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Goodwill and Intangible Assets (Details) (USD $) In Thousands, unless otherwise specified | 12 Months Ended
--- | ---
Dec. 28, 2013 | Dec. 29, 2012 | Dec. 31, 2011
Changes in the carrying amount of goodwill |  |  |
Balance at the beginning of the period, gross | $ 142,658 | $ 141,153 |
Goodwill adjustments related to acquisitions | 10,563 |  |
Goodwill adjustments related to sale of practice |  | (29) |
Goodwill adjustments related to NeuCo | (63) |  |
Effect of foreign currency translation | 308 | 1,534 |
Balance at the end of the period, gross | 153,466 | 142,658 | 141,153
Balance at the beginning of the period, Accumulated impairment losses | (71,893) | (499) |
Goodwill impairment | 0 | (71,394) | 0
Balance at the end of the period, Accumulated impairment losses | (71,893) | (71,893) | (499)
Balance at the beginning of the period, net | 70,765 | 140,654 |
Balance at the end of the period, net | 81,573 | 70,765 | 140,654
Intangible assets impairment losses | $ 0 | $ 0 | $ 0

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