Specialization
Focus of research
Rehabilitation medicine aims at optimization of function, keeping individuals mobile and independent when aging and in intercurrent disease. It focuses on the transition between the domains of body functions and structures on one hand and activities and participation on the other according to the WHO International Classification of Functioning, Disability and Health (ICF) model. For this, it is of key importance to understand the functional consequences of ageing and specific diseases (and also the combination!) by understanding their underlying pathophysiology and functional prognosis. In particular, we need to know what an individual is capable of (“can do”) under given circumstances in relation to actual performance in daily life (“does”) to optimally intervene. Specifically, technological developments and the understanding of human control mechanisms are needed to address fundamental questions in the field.
1) In spite of the high adaptability of the nervous system after a lesion (“neuroplasticity”) found in animal models, the natural course of functional recovery after a stroke after is only modifiable by 5 to 10%. Distinguishing between primary neurological recovery ("restitution") and how patients deal with this (“compensation”) is of key importance to understand what a patient can learn after a stroke and hence to design tailored interventions.
2) With increasing life expectancy, aging related processes have to be accounted for when designing optimal rehabilitative strategies. Muscles are conditional for (independent) functioning, while it appears that from 40 to 50 years of age, muscle health gradually declines. The consequences of muscle aging for particularly vulnerable populations of patients with a stroke or with multiple sclerosis are still unknown. Further research into the development and the course of muscle aging (sarcopenia) over time and determining the consequences is necessary. In particular, how the neural system adapts, and whether this may be a target for intervention is still largely unknown.
The specific knowledge that the candidate brings to solve aforementioned challenges is neurocontrol. Neurocontrol studies the interaction between the neural regulator and the regulated system for instance muscles around a joint (Meskers et al. 2015). Engineering system identification techniques and control paradigms were successfully applied to clinical problems in understanding movement disorders and their treatment like spasticity (invited commentaries: Kwakkel & Meskers, Lancet Neurology 2015, Meskers & Kwakkel, Developmental Medicine and Child Neurology 2020, DeGooijer- van de Groep et al. 2018), balance disorders in aging (Pasma et al. 2015 ) and understanding the role of sensory system integrity in neurological recovery post stroke (Zandvliet et al 2019).Recently, we launched a project to measure and understand consequences of impaired blood pressure control in ageing (orthostatic hypotension, Mol et al. 2020)
Development and application of haptic robotics and smart sensors in previous funded projects in cooperation with the technical universities of Delft and Twente provide for the required tools. Understanding of disease, disease progression, recovery and recovery profiles comes from large cohort and longitudinal observational studies in relevant populations like patients with a stroke or geriatric in- and outpatients. Now is the time to pursue the application of neurocontrol paradigms to aforementioned clinical problems in translational research projects to improve diagnostics as a prerequisite for tailored interventions in rehabilitation. The candidate as a clinician with a background in engineering (PhD thesis partly at TU Delft) combined with his role as medical director of the Innovative Medical Devices Initiative center of exellence “Neurocontrol’ (a network research collaboration between entrepreneurs, engineers and clinicians) has the required skills.
- Mol A, Maier AB, van Wezel RJA, Meskers CGM. Multimodal Monitoring of Cardiovascular Responses to Postural Changes. Front Physiol. 2020 Mar 3;11:168.
- Zandvliet SB, van Wegen EEH, Campfens SF, van der Kooij H, Kwakkel G, Meskers CGM. Position-Cortical Coherence as a Marker of Afferent Pathway Integrity Early Poststroke: A Prospective Cohort Study. Neurorehabil Neural Repair. 2020 Mar 4:
- De Gooijer van de Groep KL, de Groot JH, van der Krogt H, de Vlugt E, Arendzen JH, Meskers CGM. Early Shortening of Wrist Flexor Muscles Coincides With Poor Recovery After Stroke. Neurorehabil Neural Repair. 2018 Jun;32(6-7):645-654.
- Meskers CG, de Groot JH, de Vlugt E, Schouten AC. NeuroControl of movement: system identification approach for clinical benefit. Front Integr Neurosci. 2015 Sep 8;9:48.
- Pasma JH, Engelhart D, Maier AB, Schouten AC, van der Kooij H, Meskers CG. Changes in sensory reweighting of proprioceptive information during standing balance with age and disease. J Neurophysiol. 2015 Dec;114(6):3220-33.