Students work together with a person with a request for help

Written by: Christiane Grünloh, Stephanie Jansen-Kosterink, Marian Hurmuz

 

Five groups of students from the bachelor’s programme Creative Technology (CreaTe) at the University of Twente (UT) came up with creative solutions to solve issues from rehabilitation practice during the Remote Care Nearby course!

 

We offer the course Remote Care Nearby for several years now. Researchers Christiane Grünloh, Stephanie Jansen-Kosterink and Marian Hurmuz teach and supervise these students. From Roessingh, Centre for Rehabilitation, programme coordinator innovation Ina Flierman and rehabilitation physician Reinout van Vliet are involved. In April, the students completed the course. During their final lecture, they pitched their solution within the rehabilitation centre Roessingh.

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The students worked together with (former) patients of Roessingh, who were each allowed to propose a practical challenge. The students' assignment was to work with these persons to explore this challenge in depth and find out the actual problem behind it, and then come up with a solution with the help of technology. Prototypes were developed, on which patients could give their opinions and which were tested with patients. The results of these user tests were then fed into a new version of a prototype, leading to a final version which was pitched.

 

Group 1: The Blank-AID

It is very annoying when you wake up at night, have it too hot and can't get the blanket down a bit yourself. Or when it has cooled down and you keep having to wake up your partner to help you with the blanket. When the person asked “How can I make sure I don't have to ask my partner to pull my blanket up or down during the night?”, this group came up with the following idea: rings are made on the duvet cover, through which hooks with ropes are attached. These are attached to two small motors, which can move the blanket up and down. Because arm/hand function can be too impaired, the choice was made not to operate with a button, but with a touch sensor. This makes it very user-friendly for many disabilities and conditions.

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The students created a video showcasing their progress when developing the prototype. Click here to watch this video!

 

Group 2: Brei-De-Hand (Knit-The-Hand)


When your arm/hand function has deteriorated to the extent that you can no longer perform your hobby of knitting, it takes away some of the joy of life. This person's question was much broader at first, namely “The problem I am facing is that I can only use my left (lower) arm, especially my left hand, to a very limited extent. This is occasionally difficult for balance (catching) and it limits me in certain activities I liked to do.” In discussions with the students, who were tasked with properly defining the problem, it emerged that her question was, “How can I continue to perform my hobby of knitting with a deteriorated arm/hand function?”. The solution the students came up with was the Brei-De-Hand. A band that goes around the upper arm, where you insert the back of the knitting needle to keep it in the right place. In addition, a wooden support, which can be attached with one hand, on which the centre of the knitting needle rests.

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The person already has this prototype in use and is enjoying immensely the fact that she can now knit again

“Over the past few months, I was lucky enough to take part in a project in which a group of UT students were able to come up with a solution to a problem I faced after my brain infarct. From the ‘problems’ I had indicated, my students came up with a solution for no longer being able to knit, which is one of my biggest hobbies. The whole process lasted 10 weeks and I enjoyed it SO much! The students were enthusiastic, sweet and it worked: I can knit again - with one hand! I super enjoyed taking part in this project and not just because I can knit again, I would do it again in a heartbeat.”

 

The students were also very pleased that they could deliver a prototype that can be used, as one of the students points out:

“Over the past few weeks, I have been working with 5 other students from the University of Twente on a project for Roessingh, Centre for Rehabilitation. Right from the start, we were very motivated to find a solution to the problem that was presented. It was incredibly nice to work with this person and to see that she also enjoys this project so much. After many adjustments, the prototype has been tuned to her and she can finally knit again! This outcome is better than we as a group could have hoped for and it has given us great satisfaction to see that we have been able to help her further.”

 

Group 3: Rehapp


The mental piece is incredibly important during rehabilitation. This person became very frustrated because he thought he was making little progress. He did not have a good picture of his new normal and could not compare, so he did not see how well he was actually doing. His question was therefore “How can I gain more insight into my progress so that I don't become demotivated?” The students came up with the idea of an app, in which persons can create activities, such as walking for 5 minutes. Each time they perform the activity, they keep track of their progress like a diary. Here, they can use text, media, but also emojis to indicate their mood. Through a graph, the app clearly shows the progress of the rehabilitation. By sharing this with friends and family, they can also start the conversation when it appears that the person is less satisfied or not feeling well.

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Group 4: Hoist tillift


“How can I lift my daughter out of the wheelchair and into the wheelchair with a lift that I can take to appointments?” A good question, as the current folding lift was heavy, large and inconvenient. The students came up with a smaller version, made of lightweight material, that can offer much more freedom. With small wheels attached to an extra footrest, which can be applied to all kinds of wheelchairs via an adapter, the wheelchair remains well balanced and does not become top-heavy. The lift can lift as much as a maximum weight of 150 kilos, making it also suitable for adults.

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Group 5: Hoop


This person with ALS still enjoys cycling tremendously every day, about 20 kilometres a day in a modified tricycle. Because with ALS, the strength in the muscles keeps decreasing, this also brings more and more challenges. The question the students started working on is “How can I get from my wheelchair to my tricycle independently?” For this, they came up with Hoop. A kind of half hoop, attached to the ceiling in a rail. The person places their wheelchair on the designated spot. Hoop then comes over the person from above, where he just attaches his arms over the hoop. A resting moment is built in and then the device slowly rises. The person can then step with the Hoop to reach the desired spot. This replaces the rollator, making less demands on the muscular strength of the arms. Independence is the most important factor here.

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We are very proud of what the students learnt during Remote Care Nearby and, of course, what they delivered. The cooperation between students and a person with a need for help has, as far as we are concerned, but also as far as the students are concerned, a major added value to the course! Are you interested in combining a study subject with care practice and looking for help with this? Get in touch with us!

Christiane Grünloh
FOTO ERIC BRINKHORST
FOTO ERIC BRINKHORST

Christiane Grünloh

Email: c.grunloh@rrd.nl

Tel: 088 087 5723

Stephanie Jansen-Kosterink

Email: s.jansen@rrd.nl

Tel: 088 087 5717

Marian Hurmuz

Email: m.hurmuz@rrd.nl

Tel: 088 087 5771

PhD defence of Martin Tenniglo: Stiff Knee Gait in Stroke!

Written by: Marian Hurmuz

Last week, the last RRD PhD defence of 2023 took place! Martin Tenniglo defended his PhD thesis, titled: “Stiff knee gait in stroke: Walking down the road of different treatment options”. Stroke survivors often struggle with functional consequences: cognitive, emotional, sensory and motor impairments. These functional consequences lead to limitations in daily life. Of which a common problem is stiff knee gait. Many times, this problem arises due to abnormal activity of the rectus femoris during the swing phase. Two options are available for assessing this abnormal activity. But are these also suitable in this group of people? There are also several treatment options to reduce stiff knee gait. But how effective are these? Martin has dedicated his PhD to this topic. On Thursday the 7th of December (2023), he defended his thesis, which you can find here.

 

Martin's thesis covers the following topics:

  • Identifying the effect of Motor Branch Block (MBB) or NeuroMuscular Block (NMB) of the rectus femoris on knee kinematics and functional outcomes.
  • Identifying the diagnostic value of the Duncan Ely test in predicting abnormal rectus femoris activity in people after stroke who walk with a stiff knee.
  • Investigating the effect of functional electrical stimulation of the hamstrings in stroke survivors with a stiff knee gait.
  • Investigating the effect of Botulinum toxin injection in the rectus femoris in stroke survivors with a stiff knee gait.
  • Investigating the effect of rectus femoris transfer in stroke survivors with a stiff knee gait.

 

Martin ends his thesis with 6 key messages he wants to share with the clinic and that can be applied in the clinical setting. He also indicates where the focus should be on future research related to this topic.

We are very proud of Martin and his hard work! His research has meant a lot to both science and the clinic. The three different treatment options he studies are also applied at Roessingh, Centre for Rehabilitation. Martin continues his work as a physiotherapist, gait specialist and as a specialist in electrical stimulation. Amongst others, he works on the development of a knee flexion device and on the investigation of the effect of a chemodenervation in the vastii and rectus femoris. We wish him the best of luck in his career!

 

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Ankle-foot orthoses in rehabilitation after stroke: Off to the Norwegian fjords!

Written by: Corien Nikamp

Sometimes you receive those emails that you almost send toward the trash because it's yet another invitation to a magazine or conference article, but at the last minute you read them more carefully. Thank goodness for that! At the beginning of this year, that was also the case. I received an email from someone at the Norwegian Association of Orthotic and Prosthetic Designers, NITO. She remembered my presentations on the use of ankle-foot orthoses (EVOs) after stroke, at the International Society for Prosthetics and Orthotics (ISPO) World Congress in Kobe, Japan in 2019. We had not heard of Covid-19 then, so that congress sometimes seems to be from another time. However, she had not forgotten about the congress and my presentations and invited me to their annual congress in November to tell about my PhD study, including the latest developments, in front of the Norwegian audience. Invitations like that don't come along every week, of course, so last weekend I went to Trondheim.

 

Trondheim

It was a very successful weekend. Trondheim is not an unfamiliar area for me because of previous conferences. With a waterfront hotel and views of the fjords not a bad prospect for a short visit.

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I went through the queue in 20 minutes at Schiphol airport where I calculated 4 hours, so the trip to Trondheim went without any stress. If you then have to give your presentation on Sunday morning, but a gala dinner with subsequent party is scheduled on Saturday evening, it’s wait and see whether there will be an audience. But the Norwegians proved an interested audience and the room was very well filled.

 

Presentation about early AFO-provision

In my presentation, I discussed the different effects of early AFO-provision after stroke that I investigated in a longitudinal randomised study performed at Roessingh Research and Development (RRD). Since I had 45 minutes, I was able to go into detail about the different effects we studied: effects on functional outcome measures, gait pattern, muscle activation patterns and falls. In my presentations, I always find it important to return to the original question from clinicians at Roessingh, Centre for Rehabilitation that prompted my PhD study at the time:

 

Can I help this patient this soon after a stroke by giving him/her an AFO to support walking, or is it better to wait a while longer?"

 

Summarising almost 10 years of study in 45 minutes with 4 main points?

  • Yes, there are benefits by providing an AFO early after a stroke. Functional tasks can be performed faster at a higher level (independent walking, gait speed, balance, etc.), but the final level does not differ from later provision.
  • AFOs support drop-foot after stroke, but early provision does not affect movement patterns around hip and pelvis (neither does later provision).
  • Long-term use of AFOs does not affect muscle activation patterns and thus does not evoke “muscle disuse”.
  • Falls often occur when the AFO is not worn. So pay attention to what instructions you give to patients.
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Implementation of scientific research into the clinic

I continued the presentation with the latest developments: how do we ensure implementation of the results into the clinic? Based on the results of my PhD study, I set to work with doctors and therapists from Roessingh, Centre for Rehabilitation and Roessingh Rehabilitation Technology, to bring the answers provided by the study back into practice. In doing so, we have set up a new consultation service that will make it possible to check in the first weeks after a stroke whether someone might benefit from an AFO and then provide it quickly. Also with regard to instructions for the patient and his/her relatives, more attention is now paid to the difference between walking with and without an AFO and the increased risk of falling.

The story struck a chord with the Norwegian audience. Many approving faces during the presentation, nice questions afterwards and several conversations with orthotists asking where they can find the publications.

At RRD and Roessingh we hope to contribute to improve rehabilitation care in the field of AFOs after stroke.

Curious about more details on how we shaped the consultation hour, or how we can apply knowledge related to healthcare technology innovation and implementation at RRD to your own issue? Get in touch with us!

Corien Nikamp

Corien Nikamp, PhD

Email: c.nikamp@rrd.nl

Tel: 088 087 5762

Province, Municipality and Twente Board invest in powerful MedTech Twente cluster in 2030  

Growth boost for medical technology through investment in cluster organization

The kickoff of MedTech Twente 2030 marks an important follow-up step toward further growth and internationalization of Twente's medical technology cluster. The project focuses on a growing and powerful business cluster in the region and strengthens the ecosystem in three areas: community building for knowledge sharing and cooperation within the region, cooperation with other European clusters and international profiling and positioning. The plan is also a catalyst for the creation of multiple action agendas, to get Twente into the top European medtech regions by 2030. The kick-off of MedTech Twente 2030 took place during the MedTech Business Day, part of the first MedTech Twente Week. In the presence of cluster partners, entrepreneurs and business representatives, administrators from the Province of Overijssel, the Municipality of Enschede and the Twente Board explained why they are investing in the cluster. Some medtech companies also told about their developments and the importance of strong cooperation in and profiling of the region on MedTech.
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Investment in ecosystem results in growing international position of MedTech Twente

Eddy van Hijum, Deputy Provincial Executive of Overijssel: "Together we are investing in the growth of medtech companies in the region. After the previous honors for specific medtech projects, now comes this strengthening of mutual cooperation within the MedTech Cluster and external profiling. This is going to help advance the cluster as a whole and specific companies, resulting in positive effects on welfare and prosperity in the region.

Jeroen Diepemaat, alderman for the economy of the municipality of Enschede confirms that prognosis, and sees business activity growing fast in Twente, including at Kennispark Twente. "In various places medtech companies are building and establishing themselves on the innovation campus and realizing their ambitions. I am proud that we can support all these developments with a powerful cluster organization."

Victor Jan Leurs adds. "For optimal Gross Twents Happiness, health of residents is a very important component. Future care is under heavy pressure and medical technology is one of the solutions to keep care accessible and affordable for everyone. Our region and companies belong to the national top and can play a major role in this in the long term."

Driving forces behind the regional cluster are Oost NL, University of Twente, Hogeschool Saxion, World Trade Center Twente, Roessingh Research and Development, Health Valley, Kennispark Twente, Twente Board and Novel-T. "In mid-2020, on behalf of the various stakeholders, we offered Mona Keijzer, then State Secretary for Economic Affairs, a first action agenda with targeted investment proposals for the regional MedTech cluster. It is fantastic to see the traction since then, realized from a collaboration between entrepreneurs, governments and knowledge institutions and focused on growing companies. I am looking forward to the next phase!" said Jaap Beernink, CEO Novel-T. 

 

MedTech Twente Week

The first edition of the MedTech Twente Week took place from November 2 to 4, 2022. The success of the TechMed Event has been expanded into a broad multi-day program for researchers, corporates, startups, medics, students and investors, among others. There is plenty of focus on medical technology research, bringing MedTech innovations to the market and implementing them, accelerating MedTech business and making new connections. Together, we are strengthening our future health care with medical technology.

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