Research Nick Gebruers

Abstract

Telerehabilitation and eHealth, albeit providing novel opportunities and advantages for rehabilitation and physiotherapy programs, still pose many challenges at societal, technological and individual levels. With this postdoc challenge we aim to recruit a candidate proficient in tackling these challenges at least at one of three levels: 1) societal: providing evidence of (cost-)effectiveness of telerehabilitation and eHealth in physiotherapy through large-scale intervention trials; 2) technological: advancing the technical level of eHealth in physiotherapy by research on technology and the inclusion of artificial intelligence (AI) for using collected patient data in clinical decision making; 3) individual: monitoring and/or alleviating barriers by researching emotions, cognitions, and behavior in different contexts to explain differences in outcome. By using innovative recruitment strategies (including triggering recruitment videos, and organization of a hackathon), MOVANT aims to recruit a high potential postdoc candidate to apply for an FWO postdoctoral fellowship and/or an MSCA-PF. The candidate will be supported by a promotor and a mentor team, consisting of several ZAP colleagues and the MOVANT research coordinator.

Researcher(s)

• Promoter: Meeus Mira
• Co-promoter: Gebruers Nick
• Co-promoter: Roussel Nathalie
• Fellow: Embrechts Elissa

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Gebruers Nick
• Co-promoter: Saeys Wim

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Van Daele Ulrike
• Co-promoter: Gebruers Nick
• Co-promoter: van Breda Eric
• Fellow: Schieffelers David

Research team(s)

• Movement Antwerp (MOVANT)

Project type(s)

• Research Project

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.

Researcher(s)

• Promoter: Gebruers Nick

Research team(s)

• Movement Antwerp (MOVANT)

Project website

Project type(s)

• Research Project