Intra-European family migration has extended the realm in which families live and work in Europe. This paper joins a limited number of recent attempts to analyse family migration using a children-in-families approach (Bushin 2009). In contrast to existing studies on this theme, our focus is on children's migration decision-making, experiences of step-migration and experiences of separation from parents during processes of intra-European family migration. Little is known about children's views and experiences of step-migration and separation from their parent(s) during family migration. Such experiences have implications for the spatial and temporal construction of family and childhood in Europe, where transnational mobility is increasing. This paper discusses children's experiences of separation in two research contexts, Scotland and the Republic of Ireland, to illustrate common features of the phenomena. The paper analyses family relationships relevant to migration decisions and explains their effects on children's agency, as well as on family integrity itself.

These results suggest that FM patients are able to understand and remember the complex material about pain physiology. Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

Difficulty with walking and talking in MS may be a result of a divided attention deficit or of overloading of the working memory system, and further investigation is needed. We suggest that difficulty with walking and talking in MS may lead to practical problems in everyday life, including potentially increasing the risk of falls. Clinical tools to assess cognitive-motor dual-tasking ability are needed.

Background and objectives: It has been suggested that sensitization of the central nervous system plays an important role in the development and maintenance of chronic (pain) complaints experienced by whiplash patients. According to the PRISMA guidelines, a systematic review was performed to screen and evaluate the existing clinical evidence for the presence of central sensitization in chronic whiplash. Databases and data treatment: Predefined keywords regarding central sensitization and chronic whiplash were combined in electronic search engines PubMed and Web of Science. Full text clinical reports addressing studies of central sensitization in human adults with chronic complaints due to a whiplash trauma were included and reviewed on methodological quality by two independent reviewers. Results: From the 99 articles that were identified, 24 met the inclusion criteria, and 22 articles achieved sufficient scores on methodological quality and were discussed. These studies evaluated the sensitivity to different types of stimuli (mechanical, thermal, electrical). Findings suggest that although different central mechanisms seem to be involved in sustaining the pain complaints in whiplash patients, hypersensitivity of the central nervous system plays a significant role. Persistent pain complaints, local and widespread hyperalgesia, referred pain and (thoracic) allodynia, decreased spinal reflex thresholds, inefficient diffuse noxious inhibitory controls activation and enhanced temporal summation of pain were established in chronic whiplash patients. Conclusions: Although the majority of the literature provides evidence for the presence of central sensitization in chronic whiplash, underlying mechanisms are still unclear and future studies with good methodological quality are necessary. In addition, international guidelines for the definition, clinical recognition, assessment and treatment of central sensitization are warranted.

Objective: To establish the effects of a twelve week, community based, group exercise intervention for people moderately affected with Multiple Sclerosis (MS) (Extended Disability Status Score 5-6.5). Design: Randomised controlled pilot trialSetting: Two community leisure centres.Participants: 32 subjects with MS were randomised into an intervention or control group. Intervention:The intervention group received twelve weeks of twice weekly, 60 minute group exercise sessions, which included mobility, balance and resistance exercises. The control group received usual care. Main Outcome measures:An assessor blinded to group allocation assessed participants at baseline, after eight weeks and after twelve weeks (i.e after the intervention period). The primary outcome measure was 25 Foot Walk time (T25FW), secondary outcomes assessed walking endurance, balance, physical function, leg strength, body mass index, activity levels, fatigue, anxiety and depression, quality of life and goal attainment. ResultsThe intervention led to an improvement in all outcome measures. Physical activity results showed a significant group effect (p<0.001) and interaction effect (p=0.009), post hoc analysis revealed this was significant at week eight (p<0.001) and week twelve (p=0.005).Balance confidence results showed a significant group effect (p=0.001). Good effect sizes were found for activity levels (d=1.05), dynamic balance (d=0.80), perceived balance (d=0.94) and leg strength (d=1.33). Conclusion:Although further research is required, the results of the study suggest that community based group exercise classes are a feasible option for people moderately affected with MS, and offer benefits such as improved physical activity levels, balance and leg strength.3

Taking part in an exercise class was a positive experience for people with MS. Healthcare professionals should work with exercise professionals to provide feasible exercise opportunities to help those with MS benefit from therapeutic exercise.

Abstract. Van Oosterwijck J, Nijs J, Meeus M, Lefever I, Huybrechts L, Lambrecht L, Paul L (Vrije Universiteit Brussel, Brussels; Artesis University College Antwerp, Antwerp; University Hospital Brussels, Brussels; Private Practice For Internal Medicine, Ghent ⁄ Aalst; CVS Contactgroep, Bruges; Belgium; and University of Glasgow, Glasgow, UK). Pain inhibition and postexertional malaise in myalgic encephalomyelitis ⁄ chronic fatigue syndrome. J Intern Med 2010; 268: 265-278.Objectives. To examine the efficacy of the pain inhibitory systems in patients with myalgic encephalomyelitis ⁄ chronic fatigue syndrome (ME ⁄ CFS) during two different types of exercise and to examine whether the (mal)functioning of pain inhibitory systems is associated with symptom increases following exercise.Design. A controlled experimental study.Setting and subjects. Twenty-two women with ME ⁄ CFS and 22 healthy sedentary controls were studied at the Department of Human Physiology, Vrije Universiteit Brussel.Interventions. All subjects performed a submaximal exercise test and a self-paced, physiologically limited exercise test on a cycle ergometer. The exercise tests were undertaken with continuous cardiorespiratory monitoring. Before and after the exercise bouts, subjects filled out questionnaires to assess health status, and underwent pressure pain threshold measurements. Throughout the study, subjects' activity levels were assessed using accelerometry.Results. In patients with ME ⁄ CFS, pain thresholds decreased following both types of exercise, whereas they increased in healthy subjects. This was accompanied by a worsening of the ME ⁄ CFS symptom complex post-exercise. Decreased pressure thresholds during submaximal exercise were associated with postexertional fatigue in the ME ⁄ CFS group (r = 0.454; P = 0.034).Conclusions. These observations indicate the presence of abnormal central pain processing during exercise in patients with ME ⁄ CFS and demonstrate that both submaximal exercise and self-paced, physiologically limited exercise trigger postexertional malaise in these patients. Further study is required to identify specific modes and intensity of exercise that can be performed in people with ME ⁄ CFS without exacerbating symptoms.

Abstract-Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli, maladaptive illness beliefs, inappropriate attitudes, and movement dysfunctions. Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance. This single-case study (A-B-C design) with six patients with chronic whiplash associated disorders (WAD) was aimed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms, daily functioning, pain beliefs, and behavior. Periods A and C represented assessment periods, while period B consisted of the intervention (pain neurophysiology education). Results showed a significant decrease in kinesiophobia (Tampa Scale for Kinesiophobia), the passive coping strategy of resting (Pain Coping Inventory), self-rated disability (Neck Disability Index), and photophobia (WAD Symptom List). At the same time, significantly increased pain pressure thresholds and improved pain-free movement performance (visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test) were established. Although the current results need to be verified in a randomized, controlled trial, they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD.