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1. Introduction
Rehabilitation medicine in the Netherlands was officially founded as a separate medical profession in 1955. Being a young multidisciplinary area of clinical practice and health care, rehabilitation medicine evolved from an initially clinically-founded discipline towards a more academic-based discipline at the start of this millennium. In 2008 clinical rehabilitation care was offered in 24 specialized rehabilitation centers, in university hospitals and in many of the larger general hospitals in the Netherlands.
www.revalidatie.nl/english
Human Movement Sciences has been intimately linked to rehabilitation from its inception as an academic discipline in Amsterdam in the early seventies. As distinct from other Western countries, in the Netherlands the professional training of paramedical and nursing staff is outside the university teaching program and part of a separate system of higher education that primarily offers professional bachelor and master programs. This is where physio-, occupational, vocational therapists, physical education and sports teachers are trained, also for rehabilitation practice. Human movement scientists follow a research-oriented university-based training program, focussed on the study of human movement, both with a fundamental and an applied connotation. ‘Human movement sciences’ (HMS) is an interdisciplinary study, encompassing a wide range of disciplines such as (exercise) physiology, psychology, anatomy, biomechanics, motor control & learning etc. It is offered as an independent scientific bachelor-master program at two universities (Amsterdam
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www.umcg.nl
2. The Dutch rehabilitation–research situation
The academic or research performance of the rehabilitation discipline in the Netherlands and Europe has been described briefly by Stam [5]. The survey involved the input in 4 key-rehabilitation sciences journals (Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Journal of Rehabilitation Medicine and Disability and Rehabilitation) throughout the year 2004. All publications were ranked to country of origin of the research and authors. The Netherlands ranked 3rd, among a group of 12 countries, and was responsible for 8% of the total number of publications. At (31%) the USA headed the list. However, the list would be quite different if the population size of each country were taken into account, as is indicated by Coppen and Bailey for a similar ranking on clinical medicine [6], where the USA ranked 9 and the Netherlands 6 on the number of citations per 1000 population. The impact of the contribution of the Netherlands to the field of rehabilitation research in an international context is considerable and in part explains the active organization of the current congress.
With the 4th International congress we also in part celebrate the 2nd lustrum and the success of the Rehabilitation program of the Netherlands Organization for Health Research and Development (ZonMw)
www.ZonMw.nl/english
www.scionn.nl
Many rehabilitation centers and university departments, and thus the rehabilitation field and the patients, benefit to this day from the success of the ZonMw funding program. It has boosted the scientific infrastructure of rehabilitation centers, both in personel as well as in technical facilities. It has – above all – stimulated the academic observation and thinking processes in rehabilitation practice and boosted the number of rehabilitation professionals with a research background. This is clearly of crucial importance for the quality of rehabilitation treatment and outcome. The importance of such a rehabilitation research and sciences agenda was very clearly stipulated recently by Frontera and colleagues with their analysis of the North American rehabilitation situation [8,9]; the bottom line of their statement being that: “…survival of the (…rehabilitation…) specialty, may depend, among other things on the quality of the knowledge base. Very few things could be more important for our patients.”
3. 4th International State-of-the-art-Congress ‘Rehabilitation: mobility, exercise & sports’
It is indeed in the context of this brief history that the 4th International Congress ‘Rehabilitation: Mobility, Exercise & Sports’ is taking place, as a multidisciplinary event and team effort, and as a natural outcome of the continued collaboration between (local and international) rehabilitation professionals, human movement, social and engineering sciences. The current congress program follows the preceding congresses in 1991 [10], 1998 [11] and 2004 [12–14] and the academic evolvement of the organizing team in a very natural way.
The theme ‘Rehabilitation: Mobility, Exercise & Sports’ of the 4th International Congress has also evolved from the continued research work in recent years in the (inter)national context. The program follows the intricate collaboration between human movement sciences and rehabilitation professionals and practice, which among others have evolved in the working group ‘Rehabilitation’ of the Netherlands Society of Human Movement Sciences (VvBN)
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vra.artsennet.nl
4. Mobility, Exercise & Sports
The theme of the congress, mobility exercise and sports in the context of rehabilitation practice, is of extremely great interest to human movement scientists, and rehabilitation professionals. It is indicated to be of key importance in the process of recovery in persons with chronic disease and in the context of long-term health [1,16,18–21].
Mobility is defined in the ICF as ‘…the ability moving by changing body position or location or by transferring from one place to another, by carrying, moving or manipulating objects, by walking, running or climbing, and by using various forms of transportation.’[2]. Being a mobile individual is crucial for function, participation and quality of life. The extent of mobility will be dependent on the structures and functions and the capacities of the individual, availability and quality of assistive technology and environmental optimization, as well as the interfacing between these and the individual. Above all, personal qualities will impact the final outcome (Figure 1) [1,2,15].
Important questions revolve not only around the functions and structures of individuals with different diagnoses but also around how these impact activities, participation and quality of life. Beyond that the role of assistive technology, environmental barriers and questions of their fine-tuning to individuals in the light of daily functioning (and sports) are issues for technologists and ergonomists, as well as for rehabilitation professionals and human movement scientists.
Rehabilitation practice, and the individual, can and will try to affect mobility through exercise, training and learning of motor skills and overall functional and physical capacities. Sports introduce a natural environment of physical exercise and skill learning as well as a social context of participation and enjoyment. Yet, diagnosis-specific guidelines for exercise and training as well as motor learning are often still limited in their scientific evidence-base [16,17]. Optimal strategies for rehabilitation have to be established in the context of long-term preservation of function, health and quality of life. Moreover, exercise and sports are supposed to have benefits, but the combination of impairment, assistive technology and intensity of daily activities, exercise and sports must also be viewed in the context of risks of overuse and secondary impairment, as has been described for manual wheelchair use [14,22–24]. Fine-tuning between assistive technology and individual functions and structures as well as the regular supervision and feedback of exercise and training in rehabilitation, activities of daily living and sports require a thorough understanding of underlying mechanisms and processes in a wide range of individuals, with different diagnoses, and at different levels of expertise and performance, from daily practice to elite sports at the Paralympics.
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5. What we seek for…
The current and future congresses seek for the evidence-base of mobility, exercise and sports in the context of rehabilitation diagnosis, treatment and strategy and also of long-term functioning, participation, health and quality of life. The ICF [2] is the leading contextual framework in the development of research activities, the organization of knowledge, understanding and clinical practice. The importance of the congress lies in the exchange of the state-of-the-art knowledge, lively debates and the exchange of experiences among a diversity of clinical professionals and researchers from different disciplines, backgrounds and countries, leading to a continued cross-cultural debate and exchange, as has been recently advocated as a necessity to further the international field of physical medicine and rehabilitation [26].
The keynote speakers, the oral program and the poster sessions assure such a formal and informal debate, during exhibition time, breaks, the social program and in leisure time. The congress model of a ‘one-track event for all’ has proved to be effective in that perspective and will lead to international exchange and collaboration.
As previously [10,11], and apart from the 3 day program, the congress will provide a congress book with 3-page summaries of all oral and poster contributions, which you see here in front of you. A set of 10–12 highlights of the congress will also be published in the well-established journal ‘Disability and Rehabilitation’ as a special issue. This will support the outcome of the congress as a tool in the international communication of rehabilitation and human movement sciences.
References
[1] Van der Ploeg, H.P., et al., Physical activity for people with a disability: a conceptual model. Sports Med, 2004. 34(10): p. 639–49.
[2] WHO, International Classification of Functioning, Health and Disability. 2001, Geneva: WHO.
[3] Gutenbrunner, G., A.B. Ward, and M.A. Chamberlain, White book on Physical and Rehabilitation Medicine in Europe. J Rehabil Med, 2006. 39: p. 1–48.
[4] Fletcher, R.W. and S.W. Fletcher, Knowledge Management, in Clinical Epidemiology, the essentials. 2005, Lippincott Williams & Wilkins: Philadelphia. p. 221–231.
[5] Stam, H.J., Research in physical and rehabilitation medicine in Europe: how are we doing? J Rehabil Med, 2006. 38(1): p. 1–2.
[6] Coppen, A. and J. Bailey, 20 most-cited countries in clinical medicine ranked by population size. Lancet, 2004. 363(9404): p. 250.
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[13] JRRD, S.i., Background on the 3rd International Congress. J Reh Res Dev, 2005. 42(3, supplement 1): p. 1–110.
[14] T&D, 3rd international Congress ‘Restoration of (wheeled) mobility in SCI rehabilitation, State of the art II’ I: its background. Technology and Disability, 1005. 17: p. 55–123.
[15] Rimmer, J.H., Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities. Disabil Rehabil, 2006. 28(17): p. 1087–95.
[16] Frontera, W.R., D.M. Slovnik, and D.M. Dawson, eds. Exercise in rehabilitation medicine. 2nd ed. 2006, Human Kinetics Publishers. 454.
[17] Durstine, J.L. and G.E. Moore, ACSM's Exercise management for persons with chronic diseases and disabilities. 2003, Chapaign: Human Kintecs, ACSM.
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[21] Rimmer, J.H. and D. Braddock, Health promotion for people with physical, cognitive and sensory disabilities: an emerging national priority. Am J Health Promot, 2002. 16(4): p. 220–4, ii.
[22] Nichols, P.J., P.A. Norman, and J.R. Ennis, Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions. Scand J Rehabil Med, 1979. 11(1): p. 29–32.
[23] van Drongelen, S., et al., Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury. Spinal Cord, 2006. 44(3): p. 152–9.
[24] van Drongelen, S., et al., Glenohumeral joint loading in tetraplegia during weight relief lifting: a simulation study. Clin Biomech (Bristol, Avon), 2006. 21(2): p. 128–37.
[25] Vanlandewijck, Y., Sports Science in the Paralympic movement. J Rehab Res & Devel, 2006. 43(7): p. XVII–XXIV.
[26] Negrini, S. and W.R. Frontera, The Euro-American rehabilitation focus: a cultural bridge across the ocean. Am J Phys Med Rehabil, 2008. 87(7): p. 590–1.
