PHYSIOTHERAPEUTIC THEORY AND
PRACTICE FOR NEUROLOGICAL
REHABILITATION
CONTENTS
Introductie ............................................................................................................................................................ 13
Basisprincipes van neurologische revalidatie ................................................................................................... 13
Defenitie neurorevalidatie ............................................................................................................................ 13
Klinisch redeneren als neuro-kinesitherapeut .............................................................................................. 14
10 sleutelprincipes van neurorevalidatie ...................................................................................................... 16
FAME – Fundamentele bouwstenen voor neurologische kinesitherapie ......................................................... 21
Feedback ....................................................................................................................................................... 21
Therapeutische alliantie ................................................................................................................................ 22
Bewegingsanalyse ......................................................................................................................................... 22
Omgeving ...................................................................................................................................................... 22
Stroke .................................................................................................................................................................... 23
Risicofactoren voor stroke ................................................................................................................................ 24
Vroege mobilisatie na stroke ............................................................................................................................ 24
gestandaardiseerde uitkomstmaten ................................................................................................................. 26
Ernst van de beroerte - NIHSS ....................................................................................................................... 27
Lichaamsfuncties - Fugl-Meyer (FM) ............................................................................................................. 27
beperkingen in activiteiten ........................................................................................................................... 27
Levenskwaliteit.............................................................................................................................................. 28
Participatie .................................................................................................................................................... 29
Uitkomstmaten tonen variabiliteit .................................................................................................................... 29
studies ............................................................................................................................................................... 29
Hoe progressie is stroke revalidatie? ................................................................................................................ 30
Doel revalidatie na stroke ................................................................................................................................. 31
Geobserveerde vs werkelijke uitkomsten ......................................................................................................... 32
Boostprogramma .............................................................................................................................................. 32
Revalidatie van bovenste lidmaat bij stroke patiënten ................................................................................. 33
Proportioneel herstel van bovenste lidmaat .................................................................................................... 33
Dosis, intensiteit en training ............................................................................................................................. 35
Proportioneel herstel voor het onderste lidmaat ............................................................................................. 36
1
, Voorspellen van de uitkomst van het herstel ................................................................................................... 36
Bovenste lidmaat .......................................................................................................................................... 36
Onderste lidmaat .......................................................................................................................................... 37
beperking vs activiteit ....................................................................................................................................... 38
onderste lidmaat en locomotorisch herstel ...................................................................................................... 38
Balanstraining ............................................................................................................................................... 38
Gangtraining .................................................................................................................................................. 38
Circuit class training ...................................................................................................................................... 39
(toegevoegde) Electrostimulatie ................................................................................................................... 40
Bovenste lidmaat herstel .................................................................................................................................. 40
Constraint-induced movement therapy (CIMT) ............................................................................................ 40
Bilaterale arm training .................................................................................................................................. 40
Virtual reality ................................................................................................................................................. 40
(Toegevoegde) Electrostimulatie .................................................................................................................. 41
Robot-assisted therapy ................................................................................................................................. 41
Conclusie ........................................................................................................................................................... 41
Herstel na Stroke ............................................................................................................................................... 42
Definities ....................................................................................................................................................... 42
Beoordeling ................................................................................................................................................... 43
Herstel van Bovenste extremiteit na stroke.................................................................................................. 50
Herstel van onderste extremiteit na stroke .................................................................................................. 51
Klinische implicaties ...................................................................................................................................... 52
Ziekte van Parkinson ............................................................................................................................................. 54
Evaluatie van gang en evenwicht ...................................................................................................................... 54
Evidence-bases assessment bj ziekte van parkinson .................................................................................... 54
Evalueren van gang en evenwichtsproblemen ............................................................................................. 55
Evalueren van freezing .................................................................................................................................. 57
voorspellen van vallen en evalueren van evenwicht .................................................................................... 59
Gebruik van de Mini-best test ....................................................................................................................... 60
revalidatie van bovenste lidmaat ...................................................................................................................... 62
bovenste lidmaat problemen in PD............................................................................................................... 62
Beoordelen van de boveste lidmaat funtie in pd .......................................................................................... 63
Revalidatie interventes ................................................................................................................................. 70
Nadelen en overige vragen ........................................................................................................................... 71
Samenvatting BE training .............................................................................................................................. 72
Rationale en effect van dubbeltaaktraining in PD ............................................................................................ 72
conceptuele actergrond van dubbeltaak interferentie ................................................................................. 72
2
, modellen waarom interferentie kan voorkomen .......................................................................................... 75
Waarom is dubbeltaak aangedaan bij PD ..................................................................................................... 77
Pro’s en cons voor dubbeltaak training ........................................................................................................ 78
Bewijs voor dubbeltaak training ................................................................................................................... 79
Klinische implicaties ...................................................................................................................................... 80
Klinische take home message ....................................................................................................................... 80
Workshop DT training bij PD ............................................................................................................................. 81
Testing ........................................................................................................................................................... 82
Haalbaar en leuk ........................................................................................................................................... 83
Globale cognitieve functie ............................................................................................................................ 83
Prioritiseren................................................................................................................................................... 84
Verschillende cognitieve belasting – variërende taken ................................................................................ 84
Dubbeltaak predictoren in PD ....................................................................................................................... 85
Dubbeltaak training....................................................................................................................................... 86
Casus bespreking........................................................................................................................................... 87
Examenvraag ................................................................................................................................................. 87
Samenvatting dubbeltaken ........................................................................................................................... 88
Multiple sclerosis .................................................................................................................................................. 89
Introduction ...................................................................................................................................................... 89
Afbeelding brain health!! .............................................................................................................................. 89
Classificatie van MS ....................................................................................................................................... 90
Symptomen bij MS ........................................................................................................................................ 92
Verschillende fases bij MS ............................................................................................................................. 93
Patient-behavioural evaluation ......................................................................................................................... 94
Standaard beschrijving van de p zijn gezondheidsstatus .............................................................................. 94
uitkomstmaten .............................................................................................................................................. 96
Spiertonus ..................................................................................................................................................... 98
Klinische testen en patiënt gerapporteerde uitkomstmaten ...................................................................... 102
Cognitie en motorfunctie bij MS ..................................................................................................................... 105
Cognitieve domeinen en cognitie bij MS .................................................................................................... 105
sporten, fysieke activiteit en cognitief functioneren .................................................................................. 108
Cognitie in gang en cognitieve motorische interferentie ............................................................................ 109
Dubbeltaak trainng in MS ........................................................................................................................... 112
Take home message .................................................................................................................................... 113
Sporten bij MS ................................................................................................................................................. 113
Symptomen bij MS ...................................................................................................................................... 113
vicieuze cirkel bij MS ................................................................................................................................... 113
3
, Evolutie van sport bij MS ............................................................................................................................ 114
Belangrijke aspectenbij fysieke activiteit bij MS patiënten......................................................................... 114
High Intensity interval Training (HIIT) ......................................................................................................... 115
voedingsuplementen bij MS ....................................................................................................................... 115
Pijn bij MS........................................................................................................................................................ 116
Defenitie van pijn ........................................................................................................................................ 116
Types van pijn.............................................................................................................................................. 116
Prevalentie en intensiteit van pijn bij MS ................................................................................................... 117
Lokalisatie van pijn ...................................................................................................................................... 118
Impact van MS op gezondheidsgerelateerde levenskwaliteit .................................................................... 118
Risicofactoren voor ontwikkelen van pijn bij MS ........................................................................................ 119
Uitkomstmaten voor pijn ............................................................................................................................ 119
Biopsychosociaal model van pijn ................................................................................................................ 120
Interventies voor pijn .................................................................................................................................. 121
Take home message .................................................................................................................................... 121
Gangbiomechanica en energiekost van wandelen bij MS .............................................................................. 122
Gang biomechanica ..................................................................................................................................... 122
Energiekost van wandelen .......................................................................................................................... 123
Gang bij MS ................................................................................................................................................. 125
Verbeteren van onze kennis over wandel vermoeibaarheid in MS ............................................................ 125
Kinesitherapie en uitdagende MS ................................................................................................................... 126
MS & kinesitherapie .................................................................................................................................... 126
Move to Sport en projecten ........................................................................................................................ 129
MS kinesitherapie & Covid 19 ..................................................................................................................... 130
Conclusie ..................................................................................................................................................... 131
Functie van het bovenste lidmaat bij MS ........................................................................................................ 132
beoordelen van het bovenste lidmaat ........................................................................................................ 133
bovenste lidmaat beperkingen in MS ......................................................................................................... 137
Revalidatie van het bovenste lidmaat ......................................................................................................... 138
Samenvatting .............................................................................................................................................. 140
Revalidatie tijdens acute relapse bij MS ......................................................................................................... 141
Relapse bij Multiple Sclerose ...................................................................................................................... 141
Details van multi-disciplinaire revalidatie in RCT’s ..................................................................................... 141
Raam van mogelijkheden bij oefentherapie bij MS .................................................................................... 142
Conceptueel= overweging van potentiële mechanismen ........................................................................... 142
Is er evidentie .............................................................................................................................................. 143
Perspectief van de p .................................................................................................................................... 143
4
PRACTICE FOR NEUROLOGICAL
REHABILITATION
CONTENTS
Introductie ............................................................................................................................................................ 13
Basisprincipes van neurologische revalidatie ................................................................................................... 13
Defenitie neurorevalidatie ............................................................................................................................ 13
Klinisch redeneren als neuro-kinesitherapeut .............................................................................................. 14
10 sleutelprincipes van neurorevalidatie ...................................................................................................... 16
FAME – Fundamentele bouwstenen voor neurologische kinesitherapie ......................................................... 21
Feedback ....................................................................................................................................................... 21
Therapeutische alliantie ................................................................................................................................ 22
Bewegingsanalyse ......................................................................................................................................... 22
Omgeving ...................................................................................................................................................... 22
Stroke .................................................................................................................................................................... 23
Risicofactoren voor stroke ................................................................................................................................ 24
Vroege mobilisatie na stroke ............................................................................................................................ 24
gestandaardiseerde uitkomstmaten ................................................................................................................. 26
Ernst van de beroerte - NIHSS ....................................................................................................................... 27
Lichaamsfuncties - Fugl-Meyer (FM) ............................................................................................................. 27
beperkingen in activiteiten ........................................................................................................................... 27
Levenskwaliteit.............................................................................................................................................. 28
Participatie .................................................................................................................................................... 29
Uitkomstmaten tonen variabiliteit .................................................................................................................... 29
studies ............................................................................................................................................................... 29
Hoe progressie is stroke revalidatie? ................................................................................................................ 30
Doel revalidatie na stroke ................................................................................................................................. 31
Geobserveerde vs werkelijke uitkomsten ......................................................................................................... 32
Boostprogramma .............................................................................................................................................. 32
Revalidatie van bovenste lidmaat bij stroke patiënten ................................................................................. 33
Proportioneel herstel van bovenste lidmaat .................................................................................................... 33
Dosis, intensiteit en training ............................................................................................................................. 35
Proportioneel herstel voor het onderste lidmaat ............................................................................................. 36
1
, Voorspellen van de uitkomst van het herstel ................................................................................................... 36
Bovenste lidmaat .......................................................................................................................................... 36
Onderste lidmaat .......................................................................................................................................... 37
beperking vs activiteit ....................................................................................................................................... 38
onderste lidmaat en locomotorisch herstel ...................................................................................................... 38
Balanstraining ............................................................................................................................................... 38
Gangtraining .................................................................................................................................................. 38
Circuit class training ...................................................................................................................................... 39
(toegevoegde) Electrostimulatie ................................................................................................................... 40
Bovenste lidmaat herstel .................................................................................................................................. 40
Constraint-induced movement therapy (CIMT) ............................................................................................ 40
Bilaterale arm training .................................................................................................................................. 40
Virtual reality ................................................................................................................................................. 40
(Toegevoegde) Electrostimulatie .................................................................................................................. 41
Robot-assisted therapy ................................................................................................................................. 41
Conclusie ........................................................................................................................................................... 41
Herstel na Stroke ............................................................................................................................................... 42
Definities ....................................................................................................................................................... 42
Beoordeling ................................................................................................................................................... 43
Herstel van Bovenste extremiteit na stroke.................................................................................................. 50
Herstel van onderste extremiteit na stroke .................................................................................................. 51
Klinische implicaties ...................................................................................................................................... 52
Ziekte van Parkinson ............................................................................................................................................. 54
Evaluatie van gang en evenwicht ...................................................................................................................... 54
Evidence-bases assessment bj ziekte van parkinson .................................................................................... 54
Evalueren van gang en evenwichtsproblemen ............................................................................................. 55
Evalueren van freezing .................................................................................................................................. 57
voorspellen van vallen en evalueren van evenwicht .................................................................................... 59
Gebruik van de Mini-best test ....................................................................................................................... 60
revalidatie van bovenste lidmaat ...................................................................................................................... 62
bovenste lidmaat problemen in PD............................................................................................................... 62
Beoordelen van de boveste lidmaat funtie in pd .......................................................................................... 63
Revalidatie interventes ................................................................................................................................. 70
Nadelen en overige vragen ........................................................................................................................... 71
Samenvatting BE training .............................................................................................................................. 72
Rationale en effect van dubbeltaaktraining in PD ............................................................................................ 72
conceptuele actergrond van dubbeltaak interferentie ................................................................................. 72
2
, modellen waarom interferentie kan voorkomen .......................................................................................... 75
Waarom is dubbeltaak aangedaan bij PD ..................................................................................................... 77
Pro’s en cons voor dubbeltaak training ........................................................................................................ 78
Bewijs voor dubbeltaak training ................................................................................................................... 79
Klinische implicaties ...................................................................................................................................... 80
Klinische take home message ....................................................................................................................... 80
Workshop DT training bij PD ............................................................................................................................. 81
Testing ........................................................................................................................................................... 82
Haalbaar en leuk ........................................................................................................................................... 83
Globale cognitieve functie ............................................................................................................................ 83
Prioritiseren................................................................................................................................................... 84
Verschillende cognitieve belasting – variërende taken ................................................................................ 84
Dubbeltaak predictoren in PD ....................................................................................................................... 85
Dubbeltaak training....................................................................................................................................... 86
Casus bespreking........................................................................................................................................... 87
Examenvraag ................................................................................................................................................. 87
Samenvatting dubbeltaken ........................................................................................................................... 88
Multiple sclerosis .................................................................................................................................................. 89
Introduction ...................................................................................................................................................... 89
Afbeelding brain health!! .............................................................................................................................. 89
Classificatie van MS ....................................................................................................................................... 90
Symptomen bij MS ........................................................................................................................................ 92
Verschillende fases bij MS ............................................................................................................................. 93
Patient-behavioural evaluation ......................................................................................................................... 94
Standaard beschrijving van de p zijn gezondheidsstatus .............................................................................. 94
uitkomstmaten .............................................................................................................................................. 96
Spiertonus ..................................................................................................................................................... 98
Klinische testen en patiënt gerapporteerde uitkomstmaten ...................................................................... 102
Cognitie en motorfunctie bij MS ..................................................................................................................... 105
Cognitieve domeinen en cognitie bij MS .................................................................................................... 105
sporten, fysieke activiteit en cognitief functioneren .................................................................................. 108
Cognitie in gang en cognitieve motorische interferentie ............................................................................ 109
Dubbeltaak trainng in MS ........................................................................................................................... 112
Take home message .................................................................................................................................... 113
Sporten bij MS ................................................................................................................................................. 113
Symptomen bij MS ...................................................................................................................................... 113
vicieuze cirkel bij MS ................................................................................................................................... 113
3
, Evolutie van sport bij MS ............................................................................................................................ 114
Belangrijke aspectenbij fysieke activiteit bij MS patiënten......................................................................... 114
High Intensity interval Training (HIIT) ......................................................................................................... 115
voedingsuplementen bij MS ....................................................................................................................... 115
Pijn bij MS........................................................................................................................................................ 116
Defenitie van pijn ........................................................................................................................................ 116
Types van pijn.............................................................................................................................................. 116
Prevalentie en intensiteit van pijn bij MS ................................................................................................... 117
Lokalisatie van pijn ...................................................................................................................................... 118
Impact van MS op gezondheidsgerelateerde levenskwaliteit .................................................................... 118
Risicofactoren voor ontwikkelen van pijn bij MS ........................................................................................ 119
Uitkomstmaten voor pijn ............................................................................................................................ 119
Biopsychosociaal model van pijn ................................................................................................................ 120
Interventies voor pijn .................................................................................................................................. 121
Take home message .................................................................................................................................... 121
Gangbiomechanica en energiekost van wandelen bij MS .............................................................................. 122
Gang biomechanica ..................................................................................................................................... 122
Energiekost van wandelen .......................................................................................................................... 123
Gang bij MS ................................................................................................................................................. 125
Verbeteren van onze kennis over wandel vermoeibaarheid in MS ............................................................ 125
Kinesitherapie en uitdagende MS ................................................................................................................... 126
MS & kinesitherapie .................................................................................................................................... 126
Move to Sport en projecten ........................................................................................................................ 129
MS kinesitherapie & Covid 19 ..................................................................................................................... 130
Conclusie ..................................................................................................................................................... 131
Functie van het bovenste lidmaat bij MS ........................................................................................................ 132
beoordelen van het bovenste lidmaat ........................................................................................................ 133
bovenste lidmaat beperkingen in MS ......................................................................................................... 137
Revalidatie van het bovenste lidmaat ......................................................................................................... 138
Samenvatting .............................................................................................................................................. 140
Revalidatie tijdens acute relapse bij MS ......................................................................................................... 141
Relapse bij Multiple Sclerose ...................................................................................................................... 141
Details van multi-disciplinaire revalidatie in RCT’s ..................................................................................... 141
Raam van mogelijkheden bij oefentherapie bij MS .................................................................................... 142
Conceptueel= overweging van potentiële mechanismen ........................................................................... 142
Is er evidentie .............................................................................................................................................. 143
Perspectief van de p .................................................................................................................................... 143
4
