % uptake rate) agreed to participate and recruited TLPs. In total, 55 of 75 TLPs returned informed consent and the baseline T0 survey and were provided access to ITwC (73 % uptake rate). Thirty-eight of these 55 TLPs used ITwC and completed the T1 survey (69 % usage rate). Most (66 %) TLPs were satisfied (i.e., score ≥7 (scale 1-10) on 4 survey items) with the self-care education program (mean score 7.2, SD 1.1). NPS was positive (+5). Satisfaction with the self-care education program was significantly associated with (higher) educational level and health literacy skills (P = .004, P = .038, respectively). No significant association was found with gender, age, marital status, employment status, Internet use, Internet literacy, treatment modality, time since total laryngectomy, and quality of life.

CONCLUSION: The online self-care education program ITwC supporting early rehabilitation was feasible in clinical practice. In general, TLPs were satisfied with the program.

PMID: 26306518 [PubMed – as supplied by publisher]

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The Koolen-de Vries syndrome: a phenotypic comparison of patients with a 17q21.31 microdeletion versus a KANSL1 sequence variant.

The Koolen-de Vries syndrome: a phenotypic comparison of patients with a 17q21.31 microdeletion versus a KANSL1 sequence variant.

Eur J Hum Genet. 2015 Aug 26;

Authors: Koolen DA, Pfundt R, Linda K, Beunders G, Veenstra-Knol HE, Conta JH, Fortuna AM, Gillessen-Kaesbach G, Dugan S, Halbach S, Abdul-Rahman OA, Winesett HM, Chung WK, Dalton M, Dimova PS, Mattina T, Prescott K, Zhang HZ, Saal HM, Hehir-Kwa JY, Willemsen MH, Ockeloen CW, Jongmans MC, Van der Aa N, Failla P, Barone C, Avola E, Brooks AS, Kant SG, Gerkes EH, Firth HV, Õunap K, Bird LM, Masser-Frye D, Friedman JR, Sokunbi MA, Dixit A, Splitt M, DDD Study, Kukolich MK, McGaughran J, Coe BP, Flórez J, Nadif Kasri N, Brunner HG, Thompson EM, Gecz J, Romano C, Eichler EE, de Vries BB

Abstract

The Koolen-de Vries syndrome (KdVS; OMIM #610443), also known as the 17q21.31 microdeletion syndrome, is a clinically heterogeneous disorder characterised by (neonatal) hypotonia, developmental delay, moderate intellectual disability, and characteristic facial dysmorphism. Expressive language development is particularly impaired compared with receptive language or motor skills. Other frequently reported features include social and friendly behaviour, epilepsy, musculoskeletal anomalies, congenital heart defects, urogenital malformations, and ectodermal anomalies. The syndrome is caused by a truncating variant in the KAT8 regulatory NSL complex unit 1 (KANSL1) gene or by a 17q21.31 microdeletion encompassing KANSL1. Herein we describe a novel cohort of 45 individuals with KdVS of whom 33 have a 17q21.31 microdeletion and 12 a single-nucleotide variant (SNV) in KANSL1 (19 males, 26 females; age range 7 months to 50 years). We provide guidance about the potential pitfalls in the laboratory testing and emphasise the challenges of KANSL1 variant calling and DNA copy number analysis in the complex 17q21.31 region. Moreover, we present detailed phenotypic information, including neuropsychological features, that contribute to the broad phenotypic spectrum of the syndrome. Comparison of the phenotype of both the microdeletion and SNV patients does not show differences of clinical importance, stressing that haploinsufficiency of KANSL1 is sufficient to cause the full KdVS phenotype.European Journal of Human Genetics advance online publication, 26 August 2015; doi:10.1038/ejhg.2015.178.

PMID: 26306646 [PubMed – as supplied by publisher]

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Supramolecular Chemistry … and Beyond.

Supramolecular Chemistry … and Beyond.

Angew Chem Int Ed Engl. 2015 Aug 26;

Authors: Hirsch AK

Abstract

The research group of Jean-Marie Lehn recently celebrated its 50th anniversary. Lehn, who shared the Nobel Prize in Chemistry 1987 with Donald J. Cram and Charles J. Pedersen, has been active in many initiatives in the European chemical community, and was instrumental in the founding of Chemistry-A European Journal and ChemBioChem. This Meeting Report summarizes the symposium that was recently held to commemorate the achievements of the Lehn group.

PMID: 26306880 [PubMed – as supplied by publisher]

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The ability of general movements to predict motor function at school age in healthy, term born children.

Background
General movement in infants predict neurological outcome, in particular cerebral palsy
(CP). During this period, the motor repertoire also consists of a large variety of other movements and
postural patterns, the so-called concurrent motor repertoire. Besides detecting CP, these movement
have some predictive value for MND. Most of the previous studies have investigated preterm and term
born high-risk children. Little is known about the development of movement patterns and their
predictive value in healthy term born children at school age.
Aims
To investigate the relation between the early motor repertoire at the age of 3 months post term
and motor function at school age in healthy, term born children.
Method
All children (n=88) who were videotaped between 9 and 16 weeks post term age (mean age
13.1 (+/- 1.85) weeks) in the University Medical Centre Groningen were invited at school age to
participate in an extensive follow-up program. The follow up group (n=65) had a mean age of 6.0 ( +/-
0.49) years and 63o/o were boys. The relation of the FMs and the concurrent motor repertoire with the
outcomes of theM-ABC and the DCD-Q was analyzed.
Results and conclusions
Our data suggests that in healthy term born children, the motor function at
school age is associated with the early motor repertoire at 3 months, this concerns especially the
quality and to some extent the temporal organization of the FMs, individual postural patterns,
predominant fisting and the quality of the concurrent motor repertoire.

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Relationship between motor skill performance and executive functioning in elementary school children with Pervasive Developmental Disorder Not Otherwise Specified.

This study had two aims. The first aim was to investigate motor skills in children diagnosed with PDDNOS.
The second aim was to examine the relationship between motor performance and executive
functioning (EF) in children with PDD-NOS. Fifty-three children with PDD-NOS, ages 7-12 years,
participated; 39 were boys and 14 were girls. The Movement ABC was used to assess motor skills and
included measures of manual dexterity, ball skills and balance skills. Executive functioning was measured
with the Tower Of London-test {TOL), which assessed planning in terms of problem solving. Children had
more motor problems compared to the norm, on manual dexterity, ball skills, balance skills and the total
movement ABC. A relationship between ball skill performance and problem solving was found. The
present study highlights the importance of supporting children with PDD-NOS in their motor development.

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Influence of Optical Acceleration on Initiation Times in Catching Fly Balls.

A specifying variable that indicates the relation between optical information and movement can contribute
to the search for the use of direct perception. In catching fly balls optical acceleration (OA), as
described by Chapman (1968), is seen as a possible specifying variable. Apart from that it is possible
to make a distinction between acceleration and deceleration, the use of OA is not proven. It is unclear
what variable and what corresponding threshold value is used and therefore it is necessary to analyze
a pattern in OA. This study was designed to show the use of OA by comparing this pattern in OA with
the pattern in initiation times. The first experiment was found to be necessary to improve the experimental
setup for catching in the virtual environment. In the second experiment, a qualitative comparison
of the patterns largely agreed for balls landing in front. This especially counted for trajectories were
the change in OA was based on the height of the ball trajectory. During the experiments, participants
had the tendency to move backwards regardless of the landing location of the ball. This caused such a
distortion in the initiation times for the balls landing behind, that these initiation times became useless
for the qualitative comparison. Thus, in the qualitative comparison of the second experiment the use of
OA as a specifying variable, in catching fly balls that landed in front, seems to be present.

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Physical activity and psychopathology in anorexia nervosa and bulimia nervosa.

Background:
Excessive physical activity plays a complex role in the development and maintenance
of Anorexia Nervosa (AN) and Bulimia Nervosa (BN).
Objective:
To objectively quantify and examine physical activity in AN and BN patients and to
examine the association between physical activity and the psychopathological features obsessivecompulsiveness,
anxiety, depression, weight preoccupation and body attitude in AN and BN patients.
Method:
Twenty-six female AN patients and thirteen female BN patients, admitted to an inpatient
treatment unit, wore an RT3 accelerometer during seven days and completed questionnaires about
physical activity (SQUASH) and psychopathological features (SCL-90-R, BDI, EDI and BAT).
Results:
There was no significant difference in physical activity between AN and BN patients (p=O.ll)
and the ICC between the seven days was 0.65 (95%CI=0.50-0.79) in AN and 0.85 (95%CI=0.73-0.94)
in BN. Physical activity, measured with the accelerometer, was positively correlated with depression
in AN patients (r=0.45; p=0.03; (3=0.67), but negatively in BN patients (r=-0.60; p=0.03; (3=0.68).
Physical activity before admission to the inpatient unit, measured with the SQUASH, was significantly
correlated with anxiety (r=0.60; p=O.Ol; ~=0.95) and depression (r=0.47; p=0.04; ~=0 . 74) in AN.
Conclusion:
There are no differences in physical activity on the inpatient unit between AN and BN
patients, but the association between physical activity and depression is different in AN and BN. Also,
there is an association between physical activity before admission to the inpatient unit and anxiety and
depression in AN.

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Inflammatory and growth factor responses to continuous and intermittent exercise in youth with Crohn’s disease.

Purpose:
Acute bouts of exercise might amplify the inflammation underlying the pathology
in youth with Crohn’s Disease (CD). The type of exercise that stimulates growth factors but
does not exacerbate the inflammation in CD is unknown. We therefore examined the
response of markers of inflammation and growth factors to acute bouts of moderate intensity
continuous exercise (MICE) and high intensity intermittent exercise (HIIE) in youth with CD.
We also investigated the relationship between the degree of inflammation during and
following an acute bout of exercise and levels of physical activity.
Patients and methods:
Fifteen patients performed both the MICE (2 x 30 min of cycling at
50% of peak mechanical power (Wpeak) at 60 rpm) and the RITE (6 bouts of 4 x 15-sec of
cycling at 100% of Wpeak at 60 rpm). Blood was collected at rest (REST), at the mid-point of
exercise (EX-50%), at the end of exercise (EX-100%) and at 30 (REC-50%) and 60 min
(REC-1 00%) after the end of exercise. Physical activity was measured for seven consecutive
days using accelerometers.
Results:
Both MICE and HIIE induced an increase in total leukocytes, neutrophils,
lymphocytes, monocytes and GH and a decrease in IGF-I. MICE induced a greater increase
in leukocytes (p < 0.05), neutrophils (p < 0.05), lymphocytes (p < 0.001), monocytes (p < 0.05), IL-6 (p < 0.05) and GH (p < 0.05) and a similar decrease in IGF-I compared with HIIE. For MICE, leukocytes and neutrophils continued to increase into the recovery period, lymphocytes increased during and directly after the exercise and returned to baseline levels at REC-50%, and monocytes increased at EX-100% and remained elevated during the entire hour of recovery. IL-6 increased at EX-100% and returned to baseline levels at REC-100%. No change in IL-6 was detected following HIIE. IGF-I decreased during exercise for both MICE and HIIE and returned to baseline levels at REC-50%. TNF-a did not change significantly for either exercise. No correlations were found between physical activity and levels of inflammation both at rest and in response to exercise. Conclusion: Both types of acute exercise did not exacerbate the levels of measured proinflammatory cytokines underlying the pathology in CD. Decreases in IGF-I were similar between the exercises; however, the GH response in MICE was greater than in HIIE.

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The validity of the DCDQ-2007 as a screening measure for DCD in adolescents.

The progression of Developmental Coordination Disorder (DCD) into adolescence is not well
documented, partly due to a lack of appropriate screening measures for motor difficulties in
this particular age group. Both the Developmental Coordination Disorder Questionnaire
(DCDQ) and the Movement Assessment Battery for Children (MABC) have been revised,
now containing a wider age range, up to adolescence. Reliability and validity of the revised
DCDQ-2007 was assessed using a population based sample of31 adolescents (mean 14.1y,
sd 0.88y). Psychometric properties of the DCDQ-2007 were investigated and sensitivity and
specificity were assessed with the MABC-2 as a criterion standard. The DCDQ-2007 seemed
to be a reliable instrument when looking at the internal consistency and a relationship between
the outcome of the parental report and the MABC-2 was suggested. The DCDQ-2007 met the
standard for sensitivity (80%). However insufficient specificity was revealed, limiting the
reliability of the DCDQ-2007 for screening for DCD in adolescents.

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The Relationship between Cognitive Function and Cardiorespiratory Fitness in Institutionalized Older Adults.

Background.
Cardiorespiratory fitness (CRF) exercise programs have beneficial
effects on cognitive function (CF) in cognitively healthy institutionalized older adults.
Therefore, CRF exercise programs may be used therapeutically in cognitively impaired
institutionalized older adults. However, studies confirming the relationship between CF
and CRF in cognitively impaired older adults, generally included community-based
subjects. Therefore, this study investigated this relationship in cognitively impaired
institutionalized subjects, to affirm whether CRF exercise programs could possibly affect
their CF positively.
Methods.
Thirty-six institutionalized older adults, mean age 85.9 (5.0)
years, participated. CF was assessed with neuropsychological tests for memory and
executive function (EF). The two minute walking tests (2MWT) indicated CRF. A lower
and a higher CF group were created based on CF scores.
Results.
In the total sample,
memory and EF correlated significantly with the 2MWT: r ranged between .351 and .516
and between .394 and .611, respectively. In the lower and higher CF group, positive
correlations between CF and the 2MWT were non significant (p>0.05): r ranged
between .011 and .592 and between .001 and .336, respectively.
Conclusion.
The
relationship between CF and CRF in cognitively impaired institutionalized older adults
was non significant. However, moderate correlations may be significant with a larger
sample. Therefore, the relationship between CF and CRF is not refuted in cognitively
impaired institutionalized older adults. Consequently, future studies should use large
sample sizes when investigating the relationship between CF and CRF in cognitively
impaired institutionalized older adults.

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Children with Learning Disabilities Participate Less in Sports, and Experience Less Role Modelling and Support in Sports from Their Parents than Typically Developing Children.

The aims of the present study were to compare sport participation and activity
between children with LD and typically developing children, to investigate an
association between sport participation and both role modelling and parental
support, and to compare role modelling and parental support between children
with LD and typically developing children. Children in the age of7-13 years and
their parents completed sport participation and activity, role modelling and
parental support questionnaires. Results showed that children with LD
participated less and were less active in sports than typically developing children.
An association was found between sport participation and role modelling, and
between sport participation and parental support. Children with LD received less
role modelling and parental support than typically developing children. This
study highlights the need for informing parents of children with LD about role
modelling and parental support effects on sport participation of their child.

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Discriminating Chronic Heart Failure in Chronic Obstructive Pulmonary Disease.

Chronic Heart Failure (CHF) is not diagnosed in about 20o/o of the patients with Chronic
Obstructive Pulmonary Disease (COPD). The symptoms linked to CHF have an overlap with
the symptoms of COPD. The aim of this exploratory study is to examine diagnostic criteria to
discriminate patients with CHF in a group of patients with COPD. Diagnostic criteria used in
this study are: NT-proBNP, ~Vo2/b.Load, the 0 2 pulse and V02.
Three groups will be included in this study; patients with COPD, patients with CHF and
patients with COPD&CHF. All patients are recruited out of the out patients treatment. The
b.Vo2/b.Load, the 0 2 pulse and V02 will be measured in an cycle ergo meter test and the
levels of serum NT-proBNP values will be measured in the blood.
In total 67 patients were included in this study; 25 patients with only COPD, 20 patients with
COPD and diagnosed CHF and 22 patients with CHF. Levels of NT-proBNP differed
significantly between the three groups. A correlation of r=0.599 was found between NTproBNP
and LVEF. The 02 in rest of patients with COPD is significant lower than patients
with COPD&CHF (p=0.043) and CHF (p=0.008). The values of the ~V02/~Ioad are widely
deviated in COPD and in COPD&CHF. Patients with COPD&CHF who do take beta blockers
have the slope of CHF and patients without beta blockers have the slope of COPD.
Conclusion of this study is that NT-proBNP in combination with the 02 in rest, is a good
measurement to control for CHF in patients with COPD.

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Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa – best clinical practice guidelines.

Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa – best clinical practice guidelines.

Br J Dermatol. 2015 Aug 24;

Authors: Mellerio JE, Robertson SJ, Bernardis C, Diem A, Fine JD, George R, Goldberg D, Halmos GB, Harries M, Jonkman MF, Lucky A, Martinez AE, Maubec E, Morris S, Murrell DF, Palisson F, Pillay EI, Robson A, Salas-Alanis JC, McGrath JA

Abstract

This article summarises recommendations reached following systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa (EB). The guidelines are intended to help inform decision-making by clinicians dealing with this complex complication of a devastating disease. This article is protected by copyright. All rights reserved.

PMID: 26302137 [PubMed – as supplied by publisher]

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The Effect of a Motor Intervention on Ball Skill Performance of Children with Learning Disabilities.

The goal of this study was to investigate the effects of a motor intervention on
qualitative and quantitative ball skill performance of children with learning disabilities
(LD). A quasi-experimental pre-post intervention design was used. The children, aged 6-
10 years, (n=77, 55 boys and 22 girls), divided into an experimental (n=39) and a control
group (n=38), were assessed on the Test of Gross Motor Development and the Test to
measure ball skills in an open environment before and after the intervention. The
analyses revealed that children with LD who received the 9-week motor intervention did
not demonstrate significant more improvement in qualitative and quantitative ball skill
performance in comparison with the control group. This could be due to the low
intensity of the intervention, the low teacher-child ratio, and the heterogeneity of the
groups. Adaptations of the intervention and recommendations for future research are
discussed.

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‘Combined clinical and home-based rehabilitation for stroke patients': a pilot study to evaluate which category of stroke patients benefits most from this intervention.

Three stroke patients were investigated in this study to evaluate a combined clinical- and
home-based rehabilitation. The hypothesis was tested whether stroke patients would benefit
from a combined treatment. To this end, two stroke patients suffering from predominantly
motor deficits and one patient from cognitive impairments were studied. The combined
treatment protocol consisted on the one hand of regular inpatient treatment at a rehabilitation
center and on the other hand of treatment sessions at home with the patient. Emphasis in the
combined treatment was on training ADL- and mobility skills. Results were gathered using
both qualitative and quantitative measurements. Results indicate that a combined treatment
protocol is feasible for stroke patient suffering from either mainly motor- or cognitive
impairment. In particular the involvement of the home-context and presence of the partner in
that context were mentioned as specific plus points. In addition the therapists indicated that
domiciliary treatment provided the opportunity to train skills more specifically. Summarizing
this study provides important new knowledge with respect to advantages of home-based
rehabilitation for stroke patients in addition to inpatient rehabilitation. Future studies on this
subject should seek to further develop the treatment protocol used in this study.

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Influence of gravity compensation on kinematics and muscle activation patterns during reach and retrieval in cervical spinal cord injury.

Background:
Many applications in upper extremity rehabilitation after a cervical spinal cord
injury (SCI), for example robotics, include arm support during treatment. The specific effect of
arm support (gravity compensation) on kinematics and muscle activation characteristics in
SCI subjects is largely unknown.
Objective:
To assess the influence of gravity compensation on the upper extremity of SCI
subjects during reach and retrieval.
Methods:
Nine subjects with a cervical spinal cord injury performed a maximal reaching task
and a reach and retrieval task with and without gravity compensation. Angles at elbow and
shoulder joints and muscle activation patterns were measured and compared for both gravity
conditions.
Results:
During the maximal reaching task with gravity compensation seven subjects
showed less elbow extension (range 1.8-4.5 degrees). In the reach and retrieval task with
gravity compensation all subjects showed decreased elbow extension (11.0-0.1 °).
Furthermore, a movement execution closer to the body was seen. Regarding muscle
activation, timing was not influenced by gravity compensation. However, the amplitude of
activation decreased especially in anti-gravity muscles (descending part trapezius (mean
decrease (±SD) of 18.2% ±37.5°/o); anterior part deltoid (37.7°/o ±16.7%); posterior part
deltoid (32.0% ±13.9o/o); long head biceps (49.6% ±20.0%)).
Conclusions:
Arm support of the upper extremity influenced the kinematics of the upper
extremity, and the amplitude of the muscle activation however the timing of the muscle
activation was not affected. These results might have implications for the use of arm support
integrated in rehabilitation programs.

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The effect of soleplate stiffness of an ankle-foot orthosis on the toe-off phase during walking in healthy people.

Introduction:
A common therapeutic approach to improve the walking ability of stroke patients is the
prescription of an ankle-foot orthosis (AFO). Several designs of AFOs are available for stroke
patients, but AFOs are designed with pre-positioning of the heel in mind, while the influence of the
AFO on the third rocker of the gait has largely been ignored. In this study the focus is on the stiffness
of the soleplate of the AFO and its effect on the toe-off phase at two different walking velocities.
Methods:
A randomized crossover trial was used to study the effects of the soleplate stiffness of an
AFO on the toe-off in healthy people. The healthy volunteers walked at 2 different velocities (selfselected
velocity and at 0.5m/s) wearing standardized shoes, in a random order. Walking with ‘shoesonly’
formed the control condition and walking with each of the four AFOs created the intervention
conditions. The primary outcome measure was the vertical ground reaction force (GRF). To analyse
both kinematic and kinetic data a total of 14 parameters were assessed.
Results:
No statistical significance difference between GRF, knee and hip angles, and ankle moment
existed between the different conditions at either walking velocity. There was a statistically significant
delay in the timing of the plantarflexion movement during heel strike of all the AFO conditions
compared with the shoes-only condition when walking at a slow velocity and between shoes-only and
AF02, AF03, and AFO 4 when walking at a self-selected velocity. At either velocity there was no
differences between the AFOs. The plantarflexion movement at toe-off was significantly decreased in
all the AFO conditions compared with to shoes-only at either velocity, again with no differences
between the AFOs.
Conclusion:
There was a lack of difference between the AFOs on different gait characteristics of the
healthy volunteers. The AFOs decreased the plantarflexion movement during toe-off but this did not
have an effect on the vertical GRF during the forefoot rocker, which means that the soleplate stiffness
could support the vertical GRF, or there must be a compensation strategy available to overcome the
mechanical constraints imposed by the AFO.

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Medische consultfasering; Een vergelijkende studie tussen medisch specialisten en artsen in opleiding tot een specialisme in termen van de fasering van het medisch consult

Dit onderzoek richt zich op de verschillen in consulten tussen medisch specialisten en artsen in opleiding tot een specialisme op de polikliniek van de afdeling Orthopedie in het Universitair Medisch Centrum Groningen. Naar aanleiding van eerder onderzoek is er vanuit deze afdeling de vraag ontstaan op welke wijze de consulten van specialisten verschillen van artsen in opleiding tot een specialisme.

De bestaande literatuur geeft aan dat medisch institutionele communicatie, als multimodaal fenomeen, een complexe vorm van interactie is. Goede communicatie tussen arts en patiënt is van belang voor effectieve gezondheidszorg en heeft een positieve invloed op onder andere de patiënttevredenheid. Ondanks het groeiende inzicht in arts-patiëntcommunicatie en een transitie naar meer patiëntgerichte communicatie, komen er nog steeds interactionele problemen voor op dit gebied. Verschillende onderzoekers hebben modellen voorgesteld die medische consultvoering in een aantal chronologisch geordende fasen plaatsen. Er bestaan echter verschillen in de wijze waarop deze modellen gestructureerd zijn. Daarnaast is het bekend dat ervaren artsen de fasering van het consult op een andere manier hanteren dan de minder ervaren artsen.

Methode
Voor dit onderzoek zijn in totaal acht gesprekken van vervolgconsulten van specialisten en artsen in opleiding tot een specialisme geanalyseerd. Er is een kwantitatieve analyse uitgevoerd met het consultfaseringsmodel dat men in het UMC Groningen hanteert. Hiermee is de fasering van elk consult bepaald.

Resultaten
Uit analyse van de fasering blijkt dat de consulten van specialisten een langere tijdsduur hebben en dat zij de fasering van het consult meer comprimeren door het overslaan van de fase van de diagnose. Ook blijkt dat specialisten zowel relatief als absoluut, ongeveer tweemaal zoveel tijd besteden aan de fase van het behandelingsvoorstel ten opzichte van artsen in opleiding. In tegenstelling tot het behandelingsvoorstel, duren de fasen van het lichamelijk onderzoek en de afsluiting juist langer bij artsen in opleiding.

De resultaten over de fase van het behandelingsvoorstel zijn nader bekeken in een kwalitatieve analyse. Hiervoor is een inventarisatie van alle handelingen in het behandelingsvoorstel gemaakt. Hieruit blijkt dat specialisten meer tijd besteden aan het uitleggen van medische processen. Daarnaast komen adviserende handelingen bij specialisten wel voor en hanteren zij een minder fluctuerend handelingspatroon.

Een analyse van de transities naar de verschillende fasen laat zien dat conventionele transities een aanloop naar de wisseling vertonen, terwijl dit bij onverwachte of controversiële transities niet het geval is. Zowel artsen als patiënten kunnen echter een non-conventionele transitie inzetten.

Advies
In vervolgstudies kan onderhavig onderzoek herhaald worden bij een groter corpus met andere consultvormen. Ook kan vervolgonderzoek zich richten op het in detail in kaart brengen van de onderliggende subfasen van de bestaande faseringsmodellen.

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Detecting perturbed steps with an ambulatory method. And a comparison with a laboratory method.

Introduction:
This study aimed at finding a method to identify perturbed balance based upon an
ambulatory method and compare this to a laboratory method. The approach which has been
developed may be helpful in selecting older people at risk of falling, since evidence is strongest
that an intervention to reduce falls is most effective in that population.
Method:
Ten healthy participants walked on a treadmill and received perturbations in eight
directions, at two moments in the stride cycle and at two walking velocities. With an instrumented
treadmill centre of pressure was measured. The centre of pressure was used to calculate the
extrapolated centre of mass. With a hybrid wireless sensor, 3D acceleration, 3D magnetization
and 3D angular velocity at the sacrum were measured.
Data analysis:
For the laboratory method, the margin between the centre of pressure and the
extrapolated centre of mass at footcontact was used as a measure for balance. The new
ambulatory method used a peak detection approach to identify perturbed balance. It was analyzed
whether giving perturbations resulted in perturbed balance measured with both the laboratory
method and the ambulatory method. Also the level of agreement between the laboratory and
ambulatory method was determined.
Results:
Analyses revealed an overall sensitivity of 84.5 % and specificity of 94.8% for
ambulatory method and a overall sensitivity of 77.8% and specificity of 96.3% for the laboratory
method. Direction of the perturbation and walking velocity had little influence on the probability
of detection. When the ambulatory method was compared with the laboratory method, a
sensitivity of 69.0% and a specificity of 93.4% were found.
Discussion:
Detection of perturbed steps with both the laboratory and ambulatory method showed
high sensitivity and specificity. Sensitivity was not dependent on direction of perturbation,
moment of stride cycle and walking velocity. When the ambulatory method was compared with
the laboratory method, a moderate sensitivity and high specificity was found. With further
refinement and study, this ambulatory method may be useful in selecting older people at risk of
falling for interventions to reduce falls.

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Validity of the DCDDaily: a Measuring Instrument for Activities of Daily Living for children with Developmental Coordination Disorder.

In this study the validity of the DCDDaily is investigated, a standardized measuring instrument for the systematic
assessment of daily routine motor activities for five to nine years old children. Fourteen children with Developmental
Coordination Disorder (DCD) and 72 control children were assessed with the DCDDaily. The DCDDaily discriminated
between children with DCD and control children. Performance on the DCDDaily was compared to performance on the
Movement Assessment Battery for Children-2 (M-ABC-2), the checklist of the M-ABC-2 and the Developmental
Coordination Disorder Questionnaire (DCD-Q). Significant correlations were obtained between the DCDDaily and the
M-ABC-2, the checklist of the M-ABC-2 and the DCD-Q (respectively r=-0.68; r= 0.34; r=-0.36). Sensitivity of the
DCDDaily was 81%, specificity 63% with the M-ABC-2 as standard. Concluding, the DCDDaily is a valid instrument to
measure motor performance in activities of daily living.

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