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Tal-Saban M, Zaguri-Vittenberg S, Ivzori Y. Enhancing Occupational Therapists' Intervention Capabilities With Adolescents With Neurodevelopmental Disorders. Can J Occup Ther 2024:84174241272010. [PMID: 39119699 DOI: 10.1177/00084174241272010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Background. Adolescents with neurodevelopmental disorders (NDDs) have an increased risk of participation limitations. Occupational therapy faces knowledge-to-practice gaps among this population. Purpose. To examine the effectiveness of a continuing-education program for occupational therapists working with adolescents with NDDs. Methods. The study used a mixed-method design, including pre-post comparisons of competence and sense of self-efficacy of occupational therapists to work with adolescents with NDDs. Interviews regarding the program's perceived contribution to practice were conducted. Results. Post-program results showed significantly (p < .001) higher professional competence and self-efficacy for interventions and evaluation skills with NDD's adolescents and transition programs as well as higher knowledge about adolescence and NDDs characteristics. Contrary, there was no change in competence and self-efficacy regarding client-centred interventions with adolescents. Program participants increased their professional confidence and incorporated evidence-based methods into routine practice. Conclusions and Implications. The continuing-education program that was examined expanded the occupational therapy practitioner's knowledge and professional skills, resulting in a change in their capacity to practice with adolescents narrowing the knowledge-to-practice gap. Future studies involving the client perspective, regarding their participation may validate and support continuing-education program for occupational therapists.
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Zahlander J, Fäldt A, Kirby A, Johansen K. Exploring adults' recollections of growing up with childhood motor difficulties: a qualitative study using systematic text condensation. BMJ Open 2024; 14:e084346. [PMID: 39122399 DOI: 10.1136/bmjopen-2024-084346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE To explore the ramifications of childhood motor difficulties, providing insights into their impact and consequences over time. DESIGN A qualitative study using semistructured individual interviews. Data were analysed using systematic text condensation. SETTING Neonatal intensive care recipients born at Uppsala University Children's Hospital, Uppsala, Sweden, between 1986 and 1989, were enrolled in a longitudinal follow-up study and subsequently interviewed in 2019-2020. PARTICIPANTS 13 individuals in their early 30s, who met the criteria for developmental coordination disorder or performed below the 5th percentile on motor tests at 6.5 years of age, were interviewed. Those with co-occurring deficits in attention or social behavioural at age 6.5 were excluded. RESULTS Two themes emerged: (1) lifelong challenges and (2) navigating the journey of motor difficulties: support, awareness and confidence. Five participants reported persistent motor difficulties. They adapted and integrated these challenges into their daily lives without feeling constrained. Parental support was crucial to their success, whereas support from schools was limited. CONCLUSION Adults who faced motor difficulties in childhood developed effective coping strategies, overcame challenges and now lead fulfilling lives. The findings stress the importance of parental support and understanding, addressing contextual factors and fostering positive attitudes and supportive environments to enhance well-being and participation.
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Affiliation(s)
- Johanna Zahlander
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Fäldt
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Kine Johansen
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Zaguri-Vittenberg S, Weintraub N, Tal-Saban M. "It feels as though I need to exert more effort than others": the experience of daily participation of young adults with developmental coordination disorder (DCD) - a qualitative study. Disabil Rehabil 2024; 46:3332-3341. [PMID: 37567872 DOI: 10.1080/09638288.2023.2246376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Participation difficulties among adults with developmental coordination disorder (DCD) have been documented. However, little attention has been given to the subjective aspects of participation, also called occupational experience, including feeling during engagement in activities and their meaning. This study aimed to explore the occupational experience of young adults with DCD. MATERIALS AND METHODS Informed by the phenomenological approach, we conducted semi-structured interviews with 10 young adults with DCD. FINDINGS Three themes emerged: (1) Complexity of occupational experience; describes the motives for participation, with variations in experience across activities and individuals. Participants engage in activities that provide them with pleasure and fulfillment, while other activities require constant effort and cause stress and shame; (2) The role of internal factors; illustrates the influence of poor motor and organizational/planning skills, self-acceptance; and utilizing strategies on the participants' occupational experience; and (3) The role of the social environment; reveals the participants' dual perception of their environment - as a source of criticism as well as a source of support. CONCLUSIONS Individuals with DCD may benefit from intervention during young adulthood to enhance their well-being. The interventions should target their subjective occupational experiences in addition to their objective performance difficulties, by enhancing their psycho-social resources.
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Affiliation(s)
| | - Naomi Weintraub
- School of Occupational Therapy, Hebrew University, Jerusalem, Israel
| | - Miri Tal-Saban
- School of Occupational Therapy, Hebrew University, Jerusalem, Israel
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Steenbergen B, Valtr L, Dunford C, Prunty M, Bekhuis H, Temlali TY, van Abswoude F, Lust JM, Warlop G, Augustijn M, Smits-Engelsman BCM, Wilson PH. Awareness about developmental coordination disorder. Front Public Health 2024; 12:1345257. [PMID: 38362216 PMCID: PMC10867205 DOI: 10.3389/fpubh.2024.1345257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
The present paper is designed to promote awareness of DCD outside the academic world. With a prevalence of 5-6% it is one of the most common disorders of child development. It is therefore surprising that so little is known about it among professionals in child healthcare and education. Parents have expressed frustration about this lack of awareness, including the general public. The general aim of this paper was to describe those critical aspects of DCD that will promote awareness.
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Affiliation(s)
- Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Ludvík Valtr
- Faculty of Physical Culture, Palacký University, Olomouc, Czechia
| | - Carolyn Dunford
- Department of Health Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Melissa Prunty
- Department of Health Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Hidde Bekhuis
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Femke van Abswoude
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jessica M. Lust
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Griet Warlop
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Mireille Augustijn
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Bouwien C. M. Smits-Engelsman
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Physical Activity, Sport and Recreation, Faculty Health Sciences, North-West University, Potchefstroom, South Africa
| | - Peter H. Wilson
- Faculty of Physical Culture, Palacký University, Olomouc, Czechia
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, VIC, Australia
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Mancini VO, Licari MK, Alvares GA, McQueen MC, McIntyre S, Reynolds JE, Reid SL, Spittle AJ, Williams J. Psychosocial wellbeing, parental concerns, and familial impact of children with developmental coordination disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 145:104659. [PMID: 38160588 DOI: 10.1016/j.ridd.2023.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/07/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Developmental Coordination Disorder (DCD) is a neurodevelopmental condition impacting motor skill acquisition and competence. While previous studies have identified adverse psychosocial outcomes in DCD, they are limited by small or population-screened, community-based samples. AIMS To understand the psychosocial difficulties, parental concerns, and familial impacts of childhood DCD in a large population-based sample. METHODS AND PROCEDURES Parents of 310 children aged 4 - 18 years with a diagnosis of DCD (or synonymous term) completed the Impact for DCD survey. Parent-rated measures of emotional problems, peer problems, and prosocial behaviour were compared to normative data. Parental concerns for the impact of DCD on participation, interaction, emotional well-being, and the family system were examined. OUTCOMES AND RESULTS Compared to typically developing children, children with DCD were rated significantly higher for emotional and peer problems, and significantly lower for prosocial behaviours. Parents most commonly reported concerns for their child's future and withdrawal from physical activity. The presence of one or more co-occurring disorders did not significantly influence outcomes. CONCLUSION AND IMPLICATIONS Findings highlight the poor psychosocial outcomes for children with DCD. Crucially, poor psychosocial outcomes were just as likely in those with a single diagnosis of DCD as those with DCD and multiple co-occurring diagnoses. Parents reported concerns for their child (i.e., non-participation and social withdrawal) that are not targeted in existing DCD intervention modalities and emphasised the impact of DCD on the whole family unit. WHAT THIS PAPER ADDS This paper presents data from the largest parent-reported survey of children with a known diagnosis of DCD (or synonymous labels). It highlights the significant impact of DCD on psychosocial outcomes in children across age groups. The children in this study were rated by their parents to have significantly higher levels of emotional and peer problems, and lower prosocial behaviours, than similarly aged Australian children without DCD. It also challenges the misconception that poor psychosocial outcomes in DCD are the result of co-occurring disorders, with outcomes observed to be as poor in children with a sole diagnosis of DCD in this sample. Furthermore, findings highlighted the significant worry and concern that parents with DCD face, particularly around their child's participation and their emotional health. Finally, parents reported on the considerable impact that DCD had on their family unit, regularly causing worry and concern, influencing their choice of activities, and causing financial strain. These concerns and impacts are not addressed in current intervention models for DCD and highlight the need for support mechanisms moving forward.
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Affiliation(s)
- Vincent O Mancini
- Telethon Kids Institute, Nedlands, Australia; UWA Medical School, Division of Paediatrics, University of Western Australia, Crawley, Australia
| | | | | | - Matthew C McQueen
- School of Human Sciences, University of Western Australia, Crawley, Australia; Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Sarah McIntyre
- Telethon Kids Institute, Nedlands, Australia; Cerebral Palsy Alliance, Specialty of Child & Adolescent Health, The University of Sydney, Camperdown, Australia
| | | | - Siobhan L Reid
- School of Human Sciences, University of Western Australia, Crawley, Australia
| | - Alicia J Spittle
- Department of Physiotherapy University of Melbourne, Parkville 3052, Australia
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van der Veer IPA, Rameckers EAA, Steenbergen B, Bastiaenen CHG, Klingels K. How do paediatric physical therapists teach motor skills to children with Developmental Coordination Disorder? An interview study. PLoS One 2024; 19:e0297119. [PMID: 38300942 PMCID: PMC10833570 DOI: 10.1371/journal.pone.0297119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND When teaching motor skills, paediatric physical therapists (PPTs) use various motor learning strategies (MLSs), adapting these to suit the individual child and the task being practised. Knowledge about the clinical decision-making process of PPTs in choosing and adapting MLSs when treating children with Developmental Coordination Disorder (DCD) is currently lacking. Therefore, this qualitative study aimed to explore PPTs' use of MLSs when teaching motor skills to children with DCD. METHODS Semi-structured individual and group interviews were conducted with PPTs with a wide range of experience in treating children with DCD. A conventional content analysis approach was used where all transcripts were open-coded by two reviewers independently. Categories and themes were discussed within the research group. Data were collected until saturation was reached. RESULTS Twenty-six PPTs (median age: 49 years; range: 26-66) participated in 12 individual interviews and two focus-group interviews. Six themes were identified: (1) PPTs treated children in a tailor-made way; (2) PPTs' teaching style was either more indirect or direct; (3) PPTs used various strategies to improve children's motivation; (4) PPTs had reached the optimal level of practice when children were challenged; (5) PPTs gave special attention to automatization and transfer during treatment; and (6) PPTs considered task complexity when choosing MLSs, which appeared determined by task constraints, environmental demands, child and therapist characteristics. CONCLUSION PPTs' clinical decision-making processes in choosing MLSs appeared strongly influenced by therapist characteristics like knowledge and experience, resulting in large variation in the use of MLSs and teaching styles to enhance motivation, automatization, and transfer. This study indicates the importance of the level of education on using MLSs to teach children motor skills, and clinical decision-making. Future research should focus on implementing this knowledge into daily practice.
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Affiliation(s)
- Ingrid P. A. van der Veer
- Rehabilitation Research Centre—REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Eugene A. A. Rameckers
- Rehabilitation Research Centre—REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Caroline H. G. Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Katrijn Klingels
- Rehabilitation Research Centre—REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Humble A, Yu ML, Brown T. Association between parent-proxy-reported and child-self-reported perceptions of children's motor competence and children's performance-based motor skill abilities. Scand J Occup Ther 2024; 31:2274883. [PMID: 37918007 DOI: 10.1080/11038128.2023.2274883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND When assessing motor skills, occupational therapists are encouraged to seek the perspectives of children and their parents to promote the delivery of client-centered care. AIM To investigate whether 9-12-year-old children's views and their parents' proxy views of the children's motor skill competence and their performance on a standardized, performance-based assessment are associated. MATERIALS AND METHODS Thirty 9-12-year-old children completed the Perceived Motor Competence Questionnaire in Childhood (PMC-C) and the Pictorial Scale of Perceived Movement Skill Competence - version 2 (PMSC-2), while their parents completed the Movement Assessment Battery for Children-2nd Edition Checklist (MABC-2 Checklist). Children's objective motor skills were measured by the Bruininks-Oseretsky Test of Motor Proficiency-2nd Edition (BOT-2). Spearman's rho correlations were used to analyze the data. RESULTS Significant associations were found between the BOT-2 total motor composite and the PMC-C. A significant association was found between the MABC-2 Checklist and the BOT-2 Strength and Agility composite, as well as the PMC-C total score. SIGNIFICANCE AND CONCLUSIONS Occupational therapists are encouraged to include children and their parents in the therapeutic process to capture individual perspectives and deliver client-centered care.
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Affiliation(s)
- Alice Humble
- Department of Occupational Therapy, School of Primary and Allied Health Care, Nursing, and Health Sciences Monash University, Frankston Australia
| | - Mon-Lin Yu
- Department of Occupational Therapy, School of Primary and Allied Health Care, Nursing, and Health Sciences Monash University, Frankston Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Nursing, and Health Sciences Monash University, Frankston Australia
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van der Veer IPA, Bastiaenen CHG, Rameckers EAA, Klingels K. Experts' perspectives on how to promote implicit and explicit motor learning in children: A mixed-methods study. Child Care Health Dev 2024; 50:e13147. [PMID: 37365914 DOI: 10.1111/cch.13147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Little is known about how motor learning strategies (MLSs) can promote implicit and explicit motor learning processes. This study aimed to explore experts' perspectives on therapists' use of MLSs to promote specific learning processes in children with and without developmental coordination disorder (DCD). METHODS In this mixed-methods study, two consecutive digital questionnaires were used to ascertain the opinions of international experts. Questionnaire 2 explored the findings of Questionnaire 1 in greater depth. In order to reach a certain level of agreement about the classification of MLSs as promoting either (more) implicit or (more) explicit motor learning, 5-point Likert scales were used in addition to open-ended questions. The open-ended questions were analysed with a conventional analysis approach. Open coding was performed by two reviewers independently. Categories and themes were discussed within the research team, taking both questionnaires as one dataset. RESULTS Twenty-nine experts from nine different countries with different backgrounds in research, education and/or clinical care completed the questionnaires. The results of the Likert scales showed large variation. Two themes emerged from the qualitative analyses: (1) Experts found it difficult to classify MLSs as promoting either implicit or explicit motor learning, and (2) experts stressed the need for clinical decisionmaking when choosing MLSs. CONCLUSIONS Insufficient insight was gained into how MLSs could promote (more) implicit or (more) explicit motor learning in children in general and in children with DCD specifically. But this study demonstrated the importance of clinical decisionmaking to model and adapt MLSs to child, task and environment, with therapists' knowledge of MLSs being an important prerequisite. Research is needed to better understand the various learning mechanisms of children and how MLSs can be used to manipulate these mechanisms.
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Affiliation(s)
- Ingrid P A van der Veer
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Eugene A A Rameckers
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation Research Line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Katrijn Klingels
- Rehabilitation Research Centre - REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Tal-Saban M, Weintraub N. "The clumsiness is always present": Parents perspectives of their adolescents with pDCD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104560. [PMID: 37364527 DOI: 10.1016/j.ridd.2023.104560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/28/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
AIM This study elicited the perspectives of parents of adolescents with probable Developmental Coordination Disorder (pDCD) of the implications of DCD on their adolescents' daily-life and the parents' coping strategies and future concerns. METHODS Using a phenomenological approach and thematic analysis, we conducted a focus group including 7 parents of adolescents with pDCD aged 12-18 yrs. FINDINGS Three major themes emerged from the data: (a) Manifestation and implications of DCD; Parents described the performance challenges and strengths of their adolescents; (b) Discrepancy in perceptions of DCD: Parents described a gap between them and their children's, and between the parents themselves, in their views of the child's difficulties; (c) Diagnosis of DCD and strategies for overcoming its implications: Parents' expressed the pros and cons of labeling and described strategies they used to assist their children. CONCLUSIONS It appears that adolescents with pDCD continue to experience performance limitations in daily-life activities, and psychosocial difficulties. Yet, parents and their adolescents do not always view these limitations in a similar manner. Therefore, it is important that clinicians obtain information from both parents and their adolescents'. These results may assist in developing a client-centered intervention protocol for parents and adolescents.
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Affiliation(s)
- Miri Tal-Saban
- The Neuro-Developmental Disabilities and Writing Research Laboratory, School of Occupational Therapy, Hebrew University, Jerusalem, Israel.
| | - Naomi Weintraub
- The Neuro-Developmental Disabilities and Writing Research Laboratory, School of Occupational Therapy, Hebrew University, Jerusalem, Israel
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van der Veer IPA, Bastiaenen CHG, Goetschalckx M, van der Wielen-Heezius NNF, Rameckers EAA, Klingels K. Therapists' Use of Instructions and Feedback in Motor Learning Interventions in Children with Developmental Coordination Disorder: A Video Observation Study. Phys Occup Ther Pediatr 2023; 43:678-696. [PMID: 37012672 DOI: 10.1080/01942638.2023.2194408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
AIM This qualitative study explored therapists' use of instructions and feedback when teaching motor tasks to children with developmental coordination disorder (DCD) as a first step in developing practical recommendations. METHODS A conventional content analysis approach was used to analyze videotaped treatment sessions of physical therapists using a newly developed analysis plan. Inductive coding was used to code purposively selected video segments. The codes were sorted into categories to identify key themes. Analyses were performed independently by two researchers until data saturation was reached. RESULTS Ten video-taped sessions were analyzed and 61 segments were coded. Three key themes were identified: (1) therapists' intention with the instructions and feedback was to motivate or to provide information; (2) the preferred therapists' teaching style was either direct or indirect; and (3) parameters to shape specific instructions and feedback were the focus of attention, modality, information content, timing and frequency. CONCLUSION Therapists used numerous instructions and feedback with different information content, often shaped by multiple focuses and/or modalities to motivate children or to provide specific information about task performance. Although therapists adapted instructions and feedback to child and task, future research should explore how characteristics of child and task can guide therapists' clinical decision-making.
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Affiliation(s)
| | - Caroline H G Bastiaenen
- Department of Epidemiology, Functioning, Participation & Rehabilitation research line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Mieke Goetschalckx
- Rehabilitation Research Centre - REVAL, Hasselt University, Hasselt, Belgium
| | | | - Eugene A A Rameckers
- Rehabilitation Research Centre - REVAL, Hasselt University, Hasselt, Belgium
- Department of Rehabilitation Medicine, Functioning, Participation & Rehabilitation research line, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise, Adelante Rehabilitation Centre, Valkenburg, The Netherlands
| | - Katrijn Klingels
- Rehabilitation Research Centre - REVAL, Hasselt University, Hasselt, Belgium
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