Research Interests: Psychology, Psychometrics, Attention, Motion perception, Adolescent, and 15 moreMedicine, Humans, Child, Orientation, Female, Male, Reaction Time, Arousal, Acquired Brain Injury, Psychomotor Disorders, Predictive Control, Case Control Studies, Neuropsychological Tests, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
Neural correlates of motor dysfunction in children with traumatic brain injury: exploration of compensatory recruitment patterns
Research Interests:
Research Interests:
Research Interests:
Research Interests:
The aim of this pilot study was to evaluate the effectiveness of a Neuromotor Task Training (NTT), recently developed for the treatment of children with Developmental Coordination Disorder (DCD) by pediatric physical therapists in the... more
The aim of this pilot study was to evaluate the effectiveness of a Neuromotor Task Training (NTT), recently developed for the treatment of children with Developmental Coordination Disorder (DCD) by pediatric physical therapists in the Netherlands. NTT is a task-oriented treatment program based upon recent insights from motor control and motor learning research. Ten children with DCD (intervention group) were tested before and after 9 and 18 treatment sessions on the Movement ABC and a dysgraphia scale in order to measure the effectiveness of treatment on gross and fine motor skills in general and handwriting in particular. Five children (no-treatment control group) were tested twice with a time lag of nine weeks on the Movement ABC in order to measure spontaneous improvement. No improvement was measured for the children in the notreatment control group, whereas a significant improvement was found for children in the intervention group for both quality of handwriting and performance ...
Research Interests:
Background. Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX). Objective. To measure the short-term (2... more
Background. Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX). Objective. To measure the short-term (2 weeks) and long-term (6 and 9 months) effects of a standardized functional training program versus without the addition of chemodenervation of forearm and hand muscles. Methods. Twenty children with spastic hemiplegia, aged 4 to 16 years, were matched for baseline characteristics and then randomized to standardized functional physical and occupational therapies for 6 months (PT/OT group) or to the same therapies plus multimuscle BTX-A (BTX+ group). Main outcome measures were isometric generated force, overshoot and undershoot (force production error), active and passive range of motion by goniometry (ROM), stretch restricted angle (SRA) of joints, Ashworth scores at the elbow and wrist, and the Melbourne assessment of unilateral upper limb function. All...
Research Interests: Cognitive Science, Occupational Therapy, Cerebral Palsy, Adolescent, Medicine, and 15 moreMuscle strength, Humans, Child, Movement, Female, Male, Hemiplegia, Arm, Clinical Sciences, Randomized Controlled Trial, Botulinum Toxin, Range of Motion, Neurosciences, Disability Evaluation, and Child preschool
Research Interests: Rehabilitation Medicine, Quantitative Research, Treatment Outcome, Cerebral Palsy, Adolescent, and 15 moreMedicine, Activities of Daily Living, Humans, Child, Hemiplegia, Clinical Sciences, Upper Extremity, Upper Limb, Botulinum Toxin, Range of Motion, Task Performance and Analysis, Performance Measure, Motor Skills, Child preschool, and Outcome measure
The article aims to discriminate between 2 features that in principle both may be characteristic of the frequently observed poor motor performance in girls with... more
The article aims to discriminate between 2 features that in principle both may be characteristic of the frequently observed poor motor performance in girls with Turner's syndrome (TS). On the one hand, a reduced movement speed that is independent of variations in spatial accuracy demands and therefore suggests a problem in motor execution. On the other hand, a disproportional slowing down of movement speed under spatial-accuracy demands, indicating a more central problem in motor programming. To assess their motor performance problems, 15 girls with TS (age 9.6-13.0 years) and 14 female controls (age 9.1-13.0 years) were tested using the Movement Assessment Battery for Children (MABC). In additionally, an experimental procedure using a variant of Fitts' graphic aiming task was used to try and disentangle the role of spatial-accuracy demands in different motor task conditions. The results of the MABC reestablish that overall motor performance in girls with TS is poor. The data from the Fitts' task reveal that TS girls move with the same accuracy as their normal peers but show a significantly lower speed independent of task difficulty. We conclude that a problem in motor execution is the main factor determining performance differences between girls with TS and controls.
Research Interests: Psychology, Cognitive Science, Movement disorders, Space perception, Humans, and 15 moreChild, Female, Reaction Time, Developmental neuropsychology, Task Difficulty, Developmental, Analysis of Variance, Motor Performance, Developmental Neuropsychology, Fingers, Psychomotor Disorders, Neurosciences, Motor Skills, Case Control Studies, and preadolescent
Research Interests: Cerebral Palsy, Adolescent, Medicine, Humans, Child, and 15 moreFemale, Male, Hemiplegia, Coefficient of Variation, Isometric Exercise, Fingers, Control Group, Case Control Studies, Biomechanical Phenomena, Isometric Contraction, Maximum Voluntary Contraction, Motor activity, Child preschool, Force Control, and Medical and Health Sciences
Research Interests:
Research Interests: Cognitive Science, Diffusion Tensor Imaging, Adolescent, Information Processing, Anisotropy, and 15 moreBrain, Humans, Child, Female, Male, Corticospinal Tract, Discriminant function analysis, Fractional Anisotropy, Human Brain Mapping, Diffuse Axonal Injury, Control Group, Case Control Studies, Brain injuries, Disability Evaluation, and Child preschool
Research Interests:
in patients with non-specific neck pain: a systematic review
Research Interests:
A longitudinal design was applied to differentiate between normal variations of psychomotor development and lasting handwriting deficiency (dysgraphia). Sixteen primary school children were tested with writing tasks that were recorded on... more
A longitudinal design was applied to differentiate between normal variations of psychomotor development and lasting handwriting deficiency (dysgraphia). Sixteen primary school children were tested with writing tasks that were recorded on a computer-monitoredXYtablet. These tasks represented different modules of the handwriting model of Van Galen (1991). Dependent variables were spatial errors, movement time, movement dysfluencies, trajectory length, stroke curvature, and the degree of neuromotor noise in the movement velocity profiles. The latter variable was measured by means of Power Spectral Density Analysis of the movement velocity signal, which revealed that movements of poor writers were substantially more noisy than those of proficient writers, with a noise peak in the region of neuromotor tremor. At the same time, the poor writers were less accurate. It was concluded that control of spatial accuracy rather than allograph retrieval or size control is the discriminating featur...
Research Interests: Psychology, Cognitive Science, Motor Development, Child Development, Medicine, and 15 moreHandwriting, Humans, Child, Female, Male, Reaction Time, Developmental disabilities, Differential Diagnosis, Longitudinal Studies, Agraphia, Developmental delay, Psychomotor Disorders, Power spectral density, Primary School Children, and Catching up
Falls among elderly persons create immense social problems because of their association with physical decline, serious psychosocial consequences, negative impact on the quality of life, and markedly reduced survival. In addition, falls... more
Falls among elderly persons create immense social problems because of their association with physical decline, serious psychosocial consequences, negative impact on the quality of life, and markedly reduced survival. In addition, falls pose high costs to the public health service. For these reasons, falls remain a popular topic for research. Here, we review several interesting developments that have been published during the past year. Considerable attention has been focused on early identification of fallers and prevention strategies for falls or injuries. A remaining challenge is to implement such strategies into daily clinical practice, at acceptable costs and with good acceptance. New evidence has been generated to suggest the importance of high-level processing for postural control, but it remains difficult to predict falls based upon a simple dual tasking test. Neuroimaging studies are now beginning to provide new insights into the role of cortical structures in balance regulation, and how cortical dysfunction might contribute to falls. Posturography studies using multidirectional moving platforms or computer models of balance have provided new insights into falling mechanisms, in particular the role of abnormal protective responses (stepping or grasping) and the negative effects of stiffening. Other studies have shown how a fear of falling, a common sequel to falls, may lead to secondary degeneration of postural control, thus completing a vicious loop. While these examples illustrate that falls research is very much ongoing, one cannot speak of true progress until the scientific evidence can be implemented into real life, with falls being prevented effectively in individual cases.
Research Interests:
The purpose of the present study was to examine the effect of a group-based task oriented skills training program on motor and physical ability for children with DCD. It was also investigated if there was an effect on fine motor and... more
The purpose of the present study was to examine the effect of a group-based task oriented skills training program on motor and physical ability for children with DCD. It was also investigated if there was an effect on fine motor and handwriting tasks that were not specifically practiced during the training program. Forty-one children aged 6-10years took part in this study. Children were assigned to three groups: an experimental training group consisting of 14 children with DCD, a control non-training group consisted of 13 children with DCD and a control non-training group consisting of 14 typically developed children. The measurements included were, the Movement Assessment Battery for Children (MABC), the Modified Agility Test (MAT), the Triple Hop Distance (THD), the 5 Jump-test (5JT) and the Handwriting Performance Test. All measures were administered pre and post an 8-week training program. The results showed that 10 children of the DCD training-group improved their performance i...
Research Interests: Engineering, Psychology, Occupational Therapy, Medicine, Evidence-Based Practice (Psychology), and 12 moreHuman Movement Science, Handwriting, Humans, Child, Tunisia, Female, Male, Physical Education and training, Motor Skills, Child preschool, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association [APA], 1994) provides a variety of classifications of disorders arising in childhood. One of these is... more
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, American Psychiatric Association [APA], 1994) provides a variety of classifications of disorders arising in childhood. One of these is the Developmental Coordination Disorder (DCD). Developmental Coordination Disorder appears in infancy, childhood or adolescence and is characterized by a predominance of disturbances in the acquisition of motor skills. Such disturbances may be part of a more general delay in development or a failure in skill acquisition. A further restriction is that these deficiencies are not due to demonstrable physical or neurological disorders, a Pervasive Developmental Disorder, Mental Retardation, or deficient educational opportunities.
Research Interests:
AIMS To develop a new protocol for the assessment of action observation (AO) abilities and imitation of meaningful and non-meaningful gestures, to examine its psychometric properties in children with DCD and typically developing (TD)... more
AIMS To develop a new protocol for the assessment of action observation (AO) abilities and imitation of meaningful and non-meaningful gestures, to examine its psychometric properties in children with DCD and typically developing (TD) children. BACKGROUND For learning manual skills, AO and imitation are considered fundamental abilities. Knowledge about these modalities in children with DCD is scarce and an assessment protocol is lacking. METHOD The protocol consists of 2 tests. The AO test consists of two assembly tasks. The imitation test includes 12 meaningful and 20 non-meaningful gestures. Items of both tests are rated on a 4-point scale. Twelve children with DCD (mean age 8y3m, SD, 1.30) and 11 TD children (mean age 8y2m, SD 1.52) were enrolled. For inter-rater reliability, intraclass correlation coefficients (ICC) were calculated for the total score, weighted kappa and percentage agreement for single items. Known group validity was assessed by comparison of DCD and TD group (Wi...
Research Interests:
Objective: To systematically review the best-evidence regarding physiotherapy and occupational therapy interventions for children with DCD. Method: Studies published between 1995-2010, describing a systematic review or (randomized-)... more
Objective: To systematically review the best-evidence regarding physiotherapy and occupational therapy interventions for children with DCD. Method: Studies published between 1995-2010, describing a systematic review or (randomized-) clinical trial about physiotherapy or occupational therapy intervention for children with DCD or motor impairment (not due to a medical condition) with a test score of at least 1 standard deviation below the mean, were included. Studies were processed in an evidence table. Results: 31 differently titled interventions were investigated. Sensory Integration Therapy is most frequently researched (9). Followed by Perceptual Motor Training (8). Cognitive Orientation to daily Occupational Performance and Neuromotor Task Training were both researched in 3 separate studies. Conclusion: The positive effect of physiotherapy and occupational therapy interventions in children with DCD is strongly supported in all available literature. Individualized, functional and ...
Our study aimed to analyze movement control strategies using predefined criteria for amplitude and differences in these strategies between children with and without DCD. Children with (n1⁄4 28) and without DCD (n1⁄4 15) were included. A... more
Our study aimed to analyze movement control strategies using predefined criteria for amplitude and differences in these strategies between children with and without DCD. Children with (n1⁄4 28) and without DCD (n1⁄4 15) were included. A video-observation-tool was used to score the moving body parts during a Wii Fit slalom task over multiple time points. Two-step cluster analysis was used to extract distinct movement strategies. Two different movement strategies were identified that were independently validated by a measure of task performance and a subjective mark of quality of the movement. Initial differences between groups and changes over time toward the more successful strategy were found in both groups, albeit in a different percentage. This study shows that the more efficient movement strategy is seen in the majority of the TD children and only in a small number of children with DCD, even after practice.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
In this article it is argued that Repetitive Strain Injuries (RSI) form a typically multi-factorial syndrome of complaints with muscular overuse, non-neutral and static limb postures together with enhanced cocontraction as their primary... more
In this article it is argued that Repetitive Strain Injuries (RSI) form a typically multi-factorial syndrome of complaints with muscular overuse, non-neutral and static limb postures together with enhanced cocontraction as their primary ingredients, and psychosocial stressors as secondary factors. To be acceptable, however, as a base for therapeutic intervention and prevention it is necessary to provide a psychobiological model
Research Interests:
Research Interests: Stimulus()
()
Cognitive Orientation to daily Occupational Performance (CO-OP) - De CO-OP is een in Canada ontwikkelde en in Nederland nog vrij onbekende behandelmethode voor kinderen met DCD. De methode is gebaseerd op cognitieve leertheorieÎn. In dit... more
Cognitive Orientation to daily Occupational Performance (CO-OP) - De CO-OP is een in Canada ontwikkelde en in Nederland nog vrij onbekende behandelmethode voor kinderen met DCD. De methode is gebaseerd op cognitieve leertheorieÎn. In dit artikel wordt een kort overzicht gegeven van de hoofdpunten van de CO-OR.
Research Interests:
Through recent studies, the role of proprioceptors in reactions to perturbations during gait has been finally somewhat better understood. The input from spindle afferents has been investigated with tendon taps, vibration and other forms... more
Through recent studies, the role of proprioceptors in reactions to perturbations during gait has been finally somewhat better understood. The input from spindle afferents has been investigated with tendon taps, vibration and other forms of muscle stretches, including some resembling natural perturbations (stumbling, slips, and ankle inversions). It was found that activation of spindle afferents produces short-latency response (SLR), consistent with a fast spinal pathway. These reflexes induce relatively minor activation in the stretched muscles. A central question is whether stretch reflexes can occur for stimuli that are quite remote. Thus, a new study was made to examine whether foot sole vibration is able to elicit reflex responses in upper-leg muscles, for example by conduction of vibrations throughout the whole leg. SLR responses were indeed found not only in lower- but also in upper-leg muscles. Similarly during stumbling, SLR are observed throughout the whole limb, although the primary perturbation occurs at foot level. After the SLR, much stronger activations usually occur, with latencies (85 or 120ms) well below those seen in voluntary contractions. These late responses are much more selective and presumably linked to the maintenance of stability. The role of the I(b) afferents from the Golgi tendon organs (GTO) is less clear. From animal work, it is known that these afferents are very sensitive to active muscle contraction and that they play a role in providing reinforcing feedback to extensors during the stance phase. The available evidence supports this notion in humans but lack of selective activation methods precludes more conclusive confirmation.
Research Interests:
Research Interests: Engineering, Mechanical Engineering, Robotics, Biomedical Engineering, Biomechanics, and 15 moreCybernetics, Locomotion, Medicine, Coupled Oscillator, Humans, Walking, Animals, Oscillations, Motion, Walking robot, Neural Control, Human Gait, Biomechanical Phenomena, Extremities, and Psychomotor Performance
Research Interests:
Background The Performance and Fitness (PERF-FIT) test battery for children is a recently developed, valid assessment tool for measuring motor skill-related physical fitness in 5 to 12-year-old children living in low-income settings. The... more
Background The Performance and Fitness (PERF-FIT) test battery for children is a recently developed, valid assessment tool for measuring motor skill-related physical fitness in 5 to 12-year-old children living in low-income settings. The aim of this study was to determine: (1) inter-rater reliability and (2) test-retest reliability of the PERF-FIT in children from 3 different countries (Ghana, South Africa and the Netherlands). Method For inter-rater reliability 29 children, (16 boys and 13 girls, 6–10 years) were scored by 2 raters simultaneously. For test–retest reliability 72 children, (33 boys and 39 girls, 5–12 years) performed the test twice, minimally 1 week and maximally 2 weeks apart. Relative and absolute reliability indices were calculated. ANOVA was used to examine differences between the three assessor teams in the three countries. Results The PERF-FIT demonstrated excellent inter-rater reliability (ICC, 0.99) and good test-retest reliability (ICC, ≥ 0.80) for 11 of the...
Research Interests:
Developmental Coordination Disorder (DCD) is a common childhood disorder affecting movement and coordination skills, fitness, and academic performance. Increased physical fitness may have a positive influence on physical and mental health... more
Developmental Coordination Disorder (DCD) is a common childhood disorder affecting movement and coordination skills, fitness, and academic performance. Increased physical fitness may have a positive influence on physical and mental health outcomes in children with DCD. Yet, little has been done to develop interventions to improve fitness performance in this group. The purpose of this study was to determine the effects of graded exergames in 7 to 12-year-old children with DCD and typically developing (TD) peers. Participants (32 DCD and 28 TD children) received a 30-min training session twice weekly for 10 weeks. Performance on motor coordination (MABC-2 test), balance, aerobic, and anaerobic fitness tests were assessed at the beginning and end of training. In addition, enjoyment and perception of exertion were measured for each participant during the training period. Both children with DCD and TD children significantly improved on motor coordination, balance, aerobic, and anaerobic ...
Research Interests:
ObjectivesDespite growing popularity of adolescent rugby in Zimbabwean schools, little is known about qualities or skills of schoolboy rugby players and how they differ by competitive level. Therefore, the aim of the current study was to... more
ObjectivesDespite growing popularity of adolescent rugby in Zimbabwean schools, little is known about qualities or skills of schoolboy rugby players and how they differ by competitive level. Therefore, the aim of the current study was to identify anthropometric, physiological characteristics and rugby-specific game skills capable of discriminating under-16 (U16) RU players across three proficiency levels.MethodsFollowing development of School Clinical Rugby Measure test battery, elite rugby players (n=41), subelite rugby players (n=30) and non-rugby players (n=29) were enrolled and tested for height, sitting height, body mass, skinfolds, speed, agility, upper and lower muscular strength and power, prolonged high-intensity intermittent running ability, tackling, passing and catching in a cross-sectional study.ResultsElite rugby players displayed significantly better scores for all physiological tests and game skills compared with either subelite or non-rugby players, except for Sit-a...
A common motor symptom of Parkinson's disease (PD) is micrographia, characterized by a decrease in writing amplitude. Despite the relevance of this impairment for activities of daily living, the underlying neural network abnormalities... more
A common motor symptom of Parkinson's disease (PD) is micrographia, characterized by a decrease in writing amplitude. Despite the relevance of this impairment for activities of daily living, the underlying neural network abnormalities and the impact of cueing strategies on brain connectivity are unknown. Therefore, we investigated the effects of visual cues on visuomotor network interactions during handwriting in PD and healthy controls (HCs). Twenty-eight patients with early disease, ON dopaminergic medication, and 14 age-matched controls performed a pre-writing task with and without visual cues in the scanner. Patients displayed weaker right visuo-parietal coupling than controls, suggesting impaired visuomotor integration during writing. Surprisingly, cueing did not have the expected positive effects on writing performance. Patients and controls, however, did activate similar networks during cued and uncued writing. During cued writing, the stronger influence of both visual an...
Research Interests:
This systematic review was conducted with the first objective aimed at providing an overview of the physiological characteristics commonly evaluated in rugby and the corresponding tests used to measure each construct. Secondly, the... more
This systematic review was conducted with the first objective aimed at providing an overview of the physiological characteristics commonly evaluated in rugby and the corresponding tests used to measure each construct. Secondly, the measurement properties of all identified tests per physiological construct were evaluated with the ultimate purpose of identifying tests with strongest level of evidence per construct. The review was conducted in two stages. In all stages, electronic databases of EBSCOhost, Medline and Scopus were searched for full-text articles. Stage 1 included studies examining physiological characteristics in rugby. Stage 2 included studies evaluating measurement properties of all tests identified in Stage 1 either in rugby or related sports such as Australian Rules football and Soccer. Two independent reviewers screened relevant articles from titles and abstracts for both stages. Seventy studies met the inclusion criteria for Stage 1. The studies described 63 tests a...
To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account. A systematic review of the experimental literature published between June... more
To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi-component account. A systematic review of the experimental literature published between June 2011 and September 2016 was conducted using a modified PICOS (population, intervention, comparison, outcomes, and study type) framework. A total of 106 studies were included. Behavioural data from 91 studies showed a broad cluster of deficits in the anticipatory control of movement, basic processes of motor learning, and cognitive control. Importantly, however, performance issues in DCD were often shown to be moderated by task type and difficulty. As well, we saw new evidence of compensatory processes and strategies in several studies. Neuroimaging data (15 studies, including electroencephalography) showed reduced cortical thickness in the right medial orbitofrontal cortex and altered brain activation patterns across functional networks involving p...
Research Interests:
Children with Developmental Coordination Disorder (DCD) experience movement difficulties that may be linked to processes involved in motor imagery (MI). This paper discusses recent advances in theory that underpin the use of MI training... more
Children with Developmental Coordination Disorder (DCD) experience movement difficulties that may be linked to processes involved in motor imagery (MI). This paper discusses recent advances in theory that underpin the use of MI training for children with DCD. This knowledge is translated in a new MI training protocol which is compared with the cognitive orientation to daily occupational performance (CO-OP). Children meeting DSM-5 criteria for DCD were assigned to MI (n = 4) or CO-OP (n = 4) interventions and completed nine treatment sessions, including homework exercises. Results were positive, with two children in the MI group and three in the CO-OP group improving their m-ABC-2 score by ≥ 2 standard scores, interpreted as a clinically meaningful change. Moreover, all children and parents noticed improvements in motor skills after training. This is the first study to demonstrate the feasibility of a theoretically principled treatment protocol for MI training in children with DCD, a...
Research Interests:
The Strengths and Difficulties Questionnaire (SDQ) is validated for parents, but not yet for teachers in a broad age range of children. We conducted a cross-sectional study with 4-10 years old school children to investigate if the SDQ-T... more
The Strengths and Difficulties Questionnaire (SDQ) is validated for parents, but not yet for teachers in a broad age range of children. We conducted a cross-sectional study with 4-10 years old school children to investigate if the SDQ-T can be used instead of the validated but lengthy Teacher's Report Form (TRF) to acquire information about emotional and behavioral problems in the school community. Teachers of 453 children from primary schools were approached. Teachers of 394 children (response rate 86.9%) with a mean age of 7.1 years filled in the SDQ-T (n = 387), the TRF (n = 349) or both (n = 342). We assessed reliability by calculating internal consistency and concurrent validity (using correlation coefficients, sensitivity, specificity) of the SDQ-T compared with the TRF. Internal consistency of the SDQ-T Total Difficulties Score (SDQ-T TDS; Cronbach α = 0.80), hyperactivity/ inattention- (α = 0.86) and prosocial behavior (α = 0.81) was very good. Concurrent validity demons...
Research Interests:
Manual therapy according to the School of Manual Therapy Utrecht (MTU) is a specific type of passive manual joint mobilization. MTU has not yet been systematically compared to other manual therapies and physical therapy. In this study the... more
Manual therapy according to the School of Manual Therapy Utrecht (MTU) is a specific type of passive manual joint mobilization. MTU has not yet been systematically compared to other manual therapies and physical therapy. In this study the effectiveness of MTU is compared to physical therapy, particularly active exercise therapy (PT) in patients with non-specific neck pain. Patients neck pain, aged between 18-70 years, were included in a pragmatic randomized controlled trial with a one-year follow-up. Primary outcome measures were global perceived effect and functioning (Neck Disability Index), the secondary outcome was pain intensity (Numeric Rating Scale for Pain). Outcomes were measured at 3, 7, 13, 26 and 52 weeks. Multilevel analyses (intention-to-treat) were the primary analyses for overall between-group differences. Additional to the primary and secondary outcomes the number of treatment sessions of the MTU group and PT group was analyzed. Data were collected from September 20...