Background To gain insight into the role of plantar intrinsic foot muscles in fall-related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra-assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet-based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines. Methods Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet-based and a mainframe system. The intra-assessor reliability and standard error of measurement for the cross-sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines. Results Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet-based device showed superior repeatability. Conclusions This intra-assessor reliability study showed that a tablet-based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet-based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest.
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Background: Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature.Methods: Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system.Results: In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings – particularly for levels L4–S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases.Discussion: Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas.Conclusions: We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.
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Orthography is considered to be a major problem in Dutch education, since many pupils don’t seem to be able to master orthographic rules, even after years of education. In educational literature it is argued that the problems related to spelling are caused by approaches that focus more on rules of thumb than on linguistic insights. This is somewhat remarkable, since a good understanding of the Dutch orthographic system requires a fair amount of morphological knowledge. In order to effectively implement this knowledge, the development of a morphological awareness (MA) seems to be required. Therefore, a short intervention was designed for the upper levels of secondary schools (4 havo) which aimed to foster MA and, subsequently, improve orthographic skills. Results of this quasi-experimental study indicate that a short intervention can significantly boost MA, but that students don’t seem to be able to use MA effectively to enhance spelling performance.
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Background Altered muscle-tendon properties in clubfoot patients could play a role in the occurrence of a relapse and negatively affect physical functioning. However, there is a lack of literature about muscle-tendon properties of clubfoot relapse patients. Research question The aim of this study was to determine whether the muscle architecture of the medial gastrocnemius and the morphology of the Achilles tendon differ between typically developing children (TDC) and clubfoot patients with and without a relapse clubfoot and to determine the relationships between morphological and functional gait outcomes. Methods A cross-sectional study was carried out in clubfoot patients treated according to the Ponseti method and TDC aged 4–8 years. A division between clubfoot patients with and without a relapse was made. Fifteen clubfoot patients, 10 clubfoot relapse patients and 19 TDC were included in the study. Morphologic properties of the medial head of the Gastrocnemius muscle and Achilles tendon were assessed by ultrasonography. Functional gait outcomes were assessed using three-dimensional gait analysis. Mean group differences were analysed with ANOVA and non-parametric alternatives. Relationships between functional and morphologic parameters were determined for all clubfoot patients together and for TDC with Spearman’s rank correlation. Results Morphological and functional gait parameters did not differ between clubfoot patients with and without a relapse, with exception of lower maximal dorsiflexor moment in clubfoot relapse patients. Compared to TDC, clubfoot and relapse patients did show lower functional gait outcomes, as well as shorter and more pennate muscles with a longer Achilles tendon. In all clubfoot patients, this longer relative tendon was related to higher ankle power and plantarflexor moment. Significance In clubfoot and relapse patients, abnormalities in morphology did not always relate to worse functional gait outcomes. Understanding these relationships in all clubfoot patients may improve the knowledge about clubfoot and aid future treatment planning.
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Objectives Patients who underwent corrective surgery for tetralogy of Fallot (TOF) have increased long-term risk of cardiovascular morbidity and mortality. Yet, limited information is available on how to evaluate the risk in this population. Therefore, the aim of this study was to investigate the prognostic value of aerobic exercise capacity, along with other related parameters, at medium-term follow-up in adult patients with tetralogy of Fallot. Methods and results Between 2000 and 2003, 92 adults (age 26.2 ± 7.8 years; 63 male) with corrected TOF or TOF-type morphology underwent a cardiopulmonary exercise test (CPET) until exhaustion and echocardiography. During a mean follow-up of 7.3 ± 1.2 years (range 0.9 to 9.3 years), 2 patients died and 26 patients required at least 1 cardiac-related intervention at a mean age of 28.9 ± 7.9 years. Event-free survival tended to be higher in patients with the classical type of TOF (P = 0.061). At multivariate Cox analysis, age at CPET [hazard ratio (HR): 1.13, P = 0.006], age at correction (HR: 0.82, P = 0.037), right ventricular (RV) function (HR: 4.94, P = 0.001), QRS duration (HR: 1.02, P = 0.007), percentage of predicted peak oxygen uptake (peak VO2%) (HR: 0.96, P = 0.029) and ventilatory effi ciency slope (VE/VCO2 slope) (HR: 1.13, P = 0.021) were signifi cantly related to the incidence of death/cardiac-related intervention during medium follow-up. Conclusions Early corrective surgery and a well-preserved RV are associated with a better outcome in adults with corrected TOF. Furthermore, CPET provides important prognostic information; peak VO2% and VE/VCO2 slope are independent predictors for event-free survival in patients with corrected TOF.
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Practical experience and research reveal generic spoken language benefits after cochlear implantation. However, systematic research on specific language domains and error analyses are required to probe sub-skills. Moreover, the effect of predictive factors on distinct language domains is unknown. In this study, outcomes of 70 school-aged children with cochlear implants were compared with hearing peers. Approximately half of the children with cochlear implants achieved age-adequate language levels. Results did not reveal systematic strong or weak language domains. Error analyses showed difficulties with morphological and syntactic rules and inefficient narrative skills. Children without additional disabilities who received early intervention were raised with one spoken language, and used a second cochlear implant or contralateral hearing aid were more likely to present good language skills.
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Urban areas provide a promising context for upcycling due to the concentration of consumers and existence of bulky waste resources. Hence, upcycling initiatives emerge across European cities, but little is known about their manifestations. Building on interviews with twenty-four stakeholders from the urban upcycling ecosystem and three focus groups sessions, a morphological model was created with internal and external business model characteristics to analyse a database of 172 collected Dutch urban upcycling initiatives in the furniture and interior sector. The morphological analysis led to eleven urban upcycling manifestations with distinct business model characteristics that make up five generic categories and a landscape of urban upcycling which facilitate future research into the topic. A research agenda to study quantitative implications, regional differences, collaborative experimentation and scaling strategies of urban upcycling is proposed. Practically, the typology may facilitate policy makers and practitioners to create, scale or accelerate urban upcycling initiatives.
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This longitudinal study compared the development of oral language and more specifically narrative skills (storytelling and story retelling) in children with specific language impairment (SLI) with and without literacy delay. Therefore, 18 children with SLI and 18 matched controls with normal literacy were followed from the last year of kindergarten (mean age = 5 years 5 months) until the beginning of grade 3 (mean age = 8 years 1 month). Oral language tests measuring vocabulary, morphology, sentence and text comprehension and narrative skills were administered yearly. Based on first and third grade reading and spelling achievement, both groups were divided into a group with and a group without literacy problems. Results showed that the children with SLI and literacy delay had persistent oral language problems across all assessed language domains. The children with SLI and normal literacy skills scored also persistently low on vocabulary, morphology and story retelling skills. Only on listening comprehension and storytelling, they evolved towards the level of the control group. In conclusion, oral language skills in children with SLI and normal literacy skills remained in general poor, despite their intact literacy development during the first years of literacy instruction. Only for listening comprehension and storytelling, they improved, probably as a result of more print exposure.
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Dit artikel beschrijft de bevindingen uit een explorerend literatuuronderzoek naar de grammaticale ontwikkeling van Nederlandstalige kinderen tussen 7 en 10 jaar met en zonder een taalontwikkelingsstoornis (TOS). De resultaten worden ook in een klinische context geplaatst, met als doel logopedisten te ondersteunen in de behandeling van grammaticale problemen bij kinderen met TOS in deze leeftijdsgroep. Grammaticale problemen zijn een kernprobleem van kinderen metTOSen behandeling van deze grammaticale problemen is daarmee een kerntaak van de logopedist. De verwervingsvolgorde van grammaticale structuren bij Nederlandstalige kinderen met een normale taalontwikkeling is redelijk duidelijk tot een leeftijd van 5 á 6 jaar. Voor oudere kinderen is dit veel minder het geval. Deze informatie is echter wel van belang om passende grammaticale behandeldoelen te kunnen selecteren en prioriteren.
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Posterpresentatie op conferentie Introductie: De afgelopen twee decennia is er geen communis opinio over de vraag of er sprake is van regionale factoren bij de constituentvolgorde in de Nederlandse Gebarentaal (NGT) (Coerts, 1994; Crasborn & De Wit, 2005; Vermeerbergen, Nijen Twilhaar & Van Herreweghe, 2013). Dit onderzoek levert een bijdrage aan de discussie over constituent-volgorde in het algemeen, doordat werd onderzocht of constituentvolgorde in NGT verschillend is voor eerste- en tweedetaalverwervers van de NGT. Methode: Er namen tien participanten (studenten NGT aan de Hogeschool Utrecht) deel: vijf dove moedertaalgebruikers en vijf horende studenten (leeftijd 19-30 jaar). Productie werd uitgelokt van drie verschillende typen enkelvoudige zinnen aan de hand van plaatjes (Volterra et al., 1984): 6 zinnen met omkeerbare constituenten, 6 zinnen met niet-omkeerbare constituenten en 6 locatieve zinnen. Alle 180 geproduceerde zinnen werden getranscribeerd en syntactisch (Subject, Object, Verbum) geanalyseerd. Resultaten: De moedertaalgebruikers gaven duidelijk de voorkeur aan de volgorde SVO of SVOV bij omkeerbare zinnen en SOV voor niet-omkeerbare zinnen. Voor de locatieve zinnen werd veel variatie gevonden, met een lichte voorkeur voor OSV. De T2-verwervers vertoonden veel variatie in de productie van omkeerbare zinnen zonder duidelijk patroon. Voor de niet-omkeerbare zinnen werd een lichte voorkeur voor SOV gevonden en wederom variatie. De loca-tieve zinnen werden voornamelijk uitgedrukt in de volgorde OSV. Conclusie: Deze studie toont aan dat de constituentvolgorde van moedertaalgebruikers en T2-verwervers verschillen. Opvallend is dat de T2-verwervers de neiging hebben de regel voor locatieve zinnen ‘Het grootste element voorop in de zin’ te overgeneraliseren naar het type niet-omkeerbare zin.
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