Ongoing projects

Running away from doxorubicin-induced skeletal muscle toxicity: investigating the molecular mechanisms and protective effects of physical exercise. 01/11/2022 - 31/10/2024

Abstract

Doxorubicin (DOX) is a widely used and highly effective chemotherapeutic agent with severe side effects, affecting the quality of life of cancer patients and survivors. DOX-induced skeletal muscle toxicity, especially muscle wasting and dysfunction, is of particular concern as it increases morbidity and mortality rates. In the current proposal, we aim to investigate the role of myokines and miRNAs within the mechanisms of DOX-induced skeletal muscle wasting through an in vitro (C2C12 cell line) and in vivo (mice) model. Identification of these myokines and miRNAs, that are expressed and exert their action in skeletal muscle, offer a novel theoretical basis to unravel the underlying cellular and molecular mechanisms and provide novel insights in the diagnosis and treatment of skeletal muscle wasting following DOX-treatment. We hypothesize that myokines and miRNAs play a crucial role in the pathogenesis of DOX-induced skeletal muscle wasting. In addition, we will study the potential cellular and molecular counteracting effects of muscle contraction on muscle wasting by 1) electrical pulse stimulation on DOX-treated C2C12 cells and 2) single exercise bouts in mice immediately before each DOX-cycle. We hypothesize that exercise is a feasible strategy in clinical practice to prevent DOX-induced muscle wasting. Finally, to improve clinical translatability we will also study the therapeutic use of single exercise bouts in a murine cancer cachexia model treated with DOX.

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  • Research Project

Tackling FRAILTY: ACTIVE-AGE@home: a home-based functional exercise program for community dwelling frail older adults. 01/10/2022 - 30/09/2026

Abstract

The growing number of frail older people is exposed to high risks of adverse health outcomes e.g. falls, hospitalization, diminished mobility, increased disability in activities of daily living and ultimately premature death. Frailty affects also health-care expenditure. Physical activity (PA) interventions are the first-choice treatment to tackle frailty, but this is mostly not the first choice of the frail themselves. PA programs should be culturally appropriate, population-based taking into account barriers and facilitators reported by the frail themselves. In order to overcome the barriers and optimally benefit from the facilitators, we developed and piloted a functional training program based on the British Medical Research Council guidance, ACTIVE-AGE@home. In this program each person's goals will be identified and achieved for. The Proof of Concept studies were promising and so, we set out to conduct a pragmatic RCT to test the effectiveness and costeffectiveness. Participants are frail community dwelling older adults, the intervention is a PA program administered by professionals and the same program delivered by volunteers under supervision of professionals which we will compare with a control group receiving care as usual. The primary outcome of the study is the timed chair rise since this is one of the most important functional evaluation clinical tests because it measures lower body strength and relates it to the most demanding activities of daily living. The test is also proven valid, reliable, responsive to change. The TCR is considered a 'stress test', i.e. a test that aims to challenge the maximal physiological and/or physical capacity of the participant. Positive results will help to reduce health and social expenditures and allow to collaboration in prevention and health promotion. Therefore, during the project, a synergistic relation between all relevant stakeholders is forseen.

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Effectiveness of an eHealth self-management support program for persistent pain after breast cancer treatment: a pragmatic, multi-centric, randomized, controlled trial. 01/10/2022 - 30/09/2026

Abstract

The current state-of-the art advocates for a biopsychosocial rehabilitation approach for persistent pain after breast cancer treatment. Within this approach pain science education is combined with promotion of an active lifestyle based on self-regulation techniques. We argue for testing an innovative eHealth self-management support program for this purpose. The assumption is that this delivery mode reduces barriers to pain self-management support, through bringing timely support near to people, creating a safe environment as opposed to hospital settings, providing a multidimensional support model taking into account the biopsychosocial needs of patients, and lowering costs. This program can provide patients with the knowledge, proactive, cognitive and self-management skills to master their situation and journey towards less pain and pain-related disability and participation in normal life again. Therefore, the general aim of the proposed project is to investigate the effectiveness of an eHealth self-management support program for pain-related disability (I) in breast cancer survivors with persistent pain (P). The program makes use of an innovative chatbot format for delivering pain science education and motivating and monitoring physical activity. The eHealth program is automated and personalized using comprehensive decision-tree-based algorithms in order to promote pain self-management support. The primary scientific objective of the study is to determine the effectiveness of this eHealth self-management support program for persistent pain after breast cancer treatment compared to 1) usual care (i.e. superiority of the eHealth self-management support program) (C1) and 2) a comprehensive pain rehabilitation program delivered face-to-face in a physical therapy setting (i.e. non-inferiority of the eHealth self-management support program) (C2) on pain-related disability (O).

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Towards an understanding of the role of soft tissue structural and mechanical properties in upper limb function after breast cancer treatment: the SOFT-TI-TRIAL 01/07/2022 - 31/12/2023

Abstract

Impaired upper limb function, i.e. experiencing difficulties in performing activities of daily living with the upper limb, is with a prevalence rate of 50% at one year after surgery, very common following breast cancer treatment. Upper limb dysfunctions after breast cancer treatment are complex and multifactorial with a variety of possible contributing factors. Both in research and clinical practice, there is no doubt about the change in soft tissue properties due to breast cancer treatments, in particular surgery and radiotherapy. Problems with soft tissues include structural changes (including tissue composition and tissue volume) and altered mechanical properties (including tissue stiffness and impaired gliding of tissues relatively to each other). The challenge is to properly assess structural and mechanical properties of soft tissues to get a true understanding of their contribution to upper limb dysfunctions. Up to now, (subjective) methods with limited validity, in particular for deeper structures, were used. Soft tissue properties can be evaluated objectively in vivo by means of ultrasonography (US) and a wide range of add-ons, such as 3D freehand US volume measurement, speckle tracking and shear-wave elastography. The specific benefits of US (with its add-on techniques) allow a comprehensive objective assessment of both structural and mechanical properties of soft tissues at once. This will enable gaining knowledge on their role in upper limb function after breast cancer treatment, and as such moving the field of understanding soft tissue problems after breast cancer forward, as well as opening new avenues to better screening, prevention and treatment approaches of upper limb dysfunctions. Therefore, the aim of this project is to develop and test the reliability of a comprehensive assessment protocol for the quantification (i.e. severity) of soft tissue properties with different US techniques. With the developed protocol, in the future, we will be able to determine the role of these different soft tissue properties as a diagnostic and prognostic biomarker for upper limb dysfunctions during and after breast cancer treatment.

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Eccentric muscle training in cardiac rehabilitation: randomized controlled trial to evaluate effectiveness and feasibility in heart failure patients with reduced ejection fraction. 01/07/2022 - 31/12/2023

Abstract

Sarcopenia, which means loss of muscle mass and function, is an independent predictor of death in heart failure patients with reduced ejection fraction (HFrEF). Traditionally, dynamic resistance training is used to counter muscle loss and is characterized by a concentric phase (=shortening) and an eccentric phase (lengthening) causing movement of the limb. Since muscle strength and muscle mass increase more with eccentric training than conventional concentric training without greater cardiorespiratory demands, this modality seems promising in heart failure patients. In this blinded randomized controlled trial, the effectivity and feasability of eccentric training will be assessed in heart failure patients. Forty patients with HFrEF will be randomly assigned to a Control Group (traditional resistance training + aerobic training) or an Intervention Group (eccentric training + aerobic training). Primary outcome parameters are exercise capacity (VO2 peak), muscle strength and muscle mass. It is hypothesized that greater muscle strength and muscle mass will be obtained in the eccentric training group in comparison with traditional resistance training. This better outcome will influence VO2 peak.

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Technology-supported innovative rehabilitation 01/01/2022 - 31/12/2026

Abstract

The scientific targets of the collaboration that the Scientific Research Network aims to achieve within the five coming years. The rapid development of technology and computer science has changed our environment and our way of life enormously over the last decades. However, currently, the use and implementation of new technologies to assist and improve physiotherapy and the rehabilitation process is still in its early stages. The technology that is, or can be used, in rehabilitation can be divided into three categories: i) high tech devices whose price and complexity of use limit their use in specialized centres (i.e., robotic treadmill), ii) devices that can be used by the clinicians in their daily practice (i.e., serious games exercises with virtual reality headset), and iii) systems and solutions that can be used by the patients alone at-home (i.e., mobile health applications, feedback during rehabilitation exercises). At the moment, most of the research centres focus their works on one particular category of technology. While this can be easily understood from a research perspective, this compartmentalization made the translation between the research and clinics rather weak. In particular it does not allow a full integration of these solutions into the conventional rehabilitation pipeline and the synchronization between the different techniques available, or under development, is rather limited. These two aspects mean that, at present, the technology is far from being used to its full potential in the rehabilitation. Another great potential of using technology to support rehabilitation is that different measurements can be taken while patients are performing the rehabilitation, either in the clinic or at home. These set of measurements can be used as innovative outcomes to validate the use of new technologies or drugs and could also be used to monitor the evolution of the patients during the rehabilitation process and adapt the plan according to the real needs and specificities of the patients. Therefore, the aim of this Scientific Research Network is to create a strong network of excellence dedicated to the development and promotion of innovative technology-supported rehabilitation solutions. The main objective is to bring the network as a key player in this field and to increase the quality of the research and the care in Flanders. To achieve this, the specific objectives of this network are to: i) synchronize current and future research on technology-supported innovative interventions by organizing clusters of inter and multidisciplinary specialists across domains (i.e., motor function, cognition, fatigue); ii) join efforts to perform multicentric validation studies to increase the power and the quality of the research, an essential step in determining the level of evidence for new interventions; iii) integrate the different technologies into one pipeline to coordinate and synchronize the different technologies through all the rehabilitation process; iv) initiate discussion with machine learning and AI specialist to analyze the data collected with the new technology and the clinical data, in order to ultimately develop personalized rehabilitation; v) inform and train the professional staff via workshops, guest lectures and dedicated website; vi) inform the patients and public via the organization of general audience events and sharing of general information via the establishment of a website

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Research in Balance and Locomotion regarding Assessment and Neurorehabilitation from Children to Elderly (BALANCE). 01/10/2021 - 30/09/2026

Abstract

During the next five years I will be focussing on the following research goals: • To study human walking, considering this mode of locomotion as an outcome measurement of the underlying motor control processes governed by the principles of neuromechanics. • To study the effects of development (in children) and ageing (in elderly) on postural balance control and gait stability to better understand the changes occurring during the lifespan • To study the effects of peripheral sensory loss (e.g. proprioception, vestibular function) on postural balance control to better understand the mechanisms of sensorimotor control and identify potential central compensation mechanisms

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Improving clinical screening, diagnostic and evaluation tools of lower limb lymphedema. 01/10/2021 - 30/09/2023

Abstract

Lymphedema is a chronic, debilitating disorder characterized by abnormal tissue swelling, adipose deposition and/or tissue fibrosis. Advances in oncologic treatment have led to an ever-increasing number of cancer survivors over time. As a result, morbidities related to the treatment (such as lymphedema) are likely to increase too. In the scientific community there is a large discrepancy in the reporting of incidence and prevalence data of lower limb lymphedema (LLL), because of a lack of valid and standardized measurement tools. It is unknown, at present, which measurement methods are the most accurate to use for screening, diagnosing or evaluating LLL in clinical practice. Consequently, at this moment there is an urgent need to validate the currently limited guidelines regarding screening, diagnosing (including severity grading) and evaluating unilateral and bilateral LLL and make them more concrete and unambiguous. To meet these needs, and to encourage an international uniformity regarding the management of LLL, the proposed project aims at developing a screening, diagnostic and evaluation set for patients with unilateral or bilateral LLL that can be used in clinical practice, based on directly edema-related measurement tools. Importantly, these sets need to be used in addition to questionnaires assessing problems or limitations in mental, social and general daily functioning as well as quality of life, in order to be able to outline a holistic treatment approach.

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Augmenting clinical decision-making processes for primary care physiotherapists based on state-of-the-art artificial intelligence and deep learning techniques. 01/07/2021 - 31/12/2022

Abstract

The objective of this project is to demonstrate how patient-related physiotherapy data that is collected and stored in a structured way, can be used for data-analysis by the use of deep learning, a part of a broader family of machine learning methods. Neural networks will be used to determine which therapeutic approach can be best used for what type of patient to increase physical activity, thereby demonstrating the feasibility of using data-analysis to develop effective therapeutic strategies in patients with cardiorespiratory and metabolic diseases. Demonstrating the feasibility of data gathering, storage and analysis in physiotherapy in internal diseases in a primary care setting will be a first and major step in developing data-driven therapy. The results of this project will facilitate and enable further research in the development of data-driven medicine in multiple diseases, as well as the development of data-monitoring and tele-coaching application in healthcare. The combined expertise of both research groups, in partnership with the Belgian Physiotherapy Association (Axxon), allows this consortium to take a head start in data-driven physiotherapy research and to become a pioneer in this field in Europe.

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sCANsens: Identifying biomarkers for chronic pain after breast cancer treatment. 01/01/2021 - 31/12/2024

Abstract

Up to 40% of women experience chronic pain after treatment for breast cancer, and this pain is often very disabling. However, chronic pain after breast cancer remains under-recognised and under-treated. An effective and patient-tailored approach of (chronic) pain after breast cancer indeed requires a thorough knowledge and evaluation of the pain. In daily clinical practice, however, guidelines for a comprehensive diagnosis of pain in cancer patients and survivors are lacking. Further research in this topic is crucial for an efficient, preventive as well as curative, approach of pain after breast cancer. Besides the high prevalence and the important impact of pain in this population, the breast cancer population is also an ideal population to study chronic pain and its natural time course in different stages, since most patients start pain-free, but almost half of them end up with chronic pain. Therefore, this study aims to map biomarkers (both predictive, prognostic and diagnostic) for chronic pain after breast cancer treatment. We will study possible biopsychosocial biomarkers in relation to (chronic) pain and monitor their temporal changes from the moment of diagnosis until 1 year after surgery. The potential biomarkers are situated within the medical imaging of the brain, measurements of pain sensitivity and psychological variables.

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Understanding the heterogeneity of balance control in children with Developmental Coordination Disorder and its impact on motor performance: a synergistic approach using brain imaging, neuromechanics and functional assessments. 01/11/2020 - 31/10/2024

Abstract

Worldwide, Developmental Coordination Disorder (DCD) accounts for 5-6% of the school-aged children showing a motor delay early in childhood. Poor balance control is the most significant motor problem occurring in 73-87% of the children with DCD. These balance deficits severely affect everyday functioning, but underlying control mechanisms are still poorly understood. Therefore, the main aim of this project is understanding the heterogeneity of DCD by studying balance performance, its control mechanisms and its impact on motor performance. Based on functional performance and neuroimaging data it is hypothesized that balance performance and control of children with DCD can be situated on a continuum between cerebral palsy (CP) and typically developing children (TDC). As such a case-control study will be performed comparing balance performance, motor performance, cortical brain activity and muscular activation patterns in children with DCD to children with CP and TDC. The novelty of this study lies in the synergistic approach of combining functional assessments with brain imaging and neuromechanical analysis. This approach is a major step forward in unraveling the interplay between the control system (brain and the rest of the nervous system) and the effector system (musculoskeletal system). It can provide groundbreaking insights into the heterogeneity of DCD as well as a better understanding of the relationship between balance and motor performance.

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Induce pain to relieve pain: The effect of "exercise into discomfort" on clinical outcomes and ultrasound imaging parameters in patients with subacromial shoulder pain. 01/11/2020 - 31/10/2024

Abstract

The rotator cuff (RC) is a group of muscles and tendons that allows to move the shoulder, keeping the upper arm bone in the shoulder blade socket. An injury in the RC can cause swelling and irritation of these structures, making arm movements painful. This subacromial shoulder pain (SSP) can be caused by a combination of intrinsic factors (degeneration) and extrinsic factors (compression of the RC). Exercise therapy is the first choice of treatment in patients with SSP. However, it is not clear which parameters define the best exercises: e.g. the level of pain experienced by the patient during training. Our main hypothesis is that "exercising into discomfort" will give better results in terms of pain, functionality and quality of life. We therefore aim to identify the optimal dose of loading during exercise, steered by the patients' response. In this process, the Ultrasound (US) is a medical imaging modality that can give important information about tendon structural changes during treatment. This project will contribute to define: 1) the role of discomfort in exercise therapy for patients with SSP, 2) the relationship between tendon structural changes and pain, and 3) the optimal type of intervention that can improve changes in tendon structures visible by US. The final goal of this project is to develop the best evidence-based practice in the rehabilitation of SSP and to reduce its major socioeconomic burden.

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Unravelling risk factors for chronic dizziness in patients after an acute unilateral vestibular deafferentiation syndrome. 01/10/2020 - 30/09/2024

Abstract

In many patients with an acute unilateral vestibular deafferentiation (uVD) syndrome symptoms are expected to resolve spontaneously because of central compensation. However, more detailed observations have revealed that 29-66 % of uVD patients develop disabling chronic dizziness lasting >1 year after the acute event. Identifying predictors of chronic dizziness would allow patients at high risk to be targeted with personalized therapies to reduce healthcare costs. Therefore, the main objective of this study is to identify predictors of chronic dizziness after an acute uVD. Despite the consensus on the usefulness of physical therapy, incorporation of physical therapy programs in daily management of patients after acute uVD remains troublesome. The approach usually consists of encouraging patients to move around as much as possible without the supervision of the physical therapist. However, there are no known studies that investigate exercise adherence in acute patients who rehabilitate based on home exercise programs. Therefore, the first objective is to study the effect of the actual level of physical activity in the acute stage on long term (LT) outcome. Recent data show that LT prognosis is more linked to anxiety and somatization traits than to objective vestibular findings. Avoiding complaint-inducing movements is a known compensation strategy used by patients with an acute uVD. However these movements are very important to promote compensation. Therefore, the second objective is to study the effect of activities avoidance behavior on LT outcome. As stated above it is questioned whether objective vestibular findings can predict chronicity. However recently the Perez and Rey (PR) score was developed. It is a measure of temporal organization of refixation saccades that enables to distinguish between compensated and uncompensated vestibular patients. Therefore, the third objective is to study the effect of early central vestibular compensation as measured by the PR score on LT outcome. In patients with poor central vestibular compensation the remaining sensory cues will need to compensate for the loss of vestibular information. Patients using a visual compensation strategy can become dependent of stable visual cues. Evidence is mounting that visual field dependency is a factor contributing to visual vertigo which is a specific form of persistent perceptual postural dizziness (PPPD) which is classified as a chronic functional vestibular disorder. Therefore, the fourth objective is to study the effect of visual motion sensitivity on LT outcome. A 2-year prospective cohort study will be performed to study aforementioned risk factors for chronic dizziness. Up to 200 consecutive patients with an acute uVD will be included. Triage at the emergency department is performed by neurologists and ENT clinicians. All patients will undergo a standard ENT evaluation for dizziness. Subsequently they will be treated by means of symptomatic treatment (antivertiginous drugs) and early start of vestibular rehabilitation. Patients will be seen by a physical therapist at all measurement sessions within the first three months. Chronic dizziness is indicated by a score >30 on the Dizziness Handicap Inventory (primary outcome) after 6 months. In addition, the criteria from the Barany society will be used to see whether patients suffer from PPPD (visual vertigo) or not. Possible risk factors will be evaluated by using MOX1-activity loggers (objective 1), the Vestibular Activities Avoidance Inventory (objective 2), video Head Impulse Testing including the Perez & Rey score (objective 3), Subjective Visual Vertical test and Rod & Disc test (objective 4). Measurements will be taken 1, 2, 3, 6, 9, 10, 26 and 52 weeks after the acute event. The risk factors will be used as predictors in a logistic regression model, that predicts whether a patient will have a DHI-score above or below 30. The predictive accuracy of the model will be assessed using ROC curves.

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Unravelling chronic postsurgical pain after total knee replacement: what is the role of altered central pain processing and metabolic disorders such as obesity and diabetes? 01/10/2020 - 30/09/2024

Abstract

Total knee replacement (TKR) surgery is the most common surgical treatment for knee osteoarthritis (OA) worldwide. Despite a good outcome for the majority of patients, approximately 20% of patients experience chronic pain after surgery. Therefore, it is desirable and useful to define predictive factors for this postoperative chronic pain. It is hypothesized that the presence of altered central pain processing (CPP) may be a determinant of chronic pain after TKR surgery. Besides altered CPP, metabolic disorders such as obesity and diabetes might also contribute to postoperative chronic pain. Both disorders are risk factors for developing knee OA in the first place, but their relationship with postoperative chronic pain is not yet clear. In addition, the association between altered CPP on the one hand and obesity and diabetes on the other hand needs to be examined. Given the prediction that the incidence of TKR will increase in the future, prevention of chronic postoperative pain is of tremendous importance. Therefore, the aim of this research proposal is to unravel the contribution of preoperative altered CPP, obesity and diabetes to chronic postoperative pain after TKR surgery.

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Chemotherapy-induced myotoxicity requires healthy skeletal muscles 01/10/2020 - 30/09/2024

Abstract

Cancer survival has increased significantly over the last decades because of improved screening and the development of novel therapies. The downside of this positive evolution is that cancer treatment-related adverse events affecting the quality of life of cancer survivors has become an emerging concern. Physical long-term side effects of anthracycline chemotherapy, such as doxorubicin (DOX) and Cisplatin (CIS), include cardiovascular complications (heart failure), peripheral fatigue and muscle mass loss (wasting). While the cardiovascular toxicity of DOX has been extensively studied, this project aim to investigate the effects of DOX and/or CIS on skeletal muscle structure and (mitochondrial) metabolism. Additionally, we will evaluate the possible beneficial effect of physical exercise as a strategy to protect against DOX and CIS induced myotoxicity. This project aims to lay the foundation of a novel joint research line of the research groups of Movant, Cardiovascular Disease and Physiopharmacology to exploit scientific and operational synergies.

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Understanding heterogeneity of balance control in children with developmental coordination disorder and its impact on motor performance: a synergistic approach using brain imaging, neuromechanics and functional assessments. 01/09/2020 - 31/08/2023

Abstract

Worldwide, developmental coordination disorder (DCD) accounts for 5-6% of the school-aged children showing a motor delay with an onset early in childhood that often persists in adolescence. Poor balance control is the most significant motor problem occurring in 73-87% of the cases of children with DCD. These balance deficits severely affect everyday functioning but underlying control mechanisms are still poorly understood. Therefore, the main aim of this project is understanding the heterogeneity of DCD by studying balance control, its impact on motor performance and its control mechanisms. Based on functional performance and neuroimaging data it is hypothesized that both performance and motor control of children with DCD can be situated on the continuum of balance performance between children with cerebral palsy (CP) and their typically developing (TD) peers. As such a cross-sectional case-control study will be performed comparing balance performance, motor performance, cortical brain activity and muscular activation patterns in children with DCD to children with CP and their TD peers. This synergistic approach of combining functional assessments with brain imaging and neuromechanical analysis will provide a major step forward in unravelling the interplay between the control system (brain and the rest of the nervous system) and the effector system (musculoskeletal system) when specific balance tasks are performed. The expected outcomes of this project are new balance profiles in children with DCD as well as a better understanding of the relation between balance and motor performance. These profiles can add insights in the heterogeneity of DCD and the debate whether DCD represents pathological development or a delayed development, which would be a scientific breakthrough. Furthermore, the novelty of this study lies in the synergistic approach of combining functional assessments with brain imaging and neuromechanical analysis. This approach can provide groundbreaking insights into control mechanisms of balance and, when succesful, might serve as a gold standard for future research. Ultimately, the insights obtained in this project could enhance adequate physiotherapeutic treatment planning, improve motor potential and result in better execution of everyday activities for children with DCD.

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4D scanner for Accelerating Advanced motion Analysis and Application 01/05/2020 - 30/04/2024

Abstract

The human body is a complex bio-mechanical system that exhibits many variations in geometry and movements. Advancements in 3D scanning and 3D modeling allow to construct precise and high-resolution models of the human body. Such a 3D model often contains more than 2GB of information such that recording, processing, transmission and data storage is labor and time intensive. In this project we acquire a 3D body scanner that captures the human body shape in high precision and with virtually no effort. The equipment will allow to register the human body with an accuracy of 1mm and up, at a frame rate of 10 3D scans per second. This so called 4D scanner (3D + time) constitutes the core of our 4D center of expertise, in which the research groups Product Development, MOVANT, Vision Lab, EVECO and Op3Mech together with Center for Health and Technology (CHaT) have joined forces in a complementary collaboration with the aim to use dynamical models of the human body for the development of new products with improved comfort and functionality, to design fundamentally new products with important applications in health care, and to improve our understanding of the evolutionary history of the human body. The combination of academic and industrial expertise of Kinesiology with Product Development and virtual modeling and simulations makes the center unique in the world. The consortium will tackle open design problems with applications for mass customization (3D printing) and wearables.

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Unravelling chronic postsurgical pain after total knee replacement: what is the role of altered central pain processing and metabolic disorders such as obesity and diabetes? 01/11/2019 - 31/10/2024

Abstract

Total knee replacement (TKR) surgery is the most common surgical treatment for knee osteoarthritis (OA) worldwide. Despite a good outcome for the majority of patients, approximately 20% of patients experience chronic pain after surgery. Therefore, it is desirable and useful to define predictive factors for this postoperative chronic pain. It is hypothesized that the presence of altered central pain processing (CPP) may be a determinant of chronic pain after TKR surgery. Besides altered CPP, metabolic disorders such as obesity and diabetes might also contribute to postoperative chronic pain. Both disorders are risk factors for developing knee OA in the first place, but their relationship with postoperative chronic pain is not yet clear. In addition, the association between altered CPP on the one hand and obesity and diabetes on the other hand needs to be examined. Due to their shared relation with low grade inflammation, there might exist an undiscovered link between these conditions. Given the prediction that the incidence of TKR will increase in the future, prevention of chronic postoperative pain is of tremendous importance. Therefore, the aim of this research proposal is to unravel the contribution of preoperative altered CPP, obesity and diabetes to chronic postoperative pain after TKR surgery.

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  • Research Project

Spatial inattention and motor functioning after stroke: An in-depth analysis of the impact of visuospatial neglect on motor recovery. 01/10/2019 - 30/09/2023

Abstract

Visuospatial neglect (VSN) is a frequent post-stroke neuropsychological cognitive disorder which leaves patients with impaired or even lost awareness for stimuli and/or events on the contralesional hemispace. VSN is reported to occur in 30-70% of right-brain strokes and 20-60% of left-brain strokes. Although spontaneous neurological recovery of VSN occurs in most patients within the first 10-12 weeks post-stroke, 20-40% of patients with VSN still show symptoms a year-post stroke. The latter might have important consequences, as VSN is negatively associated with the motor recovery of the upper limb and independence during activities of daily living (ADL). Although recovery of gait is a primary goal within stroke rehabilitation, little is known about the impact of VSN on the true motor recovery of the lower limbs and on motor performance in general (as measured by gait, balance control and truncal function). As this impact is still unknown, it is difficult for clinicians to provide accurate rehabilitation strategies. Therefore, it is important to unravel the interaction between VSN on one hand and motor recovery and motor performance on the other hand. This will give us more insights in the interplay between spatially-oriented cognitive processes and motor functioning, therefore providing a possible framework for the development of new innovative rehabilitation strategies. The presence of an interaction between cognition (e.g. VSN) and motor function raises the question whether training one aspect can have carry-over effects to the other. A very relevant question is thus whether spatial retraining, designed to enhance VSN, can indirectly stimulate the recovery of motor function and performance as well. In this four-year project, we will address three main research objectives 1) Investigating the impact of VSN on true motor recovery of the lower limbs 2) Investigating the impact of VSN on motor performance as measured by gait, balance control, truncal function 3) Investigating the carry-over effects of spatial retraining on true motor recovery of the lower limbs and motor performance

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NOMADe 01/10/2019 - 30/09/2023

Abstract

Le défi principal relevé par NOMADe sera d'améliorer la qualité des solutions préventives ou curatives proposées aux populations dans la zone transfrontalière France-Wallonie-Vlaanderen (FWVL) en réduisant l'écart existant actuellement entre les connaissances scientifiques émanant des laboratoires scientifiques et universités et les acteurs de terrain impliqués dans les TNMS. Il s'agit d'assurer le transfert entre les connaissances et bonnes pratiques cliniques théoriques émanant de l'evidence-based-practice (EBP) et de l'evidence-based-medecine (EBM) vers les acteurs de terrain avec pour objectif d'un bénéfice de santé pour les populations. La solution proposée pour réduire cet écart passera par le développement d'un écosystème - ensemble d'entités interagissant dans un environnement donné - spécialisé dans les TNMS et structuré autour de quatre pôles: e-learning, R&D, expertise et validation. Le pôle e-learning consistera en une plateforme d'apprentissage en ligne qui permettra: (1) de mieux former les différents acteurs de terrain et (2) de faciliter les interactions et la communication entre les acteurs de terrain et les populations (patients). Le pôle R&D développera des "intelligent devices" standardisés d'évaluation, de monitoring ou de revalidation des populations. Le pôle d'expertise biopsychosociale permettra de garantir une approche complète du problème de santé des populations et de mettre en place des essais cliniques incluant des populations des 3 versants, en respectant les aspects éthiques régionaux. Le pôle validation s'intéressera autant aux contenus de la plateforme d'apprentissage qu'aux dispositifs numériques. La coopération transfrontalière entre les partenaires réunis par NOMADe apportera une importante plus-value aux approches existant actuellement sur les 3 versants car ces derniers possèdent des expertises mono-disciplinaires fortes et complémentaires mais non coordonnées. L'écosystème aura pour objectif de les fédérer. Le projet NOMADe ambitionne donc d'améliorer les conditions de vie des populations de la zone transfrontalière FWVl, via une amélioration et une mutualisation de la formation/éducation et des équipements disponibles pour les acteurs de terrain. Les résultats collectés dans le cadre du projet alimenteront également des campagnes de sensibilisation à destination de la population souffrant de TNMS.

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  • Research Project

Gaining insight into the complexity of pain in patients with hemophilia: a longitudinal study from a biopsychosocial perspective. 01/10/2019 - 30/09/2023

Abstract

Hemophilia is a genetic disorder characterized by recurrent bleedings in synovial joints. Thanks to tremendous scientific progress, patients with hemophilia (PwH) have a life expectancy that is comparable to the general population. However, the majority of adult PwH suffer from extremely intense and invalidating joint pain. Although the complexity of joint pain has been studied in other chronic joint pain conditions, there is an immense lack of studies examining pain in PwH. Current studies have not sufficiently focused on pain as primary outcome and thus lack valid and thorough assessments of prevalence and extent of pain, life impact and nociceptive processing. Moreover, pain is not yet studied within a biopsychosocial perspective and the role of beliefs, emotions and behavior is thus unexplored. Especially interactions between pain and beliefs, emotions and behavior are wasteland, since longitudinal studies are necessary to explore the bidirectional relations. Therefore the main aim of the current proposal is to gain more insights in joint pain in PwH enabling us to move towards an adequate pain management within this patient population. As the majority of studies in other chronic joint pain conditions has shown that the biopsychosocial perspective is crucial in pain management, we will use a consensus-based set of outcome measures that should be evaluated in patients with chronic joint pain. The primary objective is to examine pain characteristics (prevalence, intensity and extent) and life impact of pain (impact on physical functioning and quality of life) using validated outcome measures in an unselected and representative sample of adult PwH. As secondary objective we want to assess peripheral and central nociceptive processing in PwH, and examine the relationship with joint status to gain more insight in the pathophysiology of joint pain in PwH. The third objective is to record fluctuations and interrelations in pain intensity, intake of medication and physical activity to gain more insight in the relation between pain intensity and pain behavior in PwH. We will examine whether beliefs and emotions are predictive of pain behavior. The insights gathered with the current research proposal will lead to more comprehensive biopsychosocial pain assessments of PwH both in further research and in clinical practice. These ameliorated assessments unravelling contributors to chronic pain in this populations, will serve as base to steer interventions for the management of joint pain, accounting for nociceptive processing profiles and specific beliefs, emotions and behavior. We expect that proper pain management strategies will be more effective and less costly, resulting in enhanced quality of life and increased social participation for PwH.

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  • Research Project

Cellular and molecular aspects of skeletal muscle wasting in a rat model of severe burns. 01/10/2019 - 30/09/2023

Abstract

Severe burned patients undergo rapid increases in metabolism (hypermetabolism) and increased energy expenditure caused by the initial inflammatory and humoral responses. These responses also elicit, on top of the bed rest period, a cascade of negative reactions leading to additional muscle wasting. Muscle wasting itself leads to insulin resistance and may have long-term health consequences. Some of these effects persist from the first few days following severe burn injury to as long as three years later after wound closing. Although insulin resistance is assumed to be triggered by several catabolic factors, an important contributor to insulin resistance is muscle wasting itself. Insulin-resistance, may eventually lead to diabetes mellitus and is a long-term complication of severe burn patients which has major implications for future morbidity and mortality. Muscle wasting is a hallmark of burns but the underlying pathophysiological pathways are not well understood. The main aim of this project is to investigate the underlying mechanisms of muscle wasting (atrophy) in a rat model of severe burns (>40% TBSA). The first part of the study will focus on the effects of severe burn trauma in rats on the metabolomic profile of skeletal muscle, liver and blood. Secondly, we will focus on the same outcome measures during muscle disuse by means of rat hindlimb suspension with or without exercise. Thirdly, immune-histochemical, Western-blotting and biochemical analysis of the skeletal muscle activation and content of satellite cells, muscle capillarisation, autophagy and/or associated metabolic signalling pathways will be done. Finally, chemical blocking of myostatin as muscle wasting regulator will be investigated. The results of this project will be linked to the results of our ongoing clinical FWO project on exercise therapy in severely burned patients.

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Can stroke survivors re-learn normal walking? Understanding functional recovery and effects of exoskeleton-assisted training. 01/01/2019 - 09/02/2023

Abstract

Animal models suggest a limited time window of increased repair activity in the brain during the first weeks after damage, for example after a stroke. Within this time window, responsiveness to therapy is increased suggesting that this is the optimal time to start intensive rehabilitation. In great contrast, early rehabilitation is experienced by stroke patients as a time of being physical inactive. This lack of rehabilitation might explain rather disappointing mobility outcome, since a great amount of stroke survivors struggle to achieve independent community ambulation. The World Health Organisation expects an increase to 1.5 million new cases of stroke per year in 2025. If innovation in rehabilitation cannot be provided, the increasing incidence of stroke will inevitably lead to a growing chronic stroke population and a great burden for our society. A novel therapeutic strategy is a wearable exoskeleton. This device allows an earlier initiation of more intensive rehabilitation as it assists patients in walking even if they are severely affected. This technology has the potential to change acute stroke rehabilitation from an inactive into a motivating, active time as it allows early training of meaningful activity. However, due to its recent development this type of therapy is not yet investigated. We aim to fill this gap with the proposed project by investigating the effectiveness of this approach and provide evidence on an optimal time window for rehabilitation.

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Support maintenance scientific equipment (REVAKI). 01/01/2017 - 31/12/2022

Abstract

This project represents a research contract awarded by the University of Antwerp. The supervisor provides the Antwerp University research mentioned in the title of the project under the conditions stipulated by the university.

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Scientific advisor at Oscare 01/01/2017 - 31/12/2022

Abstract

Oscare is an after-care and research center for burns and scars in Antwerp. The multi-disciplinary after-care team and the research group of Oscare are experienced in the treatment of scars since 2001 and developed expertise in the domain of scientific research for innovative treatment methods for scars since 2008. The past years the research group Revaki - Movant had a successful collaboration with Oscare which has led to a first PhD. During this period Oscare has grown in all fields (prevention - treatment - research). To support further development of research within this field our research group Revaki –Movant, more particularly Ulrike Van Daele, will take active role in the research group of Oscare.

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Past projects

Pathophysiological mechanisms and exercise counter measures of hypermetabolism and muscle wasting in severe burns 01/10/2020 - 30/09/2022

Abstract

Severe burns cause a cascade of unwanted effects such as an overdrive in metabolism, loss of muscle tissue, and loss of the body's ability to effectively handle glucose as an energy source and an enhanced inflammatory state. Against common belief, these side effects have shown to persist for years, and cause long-term consequences such as a reduced physical fitness and a higher risk of developing diabetes. Despite many research efforts, much of these persistent side effects that occur in burns are not well understood. Efforts to counteract the negative effects on metabolism, the loss of muscle tissue and to prevent or lessen the amount of the inflammation have not yet been successful. Exercise rehabilitation has the potential to, at least partly, prevent and/or restore the negative consequences as has been shown in other critically ill hospitalised patients. This project will, therefore, shed more light onto 1) the short- and long-term effects of severe burns on energy metabolism, loss of muscle tissue, and inflammation in adults, and 2) the effect of an 8-week exercise rehabilitation programme during the initial period of hospitalization on these parameters. In order to successfully execute this project, we will study patients from Belgium and Chinese burn centres to get a better understanding of the bodily derangements, which will lay a foundation for better future care of burn patients.

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  • Research Project

The effect of conservative treatment of temporomandibular disorders on somatic tinnitus. 01/10/2020 - 30/09/2021

Abstract

Tinnitus, or ringing in the ears, is the phantom sensation of sound in the absence of an internal or external source for the sound which occurs in 10-15% of adults. Subjective tinnitus, influenced by the somatosensory system is called somatosensory tinnitus. In this subtype, the tinnitus can be influenced by impaired somatosensory input from the masticatory system or from the cervical spine. Our research group was able to demonstrate that non-invasive treatment of the cervical spine and of the masticatory system can lead to an improvement of tinnitus complaints (Michiels, Van de Heyning, Truijen, Hallemans, & De Hertogh, 2016; Van der Wal et al., 2020). Information on the underlying working mechanisms of these treatments is however lacking. This is important as it can shed light on tinnitus pathophysiology. We recently performed a mediation analysis and found that an improvement in temporomandibular disorder (TMD) was able to explain 35% of the observed treatment effect in patients with somatic tinnitus attributed to TMD (van der Wal et al., Submitted). TMD is however an umbrella term and further elaboration on the contribution of different components of TMD in tinnitus is needed. Of particular interest are the acting neurophysiological mechanisms. Also the assessment of a change in TMD over time needs to be improved. The current project is funded by remaining funds of a FWO TBM project and will be used to apply for.additional funding. References Michiels, S., Van de Heyning, P., Truijen, S., Hallemans, A., & De Hertogh, W. (2016). Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus? Man Ther, 26, 125-131. doi:10.1016/j.math.2016.08.005 Van der Wal, A., Michiels, S., Van de Heyning, P., Braem, M., Visscher, C., Topsakal, V., . . . De Hertogh, W. (2020). Treatment of Somatosensory Tinnitus: A Randomized Controlled Trial Studying the Effect of Orofacial Treatment as Part of a Multidisciplinary Program. J Clin Med, 9(3). doi:10.3390/jcm9030705 van der Wal, A., van de Heyning, P., Gilles, A., Jacquemin, L., Topsakal, V., Van Rompaey, V., . . . de Hertogh, W. (Submitted). Is a reduction of somatic tinnitus severity mediated by an improvement in temporomandibular disorder? Hearing Research.

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The development of a Virtual reality software application to assess and treat visuospatial neglect in central neurological conditions. 01/09/2020 - 31/08/2021

Abstract

After stroke, people can experience several impairments. Besides sensorimotor impairments, stroke often have to deal with cognitive disorders including disorientation in time and space, decreased information processing time and volume, memory problems and attentional deficits. One of these post-stroke attentional deficits is visuospatial neglect (VSN) characterized by impaired awareness for visual stimuli located on the contralesional side of space. People with VSN experience significant postural impairments and a high fall risk. In addition, consequences can be more practical of nature as patients with attentional deficits are, for example, unaware of the traffic lights at street crossings or even traffic in general, but also lack the ability to find products at grocery stores. It is obvious that people dealing with cognitive impairments encounter difficulties in all aspects of ADL (Activities of Daily Living) and community participation, and even lack the ability to live independently at home. Unfortunately, there is to date no adequate way of assessing VSN after neurological impairments with good clinimetric properties such as high ecological validity, reliability and discriminating ability between different modalities of VSN. As a consequence, treatment options are sparse and especially focused on compensatory recovery. Moreover, with current standard pen-and-paper tasks, it is hard to quantify eye-movements in relation to head movements relevant for the interpretation of the performance of the patient whether or not the patient uses compensations. Moreover, patients cannot train independent at home with assessment and monitoring on remote (telerehabilitation). As a result, patients remain highly dependent of the spontaneous recovery of the neural system because of the small treatment effects currently seen in clinical practice. However, a huge amount of patients will have persistent VSN after rehabilitation leading to substantial loss of community participation with a high dependency on (in)formal care. This project aims to deliver a solution for the aforementioned problems by means of a virtual reality (VR) application. VR has the potential to provide a three-dimensional real-life environment increasing ecological validity of the assessment of neglect. The recent technical developments in consumer head mounted displays have made virtual reality a mature, reliable and affordable technology. This means for this application that patients will not only rely on equipment accessible at hospitals or rehabilitation centers, but they can even undergo treatment at home and at their own convenience, making telerehabilitation possible. The primary users are professional caregivers within the field of neurological rehabilitation such as neuropsychologists, physiotherapists and occupational therapists. Some patients, who can take responsibility for their own rehabilitation, can use the application independently within the care facility or at home (telerehabilitation).

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Unraveling factors predicting post-surgical hypertrophic scar formation: A prospective study based on a digital biopsychosial care pathway 01/07/2020 - 31/12/2021

Abstract

Surgery can have an enormous impact on a person's life. Besides the emotional reasons (receiving a diagnosis, having to undergo (urgent) surgery, etc.), the aftermath can be heavy for the patient. Rehabilitation periods can be long, and after that period, the patient remains with a scar, which can be debilitating. The incidence of hypertrophic scarring of postsurgical incision ranges from 40% to 70%. Although at the time of development, this hypertrophic scarring is not considered a top priority, as the patient is still in the rehabilitation phase, it has been shown that hypertrophic scars greatly impact the person's quality of life. As such, it is important to prevent this process of hypertrophic scarring. However, until now there is limited specific follow-up to examine post-surgical scar conditions, so it is not clear what factors contribute to the development of hypertrophic scars and whether they are preventable. Therefore, the aim of the current application is to identify factors, inventoried by patient reported outcome measures and objective scar assessment, predicting post-surgical pathologic scar formation. Recently we have developed an e-health application for fast detection of abnormal scar formation, enabling the proposed study by offering fast and real time data recording and analysis of both patient and scar related information. The unique and specific scientific importance lies within the fact that with this study we may reveal critical points in which abnormal scar formation occurs post-surgery. Moreover, we may reveal predictors that make the difference between normotrophic and pathologic hypertrophic scar formation. If adjustable risk factors are identified we can prevent hypertrophic post-surgical by early and continuous screening, greatly enhancing patient's QOL after surgery. To achieve these goals a prospective study will be set up with specific data collection the first months after surgical incision. Evaluating self-reported scar quality, symptoms and quality of life included in the e-health tool Scarpath together with the objective examination of the scar (e.g. scar redness, elasticity) allows us to closely monitor the progression over time and allows us to gather large amount of scar and patient related parameters during wound healing which may lead to normal or hypertrophic scars. This is the first study that attempts to unravel factors leading to post-surgical hypertrophic scar formation with a patient-centered e-health based data registration system. As such, it is the first study that makes use of several PROMs which (in their paper version) are being used worldwide in the scar-related context, and can provide a proof of concept for further e-health applications. With establishing risk factors from this study future research may reveal whether specific interventions or prevention strategies are useful and as such greatly impacting patient's QOL post-surgery.

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Preparing an fMRI study to unravel the mechanisms of somatosensory tinnitus: How to alter cervical somatosensory afference in an MRI compatible way? 01/07/2020 - 31/12/2021

Abstract

Tinnitus, or ringing in the ears, is the phantom sensation of sound in the absence of an internal or external source for the sound. It occurs in 10-15% of adults. In some cases changes in somatosensory input from the cervical spine are causing or changing the tinnitus, in which case it is called cervicogenic somatic tinnitus (CST). We currently know that physical therapy treatment of the cervical spine dysfunction can decrease the tinnitus sensation, but we don't know why some patients with tinnitus experience an increase in their tinnitus when they are having an episode of neck pain and others don't. Therefore, we are working towards a large fMFI study, investigating brain activity during involuntary changes in somatosensory input using vibration, in patients with CST, patients with other types of tinnitus and patients with neck pain without tinnitus. In order to be able to succesfully apply for funding for this larger study, we first need to investigate which vibration frequency and location is best suited for altering cervical somatosensory input. The aim of this project is therefore: To investigate which vibration location and frequency causes the largest disturbance in cervical somatosensory input. This knowledge will increase our chances to successfully obtain funding for the larger study.

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  • Research Project

Pain Education after CANcer (PECAN)-app: a new, innovative delivery method for pain science education in breast cancer survivors 01/07/2020 - 31/12/2021

Abstract

Both in research and in clinical practice, interest in pain science educational interventions for treatment of persistent pain after breast cancer treatment has increased significantly over the past decades. Modern Pain Science Education (PSE) explains the neurophysiology of (chronic) pain, the nervous system's ability to modulate and perpetuate the pain experience, and highlights the influence of other factors (such as sleep, thoughts, feelings, and culture) on pain. Despite emerging evidence, some important issues should be addressed about current methods of delivery of PSE. First, the provision of individual face-to-face sessions requires considerable resources and may be prohibitive to participation if breast cancer survivors have limited means, mobility, motivation/courage or access to such services. Second, given the complex biopsychosocial nature of persistent pain after breast cancer treatment, a personalized approach is warranted. Therefore, more blended educational approaches and eHealth modalities with individualized information might be more suitable for this specific population. In order to tackle these issues, the general aim of this project is to deliver proof of concept for the use of apps using an Embodied Conversational Agent (ECA) or virtual agent in a health care setting, with specific emphasis on cancer aftercare. More specific, this project focus on an ECA-based app, the PECAN-app, for the delivery of individually-tailored PSE intervention in order to promote pain self-management and to reduce the high burden of persistent pain after breast cancer treatment. Consequently, the two-fold aim of the proposed project is: 1) To evaluate consumers' preferences for and the content and shaping of an ECA-based app, the PECAN app, to deliver PSE for cancer survivors with persistent pain through a qualitative study; and 2) To gather proof of concept for a) the convenience with and acceptability of an intervention with an ECA-based app for the delivery of PSE in breast cancer survivors with persistent pain; and b) a large efficacy trial in terms of estimates of efficacy and feasibility of methods through a pilot randomised controlled trial and qualitative study.

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The Pelvic Floor. 01/01/2020 - 31/12/2021

Abstract

Online platform 'The Pelvic Floor' Although pelvic floor problems are common in women, there is still a taboo. A multidisciplinary team of researchers from the University of Antwerp and the UZA wants to change this by launching the online platform 'The Pelvic Floor'. The online platform consists of informative blogs, links to the right informative websites and fascinating testimonials to give women the right knowledge and insights about pelvic floor problems. In this way, women receive the necessary guidance to help prevent and reduce complaints and limit relapse or deterioration. The accompanying social media campaign is strongly committed to providing preventive information. Every woman is unique and deserves genuine information about her pelvic floor. Knowing more? Be sure to take a look at the online platform.

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Towards a better understanding of ankle pain in haemophilia patients: A study examining the relationship between structure and function, taking pain mechanisms into account. 01/10/2019 - 30/09/2020

Abstract

Hemophilia is a genetic disorder characterized by recurrent bleedings in synovial joints. In many patients this leads to haemophilic athropathies, even at young ages. Unsurprisingly, the majority of adult PwH suffer from invalidating joint pain. Despite the high prevalence of pain in PwH pain assessment is not well developed and strongly differs between haemophilia treatment centers. Moreover, up to 39% of PwH report their pain is not well treated. This underscores the urgent need to improve both pain assessment and management in PwH. Ankle and knee are the most affected weight-bearing joints in PwH. Nowadays, knee arthropathy in PwH is better managed. However, this is not the case for ankle arthropathy, and many PwH have to deal with debilitating ankle pain. Studies examining ankle joint pain in PwH from a broad biopsychosocial framework are absolutely lacking, which contrasts to the bulk of literature in other musculoskeletal pain conditions Joint assessment in patients with chronic conditions should be performed according to the International Classification of Functioning, Disability and Health (ICF), the framework proposed by the World Health Organization (WHO) in which human functioning is described in terms of body structures & functions, activities & participation and contextual factors. The latter are personal or environmental factors that may act as barrier or facilitator of functioning. The aim of the current research proposal is to understand the complexity of ankle pain in PwH. This will allow to better asses and manage pain in order to achieve optimal functioning.

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Primay and secundair prevention of injuries in OBV dancers 01/09/2019 - 30/08/2021

Abstract

Both modern and classical dance are characterized by a large number of injuries caused by overload. This overload is defined as "an increase in training load resulting in a decrease in performance". Overtraining in combination with poor nutrition can lead to menstrual irregularities, which can adversely affect reproductive functions and bone mass. The combination of reduced energy availability, menstrual irregularities and reduced bone mass was called the "Female Athlete Triad (FAT)". In 2014, the International Olympic Committee (IOC) introduced the term Relative Energy Dysfunction in Sport (RED-S). It replaced the term and the syndrome that was previously called "Female Athlete Triad", which indicated the combination and interaction of a disturbed diet, irregular menstruation and reduced bone density in sports women. Recent scientific insights had made it clear that the term "Female Athlete Triad" was no longer appropriate. The RED-S syndrome refers to 'reduced physiological functioning caused by a relative energy deficiency and includes, but is not limited to, disorders of (1) metabolism, (2) menstruation, (3) bone health, (4) immunity, (5) protein synthesis and (6) cardiovascular health. However, there is a lack of studies to this day that study the interrelationships between the various conditions. Low energy availability (LEA, low energy availability) is the main cause of this complex syndrome. It is not so much a disturbed eating pattern as a disturbed energy balance that is at the root of this problem. This has an impact on many more processes in the body than was initially thought. It also not only affects women, but can also occur in male athletes. The main objective of this study is "to unravel energy metabolic aspects of RED-S in elite adolescent and adult dancers and to study the relationship with menstrual irregularities, bone quality and complaints."

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Elucidating psychological and social risk factors for low back pain in highly physically active adolescents: a case study in female pre-professional dancers. 01/07/2019 - 31/12/2020

Abstract

The general purpose of this study is to elucidate psychological and social risk factors for low back pain (LBP) in highly physically active adolescents. Using a qualitative research design, we will explore perceived causes (psychological and social) of LBP using female pre-professional dancers as a case study. This will lay the foundation for fundamental prospective studies examining causes of LBP in adolescents. Low back pain (LBP) is the leading cause of disability worldwide. The prevalence of LBP rapidly increases during adolescence, especially in females. The multidimensional nature (including biological, psychological and social factors) of LBP is widely recognized in adults, but has, despite the fact that LBP during adolescence is a risk factor for spinal pain in adulthood, rarely been investigated in adolescents. Elite adolescent dancers are a model population to unravel the etiology of adolescent LBP as they are a homogenous group that is highly physically active and that is at risk for developing LBP. The novelty of our approach is the unraveling of LBP from a multidisciplinary perspective in adolescents at risk for developing LBP in a challenging period of their life. The proposed qualitative methodology will allow to explore these factors in more depth, as validated questionnaires to examine psychological and social factors in adolescent dancers are lacking. The collaboration in this project between several disciplines will allow to obtain a more detailed insight in the person as a whole, including a great part of the individual and contextual factors underlying the etiology of LBP in highly active adolescents. More importantly, the results of the project will lay the foundation for the continuation of the research in the etiology of LBP in dancers and adolescents.

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Balance control in young children: a synergistic approach combining functional assessment and neuromechanics to unravel balance control mechanisms. 01/07/2019 - 31/12/2020

Abstract

Adequate balance control is a prerequisite to achieve postures in early life and more complex gross and fine motor skills later in childhood. Balance deficits are a common problem in children with various pathologies such as cerebral palsy, developmental coordination disorder or sensorineural hearing loss. Because of the potential impact of these balance deficits on motor development, they need to be detected early in childhood. However, balance control is complex and comprises different mechanisms such as predictive, proactive and reactive control. At present none of the available paediatric balance tests comprehend to total concept of balance control. Most tests have been focussing on balance control in static and predictable environments, ignoring the contribution of reactive balance mechanisms. This is an underrepresentation of the daily life situation involving object interactions and changing physical environments. Therefore, the aim of this project is to develop an integrated approach of assessing balance in 5 to 7 year old children covering the entire concept of balance control. A synergistic approach, combining functional assessment methods of balance performance with more in-depth neuromechanical analysis will be used. Neuromechanics focusses on the interplay between the neural processes (e.g. reaction times) and the mechanical aspects of balance control (e.g. amount of sway) unravelling balance control strategies that might otherwise remain hidden. In this way, fundamental insights will be gained into the construct of balance control and the contribution of the different mechanisms in 5 to 7 year old children. These insights will result in a validated test that allows the clinician to identify overall balance deficits as well as the specific domains of balance control that are disturbed. Identification of these domains allows for specific physiotherapeutic intervention planning. Furthermore, the better understanding of balance control mechanisms in young children will open new horizons for research regarding the contribution of balance control deficits to developmental (motor) problems in children.

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Attentional deficits and postural alignment: providing new insights in the interaction between cognition and motor function after stroke. 01/07/2019 - 31/12/2020

Abstract

Visuospatial neglect (VSN) is a neuropsychological cognitive condition characterized by an attention deficit to one side of the hemispace, often provoked by stroke. Patients with VSN fail to pay attention to the contralesional hemispace. Approximately 25-30% of stroke patients are confronted with VSN of which 40% still show VSN a year post-stroke. Patients with VSN need more time to recover from sensory-motor impairments, do not reach the same level of motor performance, and experience limitations in activities of daily living (ADL) as compared to post-stroke patients without VSN. However, until present it still remains unclear how VSN contributes to the poorer functional outcomes as observed in post-stroke patients. Results from studies investigating the role of VSN in motor deficits are inconsistent. Some studies show that patients with VSN have worse balance control and gait abilities as compared to patients without VSN, whereas others reject these findings. However, an important limitation of these studies is that they do not take into account the different subtypes of VSN. The different subtypes of VSN are based on the range of space in which the patients experience VSN, namely the personal (own body), peri-personal (within reach) and extra-personal space. It has been shown that these subtypes are important, as balance control and ADL improvement can differ within patients with VSN, depending on which subtype of VSN is most dominantly present. However, since research on this topic is only beginning to emerge, in-depth knowledge regarding the influence of the type of VSN on motor function is lacking. More specifically, the contribution of the different subtypes of VSN on balance control, gait, truncal function and perception of visual verticality has not yet been investigated, especially not from a biomechanical point of view. By unravelling this contribution, the mechanisms of action of VSN will become clearer. This will lead to a better understanding of the interactions between cognitive and motor impairments seen in post-stroke patients with VSN. Therefore, these insights might in turn fundamentally improve the way that the rehabilitation of post-stroke patients with VSN is currently provided. For example, to date, (spatial) cognitive and motor interventions are separately administered, and these cognitive therapies are not yet used to stimulate the motor system. Before cognitive therapies designed to enhance VSN can be recommended to stimulate motor improvements, a clear understanding and consensus regarding the influence of the subtypes of VSN on balance control, gait, truncal function and estimation of visual verticality is necessary. Within this pilot project, we aim to gain insight into the specific contribution of VSN on balance control, gait, truncal function and estimation of visual verticality, especially considering the subtypes of VSN using a biomechanical and clinical approach. Therefore, this project will deepen the understanding of the poor functional outcome that often accompanies post-stroke patients with VSN. The following research questions are considered within the current project: (I.) Do post-stroke patients with VSN have altered balance control, gait, truncal function and estimation of visual verticality compared to post-stroke patients without VSN, as measured by a combination of assessment methods? (II.) Is this dependent on the subtype of VSN? This funding will be used as seed money by providing the foundation for a novel research project which will be submitted to FWO in 2020, in which we aim to investigate the carry-over effects of VSN training on motor performance in post-stroke patients with VSN.

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Towards a better understanding of ankle pain in haemophilia patients: A study examining the relationship between structure and function, taking pain mechanisms into account. 01/04/2019 - 27/02/2020

Abstract

Hemophilia is genetic disorder caused characterized by recurrent bleedings, with a majority of spontaneous bleedings occurring in synovial joints. Thanks to tremendous scientific progress, patients with hemophilia (PwH) have a life expectancy that has become comparable to the general population. However, despite adequate prophylactic replacement therapy, recurrent joint bleedings still occur. These bleedings have devastating effects on joint components due to iron deposits and inflammation in the joint, resulting in synovial inflammation, cartilage degeneration and bone damage, with as end-stage a very painful and invalidating hemophilic arthropathy affecting the majority of adult PwH. Despite the high prevalence of pain in PwH pain assessment is not well developed and strongly differs between haemophilia treatment centers. Moreover, up to 39% of PwH report their pain is not well treated. This underscores the urgent need to improve both pain assessment and management in PwH. Ankles and knees are the most affected weight-bearing joints in PwH. While many adult PwH have total knee replacements in case of knee arthropathy, this is not the case for ankle arthropathy, and the majority of adult PwH have to deal with debilitating ankle pain. Joint assessment in patients with chronic conditions should be performed according to the International Classification of Functioning, Disability and Health (ICF), the framework proposed by the World Health Organization (WHO) in which human functioning is described in terms of body structures & functions, activities & participation and contextual factors. The latter are personal or environmental factors that may act as barrier or facilitator of functioning. Studies examining ankle pain in PwH from this broad biopsychosocial framework are absolutely lacking, which contrasts to the bulk of literature in other musculoskeletal pain conditions such as low back pain or osteoarthritis. Understanding the complexity of ankle pain in PwH will allow to better asses and manage pain in order to achieve optimal functioning, including a better functioning of the surrounding joints. This is the first study evaluating the structural and functional status of affected ankle joints combined with the local and central pain condition in patients with haemophilia in order to better understand the complexity of ankle pain.

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  • Research Project

Changing towards a cultural-sensitive multidisciplinary lifestyle approach for women with type 2 diabetes in Oujda, Morocco. 01/01/2019 - 31/08/2022

Abstract

This South Initiative is the first step towards a long-term general objective that aims to improve the quality of life and well-being of people living with type 2 diabetes (T2D) in the Oujda region by developing a multidisciplinary approach in the management of T2D, based upon international guidelines but adapted to the regional socio-economic and cultural context, and with a focus on empowerment of Muslim women. The intermediate results of this SI project proposal are: 1) Facilitators and perceived barriers in female patients with T2D towards change to a healthier lifestyle are known. 2) Characteristics of patients with T2D in the region of Oujda (prevalence, lifestyle, age, gender,…) are analysed. 3) Master and bachelor students have gained experience by participating to relevant research. 4) All involved stakeholders shared existing and newly ac-quired knowledge and expertise. 5) Facilitators and perceived barriers in health professionals of different disciplines to work together in the management of T2D are known.

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  • Research Project

Which exercises to prescribe in patients with subacromial pain? A multi-center randomized controlled trial. 01/10/2018 - 30/09/2022

Abstract

Shoulder pain is the third most common musculoskeletal disorder, with estimated lifetime prevalence around 10%. The prevalence for daily non-specific shoulder pain in the working population is around 12%, and up to 23% of the workforce seeking professional help with a shoulder related disorder have been sick-listed for at least one week. People with shoulder pain are often disabled to the point where they cannot live a normal life, suffering from sickness absence and poor quality of life. Clinically, subacromial pain is the most common form of complaint and causes a great loss of shoulder function, which accounts for 33% of all shoulder-related healthcare contacts. Previous studies have clearly shown that exercises are the preferred first choice of treatment for patients with subacromial pain. However, there are some studies supporting the benefits of using targeted strength training in patients with subacromial pain, but it is not clear what the best type of exercise combined with the patient response a health care provider should prescribe: should the patient feel pain during the performance of an exercise, or should pain be avoided? The present project aims to answer the following research questions: Which type of intervention (pain acceptance/pain avoidance) is superior to self-reported improved patient reported shoulder pain, function and quality of life? And which type of intervention (pain acceptance/pain avoidance) is superior to improved changes in the tendon structure, measured by Ultrasound? An RCT study will be conducted as a randomized, controlled, blinded multi-center trial in both public and private practice settings in Denmark, Belgium, Spain and The Netherlands with inclusion of patients from National Health Service musculoskeletal orthopedic outpatient departments and/or general practitioners. Both intervention groups will receive eccentric, concentric and isometric exercises of the same load, frequency, progression etc. However, the difference between both intervention groups will be based on the specific movement, which is either pain aggravation or not. The project is organized in cooperation between University of Antwerp (Belgium), University of Malaga (Spain), University College Rotterdam (The Netherlands) and University of Southern Denmark (Denmark). With this, the current project will have the assistance of the national and European shoulder networks in order to be sure of sufficient shoulder pain patients with different cultural backgrounds. This project will contribute to clarify the best treatment option in the management of subacromial pain. Clinicians and care providers will be benefited of this increase in the body of knowledge, in order to steer subacromial pain treatment and to improve clinical decision-making, and reducing the chronification of SPS. With this, the present project also attempt to reduce the massive economic burden of subacromial shoulder pain on society.

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  • Research Project

Development and validation of a screening tool for central sensitisation pain in cancer survivors 01/10/2018 - 30/09/2021

Abstract

In addition to fatigue, pain is the most common frequent persistent symptom in cancer survivors. Pain following cancer leads to poor quality of life and impaired daily functioning. Identifying the origin or mechanism of the pain is a critical step in clinical decision-making. Awareness on the presence of so called central sensitisation pain in cancer survivors has increased past decades. In this case pain can be explained by enhanced processing of nociception (sensitization) within the peripheral and/or central nervous system and by altered pain modulation. Central sensitization pain relies on different mechanisms than typical nociceptive and neuropathic pain and therefore warrants a different treatment strategy. Unfortunately, up to now, no validated tool for the identification of central sensitization pain in daily clinical practice is available. Therefore, the aim of the proposed project is to develop a tool for the identification of central sensitisation pain in cancer survivors with persistent pain several months after finishing treatment. First, the tool will be developed and validated in a cohort of cancer survivors with persistent pain recruited in a hospital setting. Second, pilot testing to prepare a large-scale validation study in a non-hospital setting will be performed. The present project will be an important step in improving pain management in cancer survivors with persistent pain.

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Pathophysiological mechanisms and exercise counter measures of hypermetabolism and muscle wasting in severe burns. 01/10/2018 - 30/09/2020

Abstract

Severe burns cause a cascade of unwanted effects such as an overdrive in metabolism, loss of muscle tissue, and loss of the body's ability to effectively handle glucose as an energy source and an enhanced inflammatory state. Against common belief, these side effects have shown to persist for years, and cause long-term consequences such as a reduced physical fitness and a higher risk of developing diabetes. Despite many research efforts, much of these persistent side effects that occur in burns are not well understood. Efforts to counteract the negative effects on metabolism, the loss of muscle tissue and to prevent or lessen the amount of the inflammation have not yet been successful. Exercise rehabilitation has the potential to, at least partly, prevent and/or restore the negative consequences as has been shown in other critically ill hospitalised patients. This project will, therefore, shed more light onto 1) the short- and long-term effects of severe burns on energy metabolism, loss of muscle tissue, and inflammation in adults, and 2) the effect of an 8-week exercise rehabilitation programme during the initial period of hospitalization on these parameters. In order to successfully execute this project, we will study patients from Belgium and Chinese burn centres to get a better understanding of the bodily derangements, which will lay a foundation for better future care of burn patients.

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Predicting outcome of total knee replacement surgery in patients with knee osteoarthritis: a prospective study on the role of phenoptypic characteristics related to osteoarthritis. 01/07/2018 - 31/12/2019

Abstract

Even though a Total Knee Replacement (TKR) is an effective surgical treatment for end-stage knee osteoarthritis (KOA) and the majority of patients report substantial pain relief and functional improvement following this surgical procedure, literature shows that 20-40% of patients are dissatisfied with the postsurgical outcome. Given the high costs related to TKR surgery and the substantial number of patients who do not meet the level of improvement after surgery, the decision to implant a TKR should be very well-considered. It is crucial to improve our understanding of the mechanisms contributing to persisting pain and disability following TKR. There is growing body of research suggesting that in a subgroup of patients with KOA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain. Briefly, this means that the pain is to a considerable degree due to hypersensitivity of the central nervous system, rather than being just caused by structural joint damage. Therefore, with our current ongoing study (funded BOF-DOCPRO4 project initiated November 1st 2017) we aim to understand the role of central pain processing in addition to structural and functional impairments related to KOA to predict unsatisfactory outcome (in terms of pain, symptoms, physical performance and QOL) after a TKR in patients with KOA. However, within the context of recent research developments in OA and recent suggestions proposed in international literature, we would like to upgrade our current research project and add a few measurements. In very recent systematic reviews, several OA phenotypes have been proposed, which are in part in line with the aims of our current ongoing study. However, we additionally want to investigate to what extent metabolic and inflammatory factors are related to the clinical expression of OA and are contributing to prognosis and treatment response. Moreover, in literature, different phenotypes are hypothesised and it is also plausible that the proposed phenotypes are not complete distinct entities and that interactions may exist. Therefore, we want to upgrade our research study and add some measurements to investigate the role of different OA characteristics, namely structural joint damage, inflammatory and metabolic factors and pain processing factors, in the clinical expression of KOA before and after a TKR. Moreover, we aim to unravel the interrelationship between these factors and to determine different phenotypes in relation to the outcome and prognosis after TKR, since these phenotypes may be particularly important for tailored treatment. In order to reach these objectives, a longitudinal prospective study will be performed, with specific data collection presurgical (T0) and 6 months (T1) and 1 year (T2) postsurgical. The strength of our current research study (including the proposal to upgrade the project and to add measurements) is that we will examine all putative prognostic factors on the basis of the biopsychosocial model. Besides several psychological factors (cognitive emotional modulation), we assess biomechanical factors (i.e. structural impairments, such as radiographic severity of OA, and functional impairments such as muscle weakness and proprioceptive deficits) and metabolic and inflammatory factors, and examine the role of altered central pain processing. We want to define OA phenotypes that are easy interpretable and possibly related to the outcome and prognosis after TKR.

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Investigation on a critical time window for gait training in stroke rehabilitation. 01/07/2018 - 31/12/2019

Abstract

Animal models have shown that motor training is effective only if initiated early after stroke. This activity-induced recovery pattern temporally matches increased gene expression important for neuronal growth and plasticity in the post-stroke brain. It seems that the brain after damage induces a window of enhanced neuroplasticity during which greatest rehabilitation gains can be achieved. In human stroke care, earlier rehabilitation is associated with improved outcome, however it remains unknown whether a similar time window exists and how to take advantage in clinical practice. In the current research project, gait training will be initiated at a very early stage using a mobile, wearable exoskeleton allowing even acute patients to walk over-ground. A comparison of clinical outcome with a group receiving the same intervention at a later stage will allow to investigate on the factor timing. Moreover, an association between functional improvement and outcomes on neuro-motor recovery (neuro-imaging, Fugl-Meyer Assessment, biomechanical gait analysis) will be investigated. This will enlighten our understanding on when an intervention should be provided in order to affect the proportions of plastic re-organization. Further research on larger populations with a longer follow-up is needed to confirm preliminary results and finally implement these insights into therapeutic strategies and clinical practice. This approach can lead to substantial changes in how rehabilitative treatment is provided to neurological patients.

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Robot-assisted gait training: a way to investigate a critical time window for stroke rehabilitation. 01/01/2018 - 31/12/2018

Abstract

Animal models suggest a limited time window of increased repair activity in the brain during the first weeks after damage, for example after a stroke. Within this time window, training responsiveness is increased suggesting that this is the optimal time to start intensive rehabilitation, e.g. gait training. Disappointingly, early stroke care is characterized by physical inactivity. This lack of intensive therapy probably explains rather disappointing mobility outcome, since half of stroke survivors leave rehabilitation facilities in a wheelchair. The World Health Organisation expects 1.5 million new cases of stroke per year in 2025. If innovation in stroke rehabilitation lacks, the increasing burden of stroke will inevitably lead to a growing disabled and dependent chronic stroke population. A novel therapeutic strategy are wearable exoskeletons. This device allows an earlier and more intensive rehabilitation approach as it assists in weightbearing and walking. This technology has the potential to change acute stroke rehabilitation from a passive into a motivating, active time as it allows early training in an enriched learning environment. However, due to its recent development this type of therapy is not yet investigated. We aim to fill this gap with the proposed project by delivering published evidence on feasibility and effectiveness.

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The effectiveness of a modern educational intervention for pain and pain-related disability after breast cancer surgery. 01/10/2017 - 30/09/2021

Abstract

In addition to fatigue, pain is the most frequent and persistent symptom following breast cancer and breast cancer treatment. Despite the effectiveness of different physical therapy modalities, such as manual techniques, passive mobilizations and exercises, many patients still experience pain and subsequent difficulties in daily functioning at short and long term. Past decades, the awareness on the important role of educational interventions in the management of pain in general has increased. Educational interventions aim at explaining and improving the knowledge, control and attitude of the patient regarding his/her pain complaint. However, these educational interventions are often restricted to more biomedical pain management instructions and general advice on physical activity and analgesics (= traditional biomedical education). Only recently, increased knowledge on pain mechanisms led to a more modern educational approach. This modern approach is suited to explain more complex issues associated with pain and takes into account many more factors related to pain. To our knowledge, only one controlled trial investigated the effectiveness of a modern educational intervention in the early stage of breast cancer treatment. The results were very promising for shoulder function. However, only short-term effects were examined, no randomization was performed and no pain-related and socio-economic outcomes were evaluated. Therefore, the aim of the proposed project is to investigate the effectiveness of a similar modern educational program, in addition to standard physical therapy care, in the early treatment phase of breast cancer in comparison with traditional biomedical education. A randomized controlled trial will be performed with a long-term follow up period. The primary outcome parameters are pain intensity and pain-related disability. Secondary outcomes are other dimensions of pain, physical and mental functioning, return to work and health-care related costs.

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Predicting outcome after total knee replacement surgery in patients with knee osteoarthritis: a prospective study on the role of altered central pain processing in addition to structural and functional impairments related to knee osteoarthritis. 01/10/2017 - 30/09/2021

Abstract

Even though a Total Knee Replacement (TKR) is an effective surgical treatment for end-stage knee osteoarthritis (KOA) and the majority of patients report substantial pain relief and functional improvement following this surgical procedure, literature shows that 20-40% of patients are dissatisfied with the postsurgical outcome. Similar to other chronic pain conditions, there is growing body of research suggesting that in a subgroup of patients with KOA the clinical picture is dominated by sensitization of central nervous system pain pathways (i.e. central sensitization) rather than by structural dysfunctions causing nociceptive pain. Briefly, this means that the pain is to a considerable degree due to hypersensitivity of the central nervous system, rather than being just caused by structural joint damage. Therefore, it is not surprising that surgical interventions such as TKRs do not guarantee pain reduction and functional recovery, as the pain goes beyond the joint. Given the high costs related to TKR surgery and the substantial number of patients who do not meet the level of improvement after surgery, the decision to implant a TKR should be very well-considered. It is crucial to improve our understanding of the mechanisms contributing to persisting pain and disability following TKR and it emphasizes the need for further research on the role of altered central pain processing in patients with end stage KOA awaiting TKR surgery. This research proposal has two main objectives: 1) to unravel to which extent central pain processing and structural and functional impairments contribute to the clinical expression of KOA (pain, symptoms, physical performance and quality of life) in patients with end-stage KOA before (at baseline) and 6 months after primary TKR surgery. 2) to unravel which factors are predictive for an unsatisfactory outcome (in terms of pain, symptoms, physical performance and quality of life) 6 months and 1 year after a primary TKR. In order to reach these objectives, a longitudinal prospective study will be performed, with specific data collection presurgical (T0) and 6 months (T1) and 1 year (T2) postsurgical. This study allows identification of prognostic factors for unsatisfactory outcome in KOA patients after a primary TKR. Previous longitudinal studies investigating predictors of poor outcome after TKR, mainly focused on structural and functional factors related to the knee joint, while central pain processing was left unnoticed. Other studies mainly focused on psychological factors as potential predictors of poor outcome. The strength of the recent proposal is that we will examine all putative prognostic factors on the basis of the biopsychosocial model. Besides several psychological factors (cognitive emotional modulation), we assess biomechanical factors (i.e. structural impairments, such as radiographic severity of OA, and functional impairments such as muscle weakness and proprioceptive deficits) and examine the role of altered central pain processing measured in four ways (Pressure Pain Thresholds, Conditioned Pain Modulation, tactile acuity, Central Sensitization Inventory questionnaire). In this study, it is hypothesized that in patients with altered central pain processing an unsatisfactory effect of TKR surgery on KOA pain, symptoms, physical performance and quality of life can be expected, as there is no clear relation between peripheral input and perceived pain. It is possible that in this subgroup interventions aiming to desensitize the central nervous system might be more beneficial. In future interventional research, it can be clarified whether new interventions, such as cognitive-behavioral therapy or therapeutic pain neuroscience education, whether or not in combination with surgery, are useful. These new interventions target different aspects such as the central nervous system in contrast to therapeutic modalities that are only directed to structural knee joint pathology.

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The effects of exercise on energy expenditure and muscle function in severe burned patients. 01/10/2017 - 30/09/2018

Abstract

Severe burned patients undergo rapid increases in metabolism (hypermetabolism) and increased energy expenditure caused by the initial inflammatory and humoral responses. These responses also elicit, on top of the bed rest period, a cascade of negative reactions leading to additional muscle wasting. Muscle wasting itself leads to insulin resistance and may have long-term health consequences. Some of these effects persist from the first few days following severe burn injury to as long as three years later after wound closing. Although insulin resistance is assumed to be triggered by several catabolic factors, an important contributor to insulin resistance is muscle wasting itself. Insulin-resistance, may eventually lead to diabetes mellitus and is a long-term complication of severe burn patients which has major implications for future morbidity and mortality. Physical exercise has been shown to affects both the metabolism as well as skeletal muscle function in oncology, cardiac patients, obstructive lung diseases and diabetic patients. In addition, physical exercise in critically-ill patients has also been shown to have beneficial effects on general health outcome parameters. Therefore, in the present study we will investigate the effects of severe burns [≥ 30 % total body surface area (TBSA)] on energy expenditure, hypermetabolism (especially insulin and glucose homeostasis) and muscle function (strength). Besides the fundamental research questions we will investigate the effect of an 8 week (3 times/week) rehabilitative exercise strength training on energy expenditure, hyper metabolism and muscle function. For the long-term effects we will investigate the Quality of Life (QoL) in patients undergoing such an additional rehabilitative program on top of standard-care. For this purpose we will use both general as well as burn specific questionnaires regarding QoL.

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Scapula Tilter: correction of scapular dyskinesis in patients with subacromial pain syndrome: the ffect of an orthopedic device. 01/09/2017 - 01/03/2019

Abstract

Subacromial pain syndrome is the most common cause of shoulder pain, accounting for 50% of all shoulder pain cases. Scapular dyskinesis has shown to be a key factor associated with many shoulder disorders, such as the subacromial pain syndrome and glenohumeral shoulder instability. Two Master students product development have created (and privately defended) a basic prototype of an orthopaedic device that is aimed at correcting the scapular position. The current project proposal is aimed at bringing this product to the market. First, the prototype will be further developed and adapted with confirmation of its efficacy, i.e. the apparatus can indeed correct scapular position. Second, this improved prototype will be used within a smallscale clinical study to demonstrate that the apparatus can reduce pain in patients with subacromial pain syndrome. At the same time, a trajectory of valorization will be developed to investigate the possibilities of bringing the product to the market.

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Tension reducing taping as a mechanotherapy for hypertrophic burn scars. 01/07/2017 - 31/12/2018

Abstract

Background: Hypertrophic scarring following burn injuries remains a real concern and clinical challenge. The prevalence of hypertrophic scarring following burns reaches up to 70%. There is increasing acknowledgement that mechanical forces can regulate inflammation and fibrosis and therefore may be used therapeutically to stimulate tissue repair and remodeling. This mechanism is referred to as "mechanotherapy". Specific objectives : A STIMPRO financing allows us to confirm the hypothesis that mechanotherapy can remodel hypertrophic scarring by use of a newly developed taping technique that reduces tension on pathological burn scars. We will also investigate whether this is related to the phases of wound healing (proliferation/ maturation). Assessment of scar variables will provide fundamental knowledge needed for further development of mechanotherapy. Novelty: This is the first study that attempts to confirm the mechanotherapy hypothesis in reducing tension, by the use of elastic therapeutic tape, to improve hypertrophic scarring. Method: A prospective cohort study will be performed. Scar sites will be treated with "standard of care" (pressure garments, silicone and moisturisers as prescribed by the treating physician) + mechanotherapy (newly developed specific taping technique with kinesio tape). A six months enrolment and intervention period followed by a 12 month follow-up period and completion period will be anticipated totalling 18 months. Link to previous and future research: This project is a continuation of the work that has been done by our consortium (REVAKI & Oscare). Our collaboration has led to the PhD. of Jill Meirte in 2016, six joint publications in peer reviewed journals and numerous presentations at international conferences. Prior to this project we have already conducted a pilot study. The confirmation of the effectiveness of the taping technique on reducing mechanical tension in the pilot study was a prerequisite for the current project. Financing and finalizing the project, as proposed here, will significantly increase our success in finding additional funding of, for example, a randomized control trial (e.g. FWO-TBM).

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Level of physical activity in relation to cardiorespiratory fitness in 6 to 8 year old ambulatory children with cerebral palsy. 18/05/2017 - 17/05/2019

Abstract

Compared to previous generations, children show increasing inactivity which puts them at risk for several health issues related to a hypoactive lifestyle. Children with neuromuscular diseases, such as Cerebral Palsy, are even at higher risk. Recently first Cerebral Palsy specific phyiscal activity and exercise guidelines were presented. Before these guidelines can be clinically implemented, insights in (hypo)active lifestyle are nescessary. The primary objective of this study is to investigate the level of physical activity in ambulatory children with CP during the first years of primary school (6-8 years old) in Flanders and to study the relation with cardiorespiratory fitness and overweight. Secondary we aim to establish a clinically applicable protocol for the evaluation of cardiorespiratory fitness in children with CP and to test the implementation in the CP Reference Centers of Antwerp and Leuven.

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T-GaiD: Treatment of Gait disorders in Dravet syndrome. 01/01/2017 - 31/12/2020

Abstract

Dravet syndrome is a severe infantile onset epilepsy syndrome with a prevalence of 1/15.000 to 1/30.000. An infant with an apparently normal development presents around 6 months of age with a convulsive status epilepticus. Seizures can be triggered by fever, illness or vaccination. Because of its drug-resistance, in the past, most attention has been paid to seizure control. However, developmental and behavioural problems also become a serious concern during the second year of life. Outcome is poor, with intellectual disability and ongoing seizures. On the long term, the deterioration in gait is very characteristic. A crouch gait pattern develops that largely impacts the daily life functioning. Most children maintain the ability to walk around the house, but for longer distances they must rely on wheel-chair use, which further negatively affects their mobility. Gait analysis, when combined with physical examination, provides quantitative information to guide treatment of gait disorders and assess its outcome. The goal of this project is the development of a clinical decision framework based upon 3D gait analysis to diagnose and treat mobility problems in children with Dravet syndrome. Two major university hospitals in Flanders (UZA and UZ Leuven) are partners in this project. The parent organisation "Stichting Dravetsyndroom Nederland/Vlaanderen" will also participate, as intermediate partner to facilitate contacts between all parties being patients and their caregivers, clinical gait labs and treating physicians.

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Predicting outcome after total knee replacement surgery in patients with knee osteoatthritis 06/10/2016 - 01/12/2017

Abstract

Factors predicting poor outcome in knee osteoarthritis patients following total knee joint replacement (TKR) surgery will be investigated, with focus on the role of pain due to neuroplasticity (i.e. hyperexcitability of the central nervous system). This will increase insight in the success rate and reasons behind the highly varying satisfaction after TKR and may help in future decision making regarding need for and timing of TKR, as well as the needs for pre- and postsurgical rehabilitation.

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The effect of conservative treatment of temporomandibular disorders on somatic tinnitus. 01/10/2016 - 30/09/2020

Abstract

This project aims to improve the quality of care for patients suffering from tinnitus attributed to a temporomandibular dysfunction (TMD). This by verifying the effect of TMD treatment on tinnitus. As a next step, underlying working mechanisms of the applied treatment will be investigated (mediating factors). Third, variables that predict the treatment outcome (responders/ non-responders) will be analysed (prognostic indicators). Our findings wil be of importance for general practitioners, ENT specialists, audiologists, dentists and physical therapists, since they all deal with patients suffering from tinnitus.

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Identification of gait adaptability strategies in healthy adults, patients with vestibular dysfunction and stroke patients. 01/10/2016 - 30/09/2020

Abstract

The objective of this PhD study is to investigate dynamic balance control in a population consisting of healthy adults, patients with vestibular dysfunction and stroke patients, thereby exploring different strategies to adapt gait to reduced dynamic balance control. To do so, biomechanical measures of gait stability, will be considered as primary outcome measures. Secondary outcome measures are postural instability, falls and fear of falling, documented using the "Dizziness Handicap Inventory" (DHI) and the "Activities specific Balance Confidence scale" (ABC). Fall risk is determined using standardized clinical tests. The goal of this study is to gain further insight into the relation between variability in foot placement, measures of biomechanical stability and postural instability, risk of falling and documented falls. Different populations will be considered, consisting of community dwelling adults, patients with vestibular deficit and stroke patients. Patients with vestibular deficit are an interesting population to study gait adaptability because, despite loss of vestibular function, in unilateral vestibular deficit no increased risk of falling is observed. In stroke patients, on the other hand, up to 50 percent annually reports a fall. Differences in gait adaptability strategies in these three populations will be investigated using a case-control design. To investigate predictive ability of gait stability measures a prospective cohort study will be performed. Insight into gait adaptability strategies creates opportunities to develop guidelines for gait training and rehabilitation.

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Rehabilitative ultrasound imaging (rusi) in the physical evaluation of shoulder pain patients. 01/10/2016 - 30/03/2017

Abstract

The main aim of the project is to study the importance of acromiohumeral distance (AHD) and coracohumeral distance (CHD) in patients with chronic shoulder pain, and establish a comparison with people free of chronic shoulder pain. Shoulder impingement syndrome (SIS) is frequently related to a decrease of acromio-humeral distance (AHD), known like one of the extrinsic factor presented as possible cause for Shoulder Pain Syndrome (SPS). The evaluation of subacromial space has been traditionally carried out by magnetic resonance imaging, although in the last years ultrasonography has appeared as a more accessible, non-invasive and non-ionizing tool to measure this space. Quantifying this space in people suffering from chronic shoulder pain is challenging. If there is any relationship between changes in AHD and shoulder pain-function and range of movement (ROM) is still unknown. On the other hand, coracohumeral distance has been also considered as a possible risk factor for people suffering for anterior shoulder pain, being measured at the moment by MRI and CT (computed tomography). If a standard method could be develop to measure both spaces, and to determine the normative values and the relationship between these quantitative measures and shoulder pain-function and mobility, it could be of help to identify, in one hand, people at risk of perpetuating chronic shoulder pain and, on the other hand, steer treatments, contributing to increase the body of knowledge of the field. Hence, the aim of this project will be to determine the association between AHD-CHD and chronic shoulder pain and function, in addition to ROM-free of pain, and how AHD-CHD can be affected after the application of a multimodal physiotherapy program.

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Scapular positioning and 3d motion in subjects with and without neck pain. 01/07/2016 - 31/12/2017

Abstract

;Neck pain is one of the three most commonly reported musculoskeletal complaints, with point prevalence's varying between 10% and 22%. The lifetime prevalence has been estimated to be between 67% and 71% indicating that approximately two-thirds of all individuals will experience an episode of neck pain at some time during life. Several alterations in scapulothoracic muscle activity has been reported in patients with neck pain. In addition, there is clinical evidence that scapular position at rest and scapular motion during elevation of the upper limb may be altered in individuals with neck pain when compared to a healthy population. However, the literature clearly lacks a comprehensive studying of this relationship between scapular dysfunctions and neck pain. These insights may contribute to the rationale for the development of new therapeutic and/or preventive interventions. Therefore, the general purpose of this study is to obtain an understanding in the movement of the scapula in patients with neck pain in comparison to healthy controls. This leads to the following research questions: Do subjects with neck pain have a different movement pattern of the scapula compared to asymptomatic control subjects? and which variables affect scapular movement in neck pain patients? Consequently, patients with grade II neck pain according to the Classification of The Bone and Joint Task Force on Neck Pain and matched controls will be enrolled in this study. Pain and function will be evaluated with a Visual Analogue Scale, Neck Disability Index, Neck Bournemouth Questionnaire and CROM for cervical range of motion. The movement of the scapula will measured with the Polhemus 3SPACE FASTRAK, in order to register three scapular motions: posterior tilting (X-axis), upward rotation (Y-axis) and external/internal rotation (Z-axis).

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Development and validation of an electrode positioning system for EIM measurement. 01/05/2016 - 30/06/2017

Abstract

Active muscle contractions are measured through elektro myography (EMG), where the electrical signals of nerves causing the muscle to contract are measured. The challenge is to measure inactive muscle contraction, aslo known as enhanced muscle tone, were no causing electrical signal is produced, however the muscle is in a contracted state. A well-known inconvenience is an enhanced muscle tone of the trapezius (stiff neck), in which physiotherapy is commonly applied to relieve the disease. In this project we aim to develop a method to measure muscle contraction independent from EMG signals, that can be applied to measure muscle tone and assess the effect of physiotherapy in patients who suffer an enhanced muscle tone.

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Research in the field of the neurological and musculoskeletal movement analysis. 01/02/2016 - 30/09/2021

Abstract

"Life is animation. To live is to move. For humans, movement is essential for our survival" Efficient movement is complex and requires an ultimate integration of balance control and movement coordination. An interesting approach to gain insight into these processes of motor control is the neuromechanical concept. This concepts stresses the interaction between the neural processes and the biomechanical laws of motion that together shape the movement patterns. The movement outcome hereby depends on the interaction between the individual and its properties, the task demands and the environmental constraints. Applications of neuromechanics include ameliorating human health problems by exploring how processes such as e.g. development, ageing, loss of sensory information or neurological pathologies affect the movement outcome. One of the most important movements in daily life is gait. During the life span, both developmental processes, such as growth and neuro-maturation, as well as ageing affect the gait pattern. The general consensus is that a lot of adaptations in gait, both in children and elderly, are related to balance control. Characterizing balance during locomotion is recently a hot topic. A range of different measures to quantify stability during locomotion are developed but the validity and reliability of each of these measures is not yet fully understood. The goal is to investigate different parameters for assessing gait stability in children, adults and elderly thereby describing changes in dynamic balance control across the entire lifespan. From the neuromechanical concept it is evident that sensory information is essential in goal directed movement and loss of sensory information might have tremendous effects on the control of locomotion. Knowledge on the processes of development and ageing on balance, together with the results from explorative research regarding good collective output variables describing stability during locomotion, will be transferred to research performed in patients with uni- or bilateral vestibular deficits (both children and adults). Good parameters should be able to detect balance deficits or deterioration of balance and provide insights into possible compensation strategies. Furthermore, therapeutic interventions such as balance training programs can be developed and evaluated based on this knowledge. Also typical problems in neurological populations, such as muscle weakness and problems with selective muscle control, give rise to a deteriorating gait that in its most progressive form is described as a crouch gait. In cerebral palsy a large body of knowledge and expertise has been built over the years on how to treat these gait problems and improve the patient's mobility. The possibilities of knowledge transfer from the treatment of CP patients to other neurological populations with gait deficits, e.g. children with Dravet syndrome, needs to be further explored.

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  • Research Project

Effectiveness of fluoroscopy-guided manua11ymph drainage for the treatment of breast cancer-related lymphoedema. 01/12/2015 - 30/11/2019

Abstract

Currently, each breast cancer patient with arm lymphoedema receives manual lymph drainage (MLD) to treat the oedema. Although MLD is applied to treat breast cancer related-lymphoedema (BCRL) for many years, there is still no consensus about its effectiveness. A possible explanation is that MLD is applied in an inefficient way: during MLD, hand manoeuvres are applied on all lymph nodes and lymphatics that may be anatomically present. After axillary dissection and/ or radiotherapy (for the treatment of breast cancer), the lymphatic system is damaged: lymph nodes are removed and often fibrosis of the superficial lymphatic system occurs. As a result, rerouting of the lymphatic drainage occurs. This rerouting is patient-specific. Consequently, it is possible that the traditional MLD needs be abandoned and a tailored approach needs to be established. Lymphofluoroscopy can aid to apply a more efficient MLD. During lymphofluoroscopy, a fluorescent substance is injected subcutaneously in the hand and it visualizes the transport of lymph from the hand up to the axilla and it demonstrates alternative pathways towards other lymph nodes. A second explanation why the traditional method of MLD is not proven to be effective, is that research has shown that MLD with high pressure (vs low pressure) is more effective to improve lymph transport, as well as gliding (vs no gliding). During the new method of MLD (or fluoroscopy-guided MLD), the therapist only performs hand movements on functional lymphatics and lymph nodes. In addition, the hand movements are applied with higher pressure and lymph transport through the lymph collaterals is stimulated by applying strikes across the skin. The main scientific objective entails examining the effectiveness of fluoroscopy-guided MLD versus traditional MLD versus placebo MLD, applied as part of the intensive and maintenance phase of Decongestive Lymphatic Therapy, for the treatment of BCRL. Primary end points are change of lymphoedema volume at the level of the hand, arm, shoulder and trunk and change of functioning problems related to the development of lymphoedema. Secondary end points are the improvement of patient's quality of life, the change of the extracellular fluid in the arm and change of lymphatic function. Secondary scientific objectives entail examining the relationship between different variables of lymphoedema at baseline. Therefore, a multi-centre double-blind randomised controlled trial will be conducted.

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  • Research Project

The effect of forefoot running on sports-related injuries of the lower limb and jump height in volleyball. 01/07/2015 - 31/12/2016

Abstract

Jump height is important in volleyball but jumping repeatedly can contribute to overuse injuries. Forefoot running is a technique that focuses on forefoot strike during running and keeping the balance on the forefoot. This study will investigate if training forefoot running is an efficient way of both preventing injuries and improving jump height in volleyball.

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  • Research Project

Explorative research regarding the control of voluntary, unpredictable movements 01/07/2015 - 31/12/2016

Abstract

The importance of assessing predictable movements in a biomechanical context has already been demonstrated in patients, athletes and dancers. Biomechanical analysis of unpredictable, non-cyclical movements has not been examined so far. This study aims to develop a method to study motor control in unpredictable movements and to gain more insight in the motor learning processes (by comparing novice and experienced performers).

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  • Research Project

Automatic detection of exercise oscillatory ventilation (EOV) in cardiopulmonary exercise testing (CPET): developing an accurate, practical and clinical applicable graphical user interface (GUI). 01/06/2015 - 31/05/2016

Abstract

Exercise oscillatory ventilation (EOV) is a strong prognostic parameter indicating early mortality. Before, this abnormal breathing pattern is often unrecognized because it is assessed subjectively by visual inspection or manually computed. The goal of this proof-of-concept, is to obtain automated detection of EOV and to create a clinical applicable interface. This interface could be integrated in existing cardiopulmonary exercise test software worldwide.

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  • Research Project

SimCP: a simulation platform to predict gait performance following orthopedic intervention in children with cerebral palsy. 01/12/2014 - 30/11/2018

Abstract

This project represents a research agreement between the UA and on the onther hand IWT. UA provides IWT research results mentioned in the title of the project under the conditions as stipulated in this contract.

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  • Research Project

Which factors influence mobility, pain and functioning in patients with adhesive capsulitis of the shoulder: a prospective longitudinal study 01/07/2014 - 31/12/2015

Abstract

The following study proposal concerns a prospective longitudinal study design in order to assess central sensitization and metabolic characteristics relative to the patients' pain, mobility and functioning in patients with adhesive capsulitis of the shoulder.

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  • Research Project

Scar tissue as a barrier in physiotherapy. 01/07/2014 - 31/12/2015

Abstract

Despite the widespread use of physical applications in physiotherapy there is lack of evidence based practice. The skin is an important barrier for topical applications. In scars, often present in patients receiving physiotherapy, the histology of the skin has changed, being an important factor of influence. The goal of this project is to investigate the bioavailability of scarred skin for vaso-active topical applications.

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  • Research Project

Development and validation of an ambulatory 3D motion capture based model to assess trunk performance and locomotion after stroke. 01/07/2014 - 31/12/2015

Abstract

In-depth biomechanical gait analyses have contributed to the understanding of movement patterns. However, movement analysis in home situations or even outdoors will augment its benefits. In this project we will develop a model linking 7 Xsens motion trackers to study trunk performance and locomotion. Furthermore, the reliability and validity of this model will be investigated by comparing the Xsens model with a Vicon optical camera system.

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  • Research Project

Manual and mechanical defibrosing techniques in scars after burns and major trauma. 01/10/2013 - 08/02/2017

Abstract

This project represents a formal research agreement between UA and on the other hand Oscare. UA provides Oscare research results mentioned in the title of the project under the conditions as stipulated in this contract.

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  • Research Project