Publications by authors named "Lysanne van Silfhout"

7 Publications

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Design recommendations for exoskeletons: Perspectives of individuals with spinal cord injury.

J Spinal Cord Med 2021 Jun 1:1-6. Epub 2021 Jun 1.

Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Objective: This study investigated the expectations of individuals with spinal cord injury (SCI) regarding exoskeletons.

Design: The survey consisted out of questions regarding multiple aspects of exoskeleton technology.

Setting: An online survey was distributed via the monthly newsletter of the Dutch Patient Association for Spinal Cord Injury (SCI).

Participants: Individuals with SCI who are members of the Dutch Patient Association for SCI.

Outcome Measures: General impression of exoskeleton technology, expectations regarding capabilities and user-friendliness, training expectations and experiences, future perspectives and points of improvement.

Results: The survey was filled out by 95 individuals with SCI, exoskeletons were considered positive and desirable by 74.7%. About 11 percent (10.5%) thought one could ambulate faster, or just as fast, while wearing an exoskeleton as able-bodied people. Furthermore, 18.9% expected not to use a wheelchair or walking aids while ambulating with the exoskeleton. Twenty-five percent believed that exoskeletons could replace wheelchairs. Some main points of improvement included being able to wear the exoskeleton in a wheelchair and while driving a car, not needing crutches while ambulating, and being able to put the exoskeleton on by oneself.

Conclusion: Individuals with SCI considered exoskeletons as a positive and desirable innovation. But based on the findings from the surveys, major points of improvement are necessary for exoskeletons to replace wheelchairs in the future. For future exoskeleton development, we recommend involvement of individuals with SCI to meet user expectations and improve in functionality, usability and quality of exoskeletons.
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June 2021

Outcomes of Stenting as a Bridge to Surgery in Malignant Colonic Obstruction, With Emphasis on Perforation Rate and Clinical Success.

Surg Laparosc Endosc Percutan Tech 2020 Aug;30(4):332-338

Gastroenterology, Rijnstate Hospital, Arnhem, The Netherlands.

Background: Colonic stent placement in acute malignant obstruction has proven to be an alternative for emergency surgery. It has been associated with reduced stoma creation and postoperative morbidity. Concerns have risen that manipulation of the tumor and risk of perforation might result in lower disease-free survival. Therefore, we investigated the long-term outcomes of stenting as a bridge to surgery in these patients, with emphasis on clinical success of the stenting procedure.

Methods: We performed a comparative study in the Rijnstate Hospital in Arnhem, The Netherlands. Data were collected from patients who underwent colonic stenting procedures or acute surgical resection due to malignant obstruction performed between 2007 and 2015. Patients treated with palliative intent were excluded.

Results: We included 92 patients, 66 underwent stent placement and 26 had an acute surgical resection. Technical and clinical success rates of the stenting procedures were 94% and 82%, respectively. No significant differences in demographic, tumor or stenting characteristics were found for patients with clinically (un)successful stent placement or stent-related perforations. Patients with unsuccessful stent procedures or perforation had higher rates of open procedures and rescue colostomy. Survival rates were similar for patients who underwent stent placements compared with acute resection. We found no significant differences in survival between patients with successful compared with unsuccessful procedures or perforation.

Conclusions: Survival rates of patients who underwent colonic stenting are similar to those of patients who had an acute resection. No negative effects on survival were observed for clinically failed stenting procedures or stent-related perforations.
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August 2020

Duplex Ultrasound May Predict the Best Level of Lower Limb Amputation in Patients with Chronic Limb-Threatening Ischemia: A Retrospective Observational Cohort Study.

Ann Vasc Surg 2020 Aug 20;67:403-410. Epub 2020 Mar 20.

Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.

Background: Despite improved revascularization options, many patients with chronic limb-threatening ischemia (CLI) require lower limb amputation. Duplex ultrasound (DUS) is recommended as first-choice imaging technique in CLI. However, the prognostic utility of DUS for planning lower limb amputations has never been described before. This study aims to evaluate if DUS and findings from physical examination could be used to help predict the best level of lower limb amputation in patients with CLI.

Methods: A retrospective cohort of 124 patients with CLI and a lower limb amputation was analyzed. Outcome measurements were reoperation, revision, and conversion rates, which were related to findings from physical examination and DUS examinations.

Results: Thirty-nine reoperations were performed, of which 17 stump revisions and 22 conversions were from below- to above-knee amputation. There was a discrepancy in findings of physical examination and DUS of 25% and 64% of femoral and popliteal pulsations respectively. Conversion rates increased with a more proximal occlusion on DUS. All patients with a vascular occlusion in the aortoiliac trajectory or deep femoral artery required a higher amputation level.

Conclusions: Physical examination seems to be unreliable, and therefore should not be used to assess the optimal level of lower extremity amputation. Performing a primary above-knee amputation in patients with vascular occlusion in the aortoiliac trajectory or deep femoral artery could significantly reduce reoperation rates.
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August 2020

Mobilising the patient: With emphasis on innovative technologies.

Injury 2020 May 9;51 Suppl 2:S15-S17. Epub 2020 Jan 9.

Department of Trauma Surgery, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands. Electronic address:

Treatment of trauma patients and fractures has changed dramatically throughout the years. From conservative methods to nowadays various kinds of screws, pins, plates and nails for optimal fixation of fractures. This lead to changes in post-operative management as well, from bedrest to (partial) weight bearing. Some patients however have very limited to no ability to mobilise, such as critical ill patients on the Intensive Care Unit, amputees or spinal cord injured patients. Due to innovations such as hydrotherapy, osseointegrated prosthesis and exoskeletons, even these people can mobilise. Thanks to innovations like these an increasing number of trauma patients are able to fully reintegrate into community life and get back to an active and independent life style.
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May 2020

Highest ambulatory speed using Lokomat gait training for individuals with a motor-complete spinal cord injury: a clinical pilot study.

Acta Neurochir (Wien) 2020 04 24;162(4):951-956. Epub 2019 Dec 24.

Department of Orthopedic Surgery, Radboudumc, Nijmegen, the Netherlands.

Background: Motor impairment and loss of ambulatory function are major consequences of a spinal cord injury (SCI). Exoskeletons are robotic devices that allow SCI patients with limited ambulatory function to walk. The mean walking speed of SCI patients using an exoskeleton is low: 0.26 m/s. Moreover, literature shows that a minimum speed of 0.59 m/s is required to replace wheelchairs in the community.

Objective: To investigate the highest ambulatory speed for SCI patients in a Lokomat.

Methods: This clinical pilot study took place in the Rehabilitation Center Kladruby, in Kladruby (Czech Republic). Six persons with motor-complete sub-acute SCI were recruited. Measurements were taken at baseline and directly after a 30 min Lokomat training. The highest achieved walking speed, vital parameters (respiratory frequency, heart rate, and blood pressure), visual analog scale for pain, and modified Ashworth scale for spasticity were recorded for each person.

Results: The highest reached walking speed in the Lokomat was on average 0.63 m/s (SD 0.03 m/s). No negative effects on the vital parameters, pain, or spasticity were observed. A significant decrease in pain after the Lokomat training was observed: 95% CI [0.336, 1.664] (p = 0.012).

Conclusion: This study shows that it is possible for motor-complete SCI individuals to ambulate faster on a Lokomat (on average 0.63 m/s) than what is currently possible with over-ground exoskeletons. No negative effects were observed while ambulating on a Lokomat. Further research investigating walking speed in exoskeletons after SCI is recommended.
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April 2020

Ten Meters Walking Speed in Spinal Cord-Injured Patients: Does Speed Predict Who Walks and Who Rolls?

Neurorehabil Neural Repair 2017 Sep 8;31(9):842-850. Epub 2017 Aug 8.

1 Radboud University Medical Centre, Nijmegen, the Netherlands.

Background: Walking speed is assumed to be a key factor in regaining ambulation after spinal cord injury (SCI). However, from the literature it remains unclear which walking speed usually results in independent community ambulation.

Objective: The primary aim of this study was to determine at which walking speed SCI patients tend to walk in the community instead of using a wheelchair. The secondary aim was to investigate clinical conditions that favor independent ambulation in the community.

Methods: Data from SCI patients were collected retrospectively from the European Multicenter Study about Spinal Cord Injury database. We determined a cutoff walking speed at which the patients tend to walk in the community by plotting a receiver operating characteristics curve, using the Spinal Cord Independence Measure for outdoor mobility. Univariate analyses investigated which factors influence independent community ambulation.

Results: A walking speed of 0.59 m/s is the cutoff between patients who do and do not ambulate independently in the community, with a sensitivity of 91.6% and a specificity of 80.3%. Age, injury severity, and lower limb muscle strength have a significant influence on independent community ambulation.

Conclusions: Patients with an SCI who regain a walking speed of 0.59 m/s tend to achieve a level of walking effectiveness that allows for independent community walking. Although such patients tend to be younger and less severely injured, this walking speed can be a target for locomotor training in rehabilitation and clinical trials that lead to a meaningful outcome level of community walking.
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September 2017

Periodic limb movements in tetraplegia.

J Spinal Cord Med 2018 05 2;41(3):318-325. Epub 2017 May 2.

a Institute for Breathing and Sleep , Austin Health , Melbourne , Australia.

Objective: To establish the prevalence of Periodic Limb Movements during Sleep (PLMS) in patients with tetraplegia, controlling for obstructive sleep apnea. To explore whether demographic and injury characteristics affect PLMS.

Study Design: Retrospective cohorts.

Setting And Participants: One hundred seventy-three participants with acute (<12 months) and 92 with chronic (>12 months) tetraplegia who underwent full overnight diagnostic sleep studies.

Interventions And Outcome Measures: Two hundred sixty-two sleep study recordings were included. A randomly selected subgroup of 21 studies was assessed for PLM during wakefulness. Data were analysed according to the current American Academy of Sleep Medicine guidelines.

Results: Of the participants, 41.6% (43(15.7) years and 14.9% female) had a motor and sensory complete lesion. Sleep was poor with both OSA (87.8% with apnea hypopnoea index ≥ 5) and PLMS (58.4% with PLMS per hour PLMSI > 15) highly prevalent. There was no difference in the PLMSI between those with OSA (36.3(39.8)) or without (42.2(37.7), P = 0.42). PLMS were evident during REM and NREM sleep in all of the 153 patients with PLMSI > 15. All 21 participants in the subgroup of studies analysed for the PLM during quiet wakefulness, exhibited limb movements. None of the modelled variables (injury completeness, gender, OSA severity or time since injury) significantly predicted a PLMSI > 15 (P = 0.343).

Conclusion: In conclusion, this study confirms the high prevalence of PLM in tetraplegia and the presence of leg movements in NREM and REM sleep along with wakefulness after controlling for OSA. No associations between the presence of PLMS and patient characteristics or injury specific aspects were found.
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May 2018