Zoekresultaten

Optimization of protocols using neuromuscular electrical stimulation for paralyzed lower-limb muscles to increase energy expenditure in people with spinal cord injury

OBJECTIVE: To evaluate if using surface neuromuscular electrical stimulation (NMES) for paralyzed lower-limb muscles results in an increase in energy expenditure and if the number of activated muscles and duty cycle affect the potential increase.DESIGN: Cross-sectional study.RESULTS: Energy expenditure during all NMES protocols was significantly higher than the condition without NMES (1.2 ± 0.2 kcal/min), with the highest increase (+ 51%; +0.7 kcal/min, 95% CI: 0.3 - 1.2) for the protocol with more muscles activated and the duty cycle with a shorter rest period. A significant decrease in muscle contraction size during NMES was found with a longer stimulation time, more muscles activated or the duty cycle with a shorter rest period.CONCLUSION: Using NMES for paralyzed lower-limb muscles can significantly increase the energy expenditure compared to sitting without NMES with the highest increase for the protocol with more muscles activated and the duty cycle with a shorter rest period. Muscle fatigue occurred significantly with the more intense NMES protocols which might cause a lower energy expenditure in a longer protocol. Future studies should further optimize the NMES parameters and investigate the long-term effects of NMES on weight management in people with SCI.

Design of a process evaluation of the implementation of a physical activity and sports stimulation programme in Dutch rehabilitation setting

BackgroundThere is a growing interest to study the transfer of evidence-based information into daily practice. The evidence-based programme Rehabilitation, Sports and Exercise (RSE) that aims to stimulate an active lifestyle during and after a rehabilitation period in people with a disability and/or chronic disease is prepared for nationwide dissemination. So far, however, little is known about the implementation of a new programme to stimulate physical activity in people with a disability in a rehabilitation setting. Therefore, a process evaluation of the implementation of the RSE programme within 18 Dutch rehabilitation centres and hospitals is performed in order to gain more insight into the implementation process itself and factors that facilitate or hamper the implementation process. This paper describes the study design of this process evaluation.MethodsDuring a three-year period, the adoption, implementation and continuation of the RSE programme is monitored and evaluated in 12 rehabilitation centres and 6 hospitals with a rehabilitation department in The Netherlands. The main process outcomes are: recruitment, reach, dose delivered, dose received, fidelity, satisfaction, maintenance and context. The process outcomes are evaluated at different levels (organisational and patient) and different time points. Data collection includes both quantitative (online registration system and questionnaires) and qualitative (focus groups and semi-structured interviews) methods.DiscussionThe nationwide dissemination of an evidence-based programme to stimulate physical activity and sports during and after a rehabilitation period is extensively monitored and evaluated on different levels (organization and patients) using mixed methods. The study will contribute to the science of translating evidence-based programmes into daily practice of the rehabilitation care. The results of the study can be used to further optimize the content of the RSE programme and to facilitate the implementation in other health facilities. Furthermore, the results of the study can help future implementation processes in the rehabilitation setting.

Controlling the stimulation of senses in design for dementia

A questionnaire to assess rehabilitation patients' experiences with motivational interviewing consultation in the context of physical activity stimulation

PURPOSE: The current article provides a description of the construction process of a short questionnaire that measures patients' experiences with a motivational interviewing consultation by a (sports) counselor in rehabilitation. Subsequently, results from confirmatory factor analyses are presented to investigate a first perspective on factorial construct validity of the questionnaire.MATERIAL AND METHODS: Based on motivational interviewing literature, an initial item pool was created. All items were critically reviewed, resulting in the new "Evaluation of Motivational Interviewing Consultation on Active Lifestyle and Sports" questionnaire. The final items were determined by a confirmatory factor analysis based on 890 completed questionnaires.RESULTS: The initial 26-item questionnaire consisted of four inter-correlated subscales. Factor analyses underpinned the proposed factors: acceptance, evocation, partnership, and non-adherent. After removing six items, an alternative model remained and showed an acceptable model fit. The internal consistency of the subscales derived varied from 0.70 to 0.90.CONCLUSION: The shortened questionnaire provides a feasible and easy to administer tool and may provide a cost saving method of assessing motivational interviewing fidelity from a patient's perspective in disability and rehabilitation. Implications for rehabilitation Many persons with a physical disability do not obtain the recommended amount of physical activity in order to maintain health. Stimulation of a physically active lifestyle through motivational interviewing is promising. Measuring motivational interviewing treatment fidelity is time consuming and often from a counselor's perspective. We developed a short questionnaire facilitating the assessment of treatment fidelity at the side of the client. Our questionnaire provides a feasible and easy to administer tool for assessing MI fidelity in daily rehabilitation practice.

Are more able students in higher education less easy to satisfy?

Student satisfaction gains an increasingly central position in the context of quality measurements. However, student satisfaction can also be stipulated as an important motivational factor for students as learners. This study combines this perspective on student satisfaction with the notion of differences in students’ ability. We hypothesize that differences in ability result in differences in student satisfaction. In line with concepts of high ability education, it is additionally hypothesized that this relation is mediated by educational stimulation - divided in cognitive, creative and professional stimulation – as well as by participation in honours programs. A structural equation modelling (N=733) of factors affecting student satisfaction in higher education shows that cognitive, creative and professional stimulation are the largest influencers of bachelor students’ sense of satisfaction. The interrelation between these three aspects of educational stimulation also shows the complexity of higher educational practice, since it suggests that cognitive stimulation cannot be realized without a creative factor, and vice versa. Professional stimulation needs both. Furthermore, the results show that educational stimulation mediates the effect of students’ ability on their educational satisfaction. This implies that changes in education can indeed influence students’ educational satisfaction, especially by providing educational quality. Finally, considering students’ ability level, it is shown that especially cognitive abler students are less easy to satisfy. The combination of educational stimulation and ability suggests that especially the more cognitive able students do not feel themselves sufficiently cognitively or creatively stimulated, and hence are less satisfied in vocational higher education.

Focused stimulation intervention in 4-and 5-year-old children with developmental language disorder: Exploring implementation in clinical practice.

Purpose: Applying evidence-based grammar intervention can be challenging for speech and language therapists (SLTs). Language in Interaction Therapy (LIT) is a focused stimulation intervention for children with weak morphosyntactic skills, which was developed to support SLTs in incorporating results from effect studies in daily practice. The aims of this Clinical Focus are (a) to explain the principles and elements of LIT and stimulate use in daily SLT practice and (b) to describe the effects of LIT on morphosyntactic skills of 4- to 5-year-olds in special education, compared to usual care. Method: With a description of LIT, we provide guidance to implement evidence-based intervention. Important elements are as follows: proper selection of therapy goals, language facilitating techniques, child-centered and clinician-directed elements, and the use of scripts. Our focus in the description is on the support and practical solutions LIT tries to provide to SLTs. We also explored the implementation of LIT in special education, to improve morphosyntax in 4- and 5-year-old children. We provided SLTs with training and designed protocols for each therapy session. The effects of LIT were measured in a single-case A-B design, repeated in five children with developmental language disorders (ages 4;2-5;7 [years;months]). Conclusion: We conclude that implementation of LIT is possible if LIT is enriched with support in goal selection, protocols to guide therapy sessions, and training and coaching. In the single-case study, four children showed more growth in mean length of utterance during and directly following the LIT intervention phase, compared to the baseline phase with usual care, and in two of them, this difference was significant. The grammatical complexity measure "TARSP-P" showed an overall significantly higher score at group level during LIT, but limited effects on an individual level.