BACKGROUND: Paratonia is a distinctive form of hypertonia, causing loss of functional mobility in early stages of dementia to severe high muscle tone and pain in the late stages. For assessing and evaluating therapeutic interventions, objective instruments are required.OBJECTIVE: Determine the psychometric properties of the MyotonPRO, a portable device that objectively measures muscle properties, in dementia patients with paratonia.METHODS: Muscle properties were assessed with the MyotonPRO by 2 assessors within one session and repeated by the main researcher after 30 min and again after 6 months. Receiver operating characteristic curves were constructed for all MyotonPRO outcomes to discriminate between participants with (n = 70) and without paratonia (n = 82). In the participants with paratonia, correlation coefficients were established between the MyotonPRO outcomes and the Modified Ashworth Scale for paratonia (MAS-P) and muscle palpation. In participants with paratonia, reliability (intraclass correlation coefficient) and agreement values (standard error of measurement and minimal detectable change) were established. Longitudinal outcome from participants with paratonia throughout the study (n = 48) was used to establish the sensitivity for change (correlation coefficient) and responsiveness (minimal clinical important difference).RESULTS: Included were 152 participants with dementia (mean [standard deviation] age of 83.5 [98.2]). The area under the curve ranged from 0.60 to 0.67 indicating the MyotonPRO is able to differentiate between participants with and without paratonia. The MyotonPRO explained 10-18% of the MAS-P score and 8-14% of the palpation score. Interclass correlation coefficients for interrater reliability ranged from 0.57 to 0.75 and from 0.54 to 0.71 for intrarater. The best agreement values were found for tone, elasticity, and stiffness. The change between baseline and 6 months in the MyotonPRO outcomes explained 8-13% of the change in the MAS-P scores. The minimal clinically important difference values were all smaller than the measurement error.CONCLUSION: The MyotonPRO is potentially applicable for cross-sectional studies between groups of paratonia patients and appears less suitable to measure intraindividual changes in paratonia. Because of the inherent variability in movement resistance in paratonia, the outcomes from the MyotonPRO should be interpreted with care; therefore, future research should focus on additional guidelines to increase the clinical interpretation and improving reproducibility.
DOCUMENT
BACKGROUND AND PURPOSE: The MyotonPRO is a portable device that measures muscle tone and biomechanical muscle properties objectively. MyotonPRO has already proven to be effective in measuring muscle properties in healthy and diseased populations. However, to the best of our knowledge, it has never been tested in individuals suffering from paratonia, a form of hypertonia frequently accompanying dementia. The aims of the present study were to (1) compare muscle tone, elasticity, and stiffness between 3 different subpopulations of young and old healthy adults and individuals with paratonia, and (2) investigate the intra- and interrater reproducibility of MyotonPRO measurements of the biceps brachii (BB) muscle in each subpopulation.METHODS: MyotonPRO measurements of muscle tone, elasticity, and dynamic stiffness were carried out by 2 investigators on 2 different days over the BB muscles of 54 participants (18 healthy young adults, 20 healthy older adults, and 16 older individuals with paratonia). Muscle properties were compared between subpopulations using ANOVA/Welch and post hoc tests. Reliability (intraclass correlation coefficient) and agreement parameters (standard error of measurement and the minimal detectable change) were calculated.RESULTS: Statistically significant differences between subpopulations were found in all parameters, except for stiffness between healthy elderly and individuals with paratonia. In the healthy subpopulations, (a) intrarater reliability was very high and intrarater agreement was good between 2 consecutive series, (b) between days intrarater reliability was low to high and intrarater agreement was variable, (c) interrater reliability was high to very high and interrater agreement was good. In individuals with paratonia, (a) intrarater reliability was moderate to high and agreement was variable between series, (b) between days intrarater reliability was poor to moderate and agreement was poor, (c) interrater reliability ranged from low to high with poor agreement.CONCLUSIONS: MyotonPRO measurements of the BB muscle showed good reproducibility in both healthy subpopulations, particularly for measurements performed within the same day. In individuals with paratonia, reliability and agreement were substantially lower. MyotonPRO can be used in clinical assessment and research. However, in individuals with paratonia, careful interpretation of results is required. Research in a larger sample of persons with paratonia at different stages of disease severity is recommended.
DOCUMENT
This review evaluates the reliability and validity of ultrasound to quantify muscles in older adults. The databases PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for studies. In 17 studies, the reliability (n = 13) and validity (n = 8) of ultrasound to quantify muscles in community-dwelling older adults (≥60 years) or a clinical population were evaluated. Four out of 13 reliability studies investigated both intra-rater and inter-rater reliability. Intraclass correlation coefficient (ICC) scores for reliability ranged from -0.26 to 1.00. The highest ICC scores were found for the vastus lateralis, rectus femoris, upper arm anterior, and the trunk (ICC = 0.72 to 1.000). All included validity studies found ICC scores ranging from 0.92 to 0.999. Two studies describing the validity of ultrasound to predict lean body mass showed good validity as compared with dual-energy X-ray absorptiometry (r(2) = 0.92 to 0.96). This systematic review shows that ultrasound is a reliable and valid tool for the assessment of muscle size in older adults. More high-quality research is required to confirm these findings in both clinical and healthy populations. Furthermore, ultrasound assessment of small muscles needs further evaluation. Ultrasound to predict lean body mass is feasible; however, future research is required to validate prediction equations in older adults with varying function and health.
DOCUMENT
Rationale: Sarcopenia is a major problem and is common in community-dwelling elderly. In daily practice, there is need for low cost and easily assessable measurement tools to assess depletion of skeletal muscle (SM) mass, for example as one of the indicators of sarcopenia. Bio-electrical impedance analysis (BIA) is often used to estimate body composition, whereas ultrasound measurement is an upcoming and promising tool, as it is quick, easy to use and inexpensive in comparison with other tools that assess SM mass. Ultrasound could assess site-specific loss of SM mass and determine myoesteatosis. Therefore, in this pilot study we aimed to assess agreement between muscle thickness of rectus femoris (RF) by ultrasound and SM mass by BIA in an older population. Methods: Twenty-six older adults (mean± standard deviation (SD) age 64 ±5.0 y, 62% women) from the Hanze Health and Ageing Study were included. SM mass by BIA was estimated using the Janssen equation. Muscle thickness of RF was assessed by analyzing ultrasound images from the right leg. Two non-parametric tests were used for analysis. Correlation between ultrasound and BIA was assessed with Spearman Rho. Agreement was determined with Kendall’s coefficient of concordance (Kendall’s W). In both tests a score ≥ 0.7 was considered a strong correlation.Results: Mean (±SD) RF thickness was 18.9 (±3.8) mm. Median SM mass (Interquartile range) was 23.5 (20.8-34.7) kg. Correlation between RF thickness and SM mass was moderately positive (Spearman r=0.611; P = 0.001), whereas Kendall’s W showed a strong agreement (W= 0.835; P=0.002).Conclusion: Ultrasound measurement of RF showed an acceptable agreement with skeletal muscle mass assessed by BIA in our sample of older adults. Therefore, ultrasound could be a promising portable tool to estimate muscle size.
DOCUMENT
Dit artikel geeft inzicht in het fenomeen 'verzuring' van spieren door inspanning.
DOCUMENT
Het Nederlandse onderwijsstelsel veroorzaakt ongelijkheid inschoolloopbanen. Het stelsel moet dus op de schop. Dat wil niet zeggen dat het stelsel tot de grond toe moet worden afgebroken. Een paar gerichte interventies zouden al veel goed doen.
DOCUMENT
Nederland is de afgelopen jaren in de ban geraakt van twee verschillende utopische gedachten, met name de lokroep van de wijk als integrerend kader voor verbetering van de sociale en fysieke infrastructuur en de lokroep van technologie als motor van een significante vooruitgang van de samenleving. Binnen het programma ID-wijk van de Stichting Experimenten Volkshuisvesting worden experimenten gestimuleerd om deze twee utopische gedachten te combineren en met technologie in de wijk verbeteringen aan te brengen. De vraag dringt zich op of in het utopische rekenstelsel een optelling van twee eenheden een grotere eenheid tot gevolg heeft, of integendeel een dergelijke combinatie leidt tot een zwakker resultaat. In deze tekst wordt een exploratie aangevat van de rekenregels van dit utopische stelsel aan de hand van de vraag of technologie sociale netwerken op wijkniveau ondersteund dan wel ondermijnt, en in welke mate door welke actoren hierin sturend kan worden opgetreden. Daarbij wordt alleen aandacht gegeven aan persoonlijke sociale netwerken, en niet aan sociale relaties tussen groepen (ouderen t.o.v. jongeren, allochtonen-autochtonen, ). De relatie van technologie met sociale cohesie tussen groepen is immers een apart vraagstuk met een eigen dynamiek en vragen, bv. of een site als www.maroc.nl de integratie bevordert of juist verzuiling volgens etnische lijnen versterkt.
DOCUMENT
Het behalen van een lesbevoegdheid kan in Nederland op verschillende manieren. Er zijn grofweg drie bevoegdheden te onderscheiden: een bevoegdheid voor het basisonderwijs en twee voor het voortgezet onderwijs, namelijk een tweedegraads bevoegdheid en een eerstegraads bevoegdheid. Het schema op de volgende pagina laat zien dat aspirantleraren verschillende routes kunnen volgen om een of meer van deze lesbevoegdheden te behalen.In dit artikel schetsen we allereerst het stelsel van lerarenopleidingen als geheel, waarbij we ingaan op wettelijke kaders en een aantal overeenkomsten en verschillen tussen de diverse opleidingen. In de daaropvolgende paragraaf lichten we meer in detail toe welke routes er bestaan en wat voor bijzonderheden ze vertonen. De laatste paragraaf zoomt in op een aantal actuele thema's en ontwikkelingen bij de lerarenopleidingen
DOCUMENT
Hoe is het sociaal werk georganiseerd in Noorwegen? Enerzijds heeft dit Scandinavische land een uitgebreid stelsel voor sociale zekerheid en is er weinig bureaucratie in vergelijking tot Nederland. Daarbij zien we dat veel sociaal werkers werkzaam zijn voor de overheid en daardoor andere verantwoordelijkheden hebben.
LINK
