Kennisbasis 11 & 12
2024 – 2025
Fleur Nootenboom
HOGESCHOOL ROTTERDAM | FYSIOTHERAPIE
,Inhoudsopgave
Thema 11 – Onderste extremiteit ..................................................................................................................... 4
KNGF Richtlijn Artrose heup en knie ................................................................................................................... 4
De diagnose artrose ....................................................................................................................................... 4
Algemeen klinisch beeld ................................................................................................................................ 5
Heupartrose ................................................................................................................................................... 5
Knieartrose .................................................................................................................................................... 5
Kenmerken artrose algemeen: ...................................................................................................................... 6
Risicofactoren voor ontstaan en de progressie van artrose: ......................................................................... 6
Beloop van Artrose ........................................................................................................................................ 6
Behandeling fysiotherapie ............................................................................................................................. 7
Behandelmethode: ........................................................................................................................................ 7
Diagnostische proces: .................................................................................................................................... 7
Anamnese ...................................................................................................................................................... 9
Lichamelijk onderzoek ................................................................................................................................. 10
Meetinstrumenten ...................................................................................................................................... 11
Indicatiestelling ............................................................................................................................................ 12
Contra-indicaties .......................................................................................................................................... 13
Algemene kenmerken van de behandeling ................................................................................................. 13
Therapeutisch proces .................................................................................................................................. 14
Centrale sensitisatiepijn in de klinische praktijk ............................................................................................... 15
2.1 – Inleiding .............................................................................................................................................. 15
2.2 – Neurofysiologie van acute pijn: van weefselnociceptie tot de pijnmatrix .......................................... 15
2.3 – Temporele summatie van pijn en wind-up ......................................................................................... 17
2.4 – Het brein moduleert pijn .................................................................................................................... 17
2.5 – De pijnneuromatrix ............................................................................................................................. 19
2.6 – Centrale sensitisatie ............................................................................................................................ 20
2.6 – Rol van stress en stressresponssystemen in het lichaam van pijnpatiënten ....................................... 21
Dynamiek van het menselijk bindweefsel ......................................................................................................... 22
7.4.1 – Structuur van pezen ......................................................................................................................... 22
7.4.2 – Aanhechting van pezen aan spierbuik en skelet .............................................................................. 23
7.4.3 – Peesbelasting ................................................................................................................................... 24
7.4.4 – Golgi-peessensoren als waarnemers van spierkracht ...................................................................... 25
12.1 – Artrose .............................................................................................................................................. 25
12.1.1 – Veroudering en slijtage .................................................................................................................. 26
12.1.2 – Synovia ........................................................................................................................................... 27
12.1.3 – Beginnende artrose ....................................................................................................................... 27
12.1.4 – Oorzaken van artrose ..................................................................................................................... 27
12.1.5 – Modellen voor het ontstaan van artrose ....................................................................................... 28
12.1.6 – Lokale schade ................................................................................................................................. 28
12.1.7 – Overgewicht ................................................................................................................................... 29
12.1.8 – Immobilisatie ................................................................................................................................. 29
12.1.9 – Samengevat ................................................................................................................................... 29
12.1.10 – Geen spontaan herstel ................................................................................................................. 30
12.2 – Gewrichtsbeschadiging en hydrops .................................................................................................. 30
12.3 – Artritis ............................................................................................................................................... 31
15.5 – Tendinopathie ................................................................................................................................... 32
15.5.1 - Classificatie van tendinopathieën ................................................................................................... 32
15.5.2 – De etiologie van de tendinopathie................................................................................................. 32
15.5.3 – De tendinopathie, een continuüm? ............................................................................................... 34
15.5.4 – de tendinopathie en pijn ............................................................................................................... 35
Kennisclip Zelfmanagement week 11.1 ............................................................................................................ 36
Common Sense Model................................................................................................................................. 37
, De vijf dimensies van ziektecognities .......................................................................................................... 37
Proces van problematische handeling naar verandering ............................................................................. 38
Beinvloeden van (beweeg-) gedrag ............................................................................................................. 38
5A’s .............................................................................................................................................................. 38
Artikelen ........................................................................................................................................................... 39
J.L. Cook - Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and
research? ..................................................................................................................................................... 39
Oefentoetsen .................................................................................................................................................... 41
Week 11.1 .................................................................................................................................................... 41
Week 11.2 .................................................................................................................................................... 42
Week 11.3 .................................................................................................................................................... 42
Week 11.4 .................................................................................................................................................... 42
Thema 12 – CVA Revalidatie ........................................................................................................................... 44
Fysiologie .......................................................................................................................................................... 44
6.4 – Functionele anatomie ......................................................................................................................... 44
6.4.1 – Anatomische begrippen ................................................................................................................... 44
6.4.2 – Hersenvliezen ................................................................................................................................... 44
6.4.3 – Ruggenmerg ..................................................................................................................................... 45
6.4.4 – Hersenstam ...................................................................................................................................... 46
6.4.5 – Cerebellum....................................................................................................................................... 47
6.4.6 – Diëncefalon ...................................................................................................................................... 47
6.4.7 – Telencefalon ..................................................................................................................................... 48
10.5.2 – Hersencirculatie ............................................................................................................................. 49
Kader 10.7 – Cerebrovasculair accident ...................................................................................................... 50
Kader 7.6 – Spasticiteit ................................................................................................................................ 51
Kader 10.7 – Cerebrovasculair incident ....................................................................................................... 51
Van contractie naar actie ................................................................................................................................. 53
2.3 – het driedeling brein ............................................................................................................................ 53
5.5 – Herstel na hersenbeschadiging ........................................................................................................... 54
7.11 – De individuele aanpak bij motorisch leren: twaalf principes ............................................................ 56
8.1 – Impliciet of expliciet leren? ................................................................................................................. 57
8.2 – Interne of externe focus van aandacht? ............................................................................................. 58
KNGF richtlijn - Beroerte ................................................................................................................................... 58
Definitie CVA: ............................................................................................................................................... 58
Deel C – Diagnostisch proces ....................................................................................................................... 58
Samenvattende aanbevelingen ................................................................................................................... 60
Leerboek klinische neurologie .......................................................................................................................... 60
8.2.1 – Taal en spraak .................................................................................................................................. 60
8.2.2 – Vloeiende en niet-vloeiende taalstoornissen .................................................................................. 60
8.2.3 – Afasie in soorten .............................................................................................................................. 60
11.1.1 – de arteriële aanvoer naar de hersenen ......................................................................................... 61
11.1.2 – Veneuze afvoer .............................................................................................................................. 62
11.1.3 – De bloed-hersenbarrière ............................................................................................................... 63
Inleiding in Evidence Based Medicine ............................................................................................................... 63
2.4 - Het PICO-systeem ................................................................................................................................ 63
3.3 - Aanpak zoekactie ................................................................................................................................. 64
3.3.1 - Metazoekmachines ........................................................................................................................... 64
4.1 – Inleiding .............................................................................................................................................. 64
4.1.1 – Validiteit ........................................................................................................................................... 64
4.1.2 – Betekenis van de resultaten ............................................................................................................. 65
4.1.3 – Toepasbaarheid ................................................................................................................................ 65
4.3 - .............................................................................................................................................................. 65
, Neurorevalidatie ............................................................................................................................................... 65
9.2 – De therapeutische situatie .................................................................................................................. 65
Neurorevalidatie in de eerste lijn: deel I ........................................................................................................... 67
Neuropsychologie ............................................................................................................................................. 68
Paragraaf 3.4 – Gezichtsveld ........................................................................................................................ 68
Paragraaf 3.6 – Neuropsychologische (cognitieve) functies ........................................................................ 71
Paragraaf 3.7 – Stemming, gedrag en persoonlijkheid ................................................................................ 71
Kennisclips ........................................................................................................................................................ 72
Week 1 – Kwetsbare schouder na CVA ........................................................................................................ 72
Week 1 – Inleiding CVA achtergrond en beeldvorming ............................................................................... 73
Week 1 – Neuroanatomie van het brein ...................................................................................................... 75
Week 1 en 2 – SR met meta-analyse ........................................................................................................... 75
Week 2 – CVA: inzicht in prognose en herstel ............................................................................................. 75
Week 3 – Cognitieve stoornissen na CVA .................................................................................................... 78
Mentale belastbaarheid .............................................................................................................................. 79
Week 3 – Veranderd gangbeeld na CVA ...................................................................................................... 81
Week 4 – CVA Best Practice ......................................................................................................................... 81
Week 4 – Spasticiteit na CVA ....................................................................................................................... 89
Artikelen ........................................................................................................................................................... 92
Week 1 en 2 - Nindorera et al. – Effectiveness of walking training .............................................................. 92
Klinimetrie - Thema 12 CVA Revalidatie ........................................................................................................... 92
1. SAFE – Shoulder abduction Finger Extension ..................................................................................... 92
2. Motricity Index ................................................................................................................................... 92
3. EmNSA – Erasmus modified Nothingham Sensory Assessment......................................................... 93
4. Bartel Index (BI) .................................................................................................................................. 94
Oefentoetsen .................................................................................................................................................... 94
Week 12.1 .................................................................................................................................................... 94
Week 12.2 .................................................................................................................................................... 95
Week 12.3 .................................................................................................................................................... 96
Week 12.4 .................................................................................................................................................... 96
2024 – 2025
Fleur Nootenboom
HOGESCHOOL ROTTERDAM | FYSIOTHERAPIE
,Inhoudsopgave
Thema 11 – Onderste extremiteit ..................................................................................................................... 4
KNGF Richtlijn Artrose heup en knie ................................................................................................................... 4
De diagnose artrose ....................................................................................................................................... 4
Algemeen klinisch beeld ................................................................................................................................ 5
Heupartrose ................................................................................................................................................... 5
Knieartrose .................................................................................................................................................... 5
Kenmerken artrose algemeen: ...................................................................................................................... 6
Risicofactoren voor ontstaan en de progressie van artrose: ......................................................................... 6
Beloop van Artrose ........................................................................................................................................ 6
Behandeling fysiotherapie ............................................................................................................................. 7
Behandelmethode: ........................................................................................................................................ 7
Diagnostische proces: .................................................................................................................................... 7
Anamnese ...................................................................................................................................................... 9
Lichamelijk onderzoek ................................................................................................................................. 10
Meetinstrumenten ...................................................................................................................................... 11
Indicatiestelling ............................................................................................................................................ 12
Contra-indicaties .......................................................................................................................................... 13
Algemene kenmerken van de behandeling ................................................................................................. 13
Therapeutisch proces .................................................................................................................................. 14
Centrale sensitisatiepijn in de klinische praktijk ............................................................................................... 15
2.1 – Inleiding .............................................................................................................................................. 15
2.2 – Neurofysiologie van acute pijn: van weefselnociceptie tot de pijnmatrix .......................................... 15
2.3 – Temporele summatie van pijn en wind-up ......................................................................................... 17
2.4 – Het brein moduleert pijn .................................................................................................................... 17
2.5 – De pijnneuromatrix ............................................................................................................................. 19
2.6 – Centrale sensitisatie ............................................................................................................................ 20
2.6 – Rol van stress en stressresponssystemen in het lichaam van pijnpatiënten ....................................... 21
Dynamiek van het menselijk bindweefsel ......................................................................................................... 22
7.4.1 – Structuur van pezen ......................................................................................................................... 22
7.4.2 – Aanhechting van pezen aan spierbuik en skelet .............................................................................. 23
7.4.3 – Peesbelasting ................................................................................................................................... 24
7.4.4 – Golgi-peessensoren als waarnemers van spierkracht ...................................................................... 25
12.1 – Artrose .............................................................................................................................................. 25
12.1.1 – Veroudering en slijtage .................................................................................................................. 26
12.1.2 – Synovia ........................................................................................................................................... 27
12.1.3 – Beginnende artrose ....................................................................................................................... 27
12.1.4 – Oorzaken van artrose ..................................................................................................................... 27
12.1.5 – Modellen voor het ontstaan van artrose ....................................................................................... 28
12.1.6 – Lokale schade ................................................................................................................................. 28
12.1.7 – Overgewicht ................................................................................................................................... 29
12.1.8 – Immobilisatie ................................................................................................................................. 29
12.1.9 – Samengevat ................................................................................................................................... 29
12.1.10 – Geen spontaan herstel ................................................................................................................. 30
12.2 – Gewrichtsbeschadiging en hydrops .................................................................................................. 30
12.3 – Artritis ............................................................................................................................................... 31
15.5 – Tendinopathie ................................................................................................................................... 32
15.5.1 - Classificatie van tendinopathieën ................................................................................................... 32
15.5.2 – De etiologie van de tendinopathie................................................................................................. 32
15.5.3 – De tendinopathie, een continuüm? ............................................................................................... 34
15.5.4 – de tendinopathie en pijn ............................................................................................................... 35
Kennisclip Zelfmanagement week 11.1 ............................................................................................................ 36
Common Sense Model................................................................................................................................. 37
, De vijf dimensies van ziektecognities .......................................................................................................... 37
Proces van problematische handeling naar verandering ............................................................................. 38
Beinvloeden van (beweeg-) gedrag ............................................................................................................. 38
5A’s .............................................................................................................................................................. 38
Artikelen ........................................................................................................................................................... 39
J.L. Cook - Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and
research? ..................................................................................................................................................... 39
Oefentoetsen .................................................................................................................................................... 41
Week 11.1 .................................................................................................................................................... 41
Week 11.2 .................................................................................................................................................... 42
Week 11.3 .................................................................................................................................................... 42
Week 11.4 .................................................................................................................................................... 42
Thema 12 – CVA Revalidatie ........................................................................................................................... 44
Fysiologie .......................................................................................................................................................... 44
6.4 – Functionele anatomie ......................................................................................................................... 44
6.4.1 – Anatomische begrippen ................................................................................................................... 44
6.4.2 – Hersenvliezen ................................................................................................................................... 44
6.4.3 – Ruggenmerg ..................................................................................................................................... 45
6.4.4 – Hersenstam ...................................................................................................................................... 46
6.4.5 – Cerebellum....................................................................................................................................... 47
6.4.6 – Diëncefalon ...................................................................................................................................... 47
6.4.7 – Telencefalon ..................................................................................................................................... 48
10.5.2 – Hersencirculatie ............................................................................................................................. 49
Kader 10.7 – Cerebrovasculair accident ...................................................................................................... 50
Kader 7.6 – Spasticiteit ................................................................................................................................ 51
Kader 10.7 – Cerebrovasculair incident ....................................................................................................... 51
Van contractie naar actie ................................................................................................................................. 53
2.3 – het driedeling brein ............................................................................................................................ 53
5.5 – Herstel na hersenbeschadiging ........................................................................................................... 54
7.11 – De individuele aanpak bij motorisch leren: twaalf principes ............................................................ 56
8.1 – Impliciet of expliciet leren? ................................................................................................................. 57
8.2 – Interne of externe focus van aandacht? ............................................................................................. 58
KNGF richtlijn - Beroerte ................................................................................................................................... 58
Definitie CVA: ............................................................................................................................................... 58
Deel C – Diagnostisch proces ....................................................................................................................... 58
Samenvattende aanbevelingen ................................................................................................................... 60
Leerboek klinische neurologie .......................................................................................................................... 60
8.2.1 – Taal en spraak .................................................................................................................................. 60
8.2.2 – Vloeiende en niet-vloeiende taalstoornissen .................................................................................. 60
8.2.3 – Afasie in soorten .............................................................................................................................. 60
11.1.1 – de arteriële aanvoer naar de hersenen ......................................................................................... 61
11.1.2 – Veneuze afvoer .............................................................................................................................. 62
11.1.3 – De bloed-hersenbarrière ............................................................................................................... 63
Inleiding in Evidence Based Medicine ............................................................................................................... 63
2.4 - Het PICO-systeem ................................................................................................................................ 63
3.3 - Aanpak zoekactie ................................................................................................................................. 64
3.3.1 - Metazoekmachines ........................................................................................................................... 64
4.1 – Inleiding .............................................................................................................................................. 64
4.1.1 – Validiteit ........................................................................................................................................... 64
4.1.2 – Betekenis van de resultaten ............................................................................................................. 65
4.1.3 – Toepasbaarheid ................................................................................................................................ 65
4.3 - .............................................................................................................................................................. 65
, Neurorevalidatie ............................................................................................................................................... 65
9.2 – De therapeutische situatie .................................................................................................................. 65
Neurorevalidatie in de eerste lijn: deel I ........................................................................................................... 67
Neuropsychologie ............................................................................................................................................. 68
Paragraaf 3.4 – Gezichtsveld ........................................................................................................................ 68
Paragraaf 3.6 – Neuropsychologische (cognitieve) functies ........................................................................ 71
Paragraaf 3.7 – Stemming, gedrag en persoonlijkheid ................................................................................ 71
Kennisclips ........................................................................................................................................................ 72
Week 1 – Kwetsbare schouder na CVA ........................................................................................................ 72
Week 1 – Inleiding CVA achtergrond en beeldvorming ............................................................................... 73
Week 1 – Neuroanatomie van het brein ...................................................................................................... 75
Week 1 en 2 – SR met meta-analyse ........................................................................................................... 75
Week 2 – CVA: inzicht in prognose en herstel ............................................................................................. 75
Week 3 – Cognitieve stoornissen na CVA .................................................................................................... 78
Mentale belastbaarheid .............................................................................................................................. 79
Week 3 – Veranderd gangbeeld na CVA ...................................................................................................... 81
Week 4 – CVA Best Practice ......................................................................................................................... 81
Week 4 – Spasticiteit na CVA ....................................................................................................................... 89
Artikelen ........................................................................................................................................................... 92
Week 1 en 2 - Nindorera et al. – Effectiveness of walking training .............................................................. 92
Klinimetrie - Thema 12 CVA Revalidatie ........................................................................................................... 92
1. SAFE – Shoulder abduction Finger Extension ..................................................................................... 92
2. Motricity Index ................................................................................................................................... 92
3. EmNSA – Erasmus modified Nothingham Sensory Assessment......................................................... 93
4. Bartel Index (BI) .................................................................................................................................. 94
Oefentoetsen .................................................................................................................................................... 94
Week 12.1 .................................................................................................................................................... 94
Week 12.2 .................................................................................................................................................... 95
Week 12.3 .................................................................................................................................................... 96
Week 12.4 .................................................................................................................................................... 96
