Amy B. Curtis

Balance, Balance Confidence, and Health-Related Quality of Life in Persons With Chronic Stroke After Body Weight-Supported Treadmill Training

OBJECTIVES To examine changes in balance, balance confidence, and health-related quality of life immediately and 6 months after body weight-supported treadmill training (BWSTT) for persons with chronic stroke (primary objective) and to determine whether changes in gait speed after BWSTT were associated with changes in these dimensions of health (secondary objective). DESIGN Prospective pre-/posttest pilot study with 6 months retention. SETTING University research laboratory settings. PARTICIPANTS A convenience sample of participants (N=19; at least 6mo poststroke; able to ambulate 0.4-0.8m/s) were recruited. INTERVENTION BWSTT was provided for 24 sessions over 8 weeks with 20 minutes of total walking each session. MAIN OUTCOME MEASURES Berg Balance Scale (BBS), Activities-Specific Balance Confidence (ABC) Scale, Stroke Impact Scale (SIS), comfortable 10-m walk test (CWT), and fast 10-m walk test (FWT). Proportions of participants who achieved minimal detectable changes (MDCs) were examined for all measures. RESULTS Statistically significant improvements were found from pre- to posttest for BBS, ABC, SIS mobility, SIS stroke recovery, and CWT scores (P<.05) and from pretest to retention on BBS, ABC, CWT, and FWT scores (P<.05). For most participants, improvements did not exceed MDCs. Changes in gait speed and BBS, ABC, and SIS scores were not associated. CONCLUSIONS The findings of this study suggest that effects of BWSTT may transfer beyond gait to positively influence balance, balance confidence, and health-related quality of life. However, for most participants, BWSTT was not sufficient to induce improvements in balance and balance confidence beyond measurement error or long-term retention of enhanced perceptions of quality of life.

Bilateral coordination and gait symmetry after body-weight supported treadmill training for persons with chronic stroke

BACKGROUND Locomotor interventions are commonly assessed using functional outcomes, but these outcomes provide limited information about changes toward recovery or compensatory mechanisms. The study purposes were to examine changes in gait symmetry and bilateral coordination following body-weight supported treadmill training in individuals with chronic hemiparesis due to stroke and to compare findings to participants without disability. METHODS Nineteen participants with stroke (>6 months) who ambulated between 0.4 and 0.8 m/s and 22 participants without disability were enrolled in this repeated-measures study. The stroke group completed 24 intervention sessions over 8 weeks with 20 minutes of walking/session. The non-disabled group served as a comparison for describing changes in symmetry and coordination. Bilateral 3-dimensional motion analysis and gait speed were assessed across 3 time points (pre-test, immediate post-test, and 6-month retention). Continuous relative phase was used to evaluate bilateral coordination (thigh-thigh, shank-shank, foot-foot) and gait symmetry was assessed with spatiotemporal ratios (step length, swing time, stance time). FINDINGS Significant improvements in continuous relative phase (shank-shank and foot-foot couplings) were found at post-test and retention for the stroke group. Significant differences in spatiotemporal symmetry ratios were not found over time. Compared to the non-disabled group, changes in bilateral coordination moved in the direction of normal recovery. Most measures of continuous relative phase were more responsive to change after training than the spatiotemporal ratios. INTERPRETATIONS After body-weight supported treadmill training, the stroke group made improvements toward recovery of normal bilateral coordination. Bilateral coordination and gait symmetry measures may assess different aspects of gait.

Effects of Body-Weight Supported Treadmill Training on Kinetic Symmetry in Persons with Chronic Stroke

BACKGROUND The purpose was to examine changes in kinetic symmetry in persons with chronic stroke immediately and 6-months after body-weight supported treadmill training. METHODS Fifteen participants at least six-months post stroke and able to ambulate between 0.4 and 0.8m/s and 20 participants without neurological conditions completed all phases of the study and were included in the analysis. The non-disabled group served as a comparison for describing changes in kinetic symmetry. The stroke group completed 24 sessions of body-weight supported treadmill training over 8-weeks with 20 minutes of total walking per session. Bilateral 3-dimensional motion analysis and gait speed were assessed 1-week before training (pre-test), 1-week after training (post-test) and 6-months after training (retention) in a repeated measures design. Relative propulsion of the paretic leg and relative positive work of the hip, knee and ankle joints of both legs were calculated to evaluate symmetry of kinetic forces. FINDINGS Statistically significant differences in relative propulsion and positive joint work within the paretic and non-paretic legs were not found over time. The stroke group significantly improved gait speed from pre- to post-test (p=.001) and pre-test to retention (p=.008). In comparison to the non-disabled group, forces produced by the stroke group were asymmetrical demonstrating compensatory adaptation. INTERPRETATION Although the participants with chronic stroke walked faster after body-weight supported treadmill training, the relative percentages of propulsion and positive work remained unchanged. These findings suggest that the increase in speed was likely due to strengthening existing compensatory strategies rather than through recovery of normal kinetic symmetry.

Using GIS and Secondary Data to Target Diabetes-Related Public Health Efforts:

Objectives. To efficiently help communities prevent and manage diabetes, health departments need to be able to target populations with high risk but low resources To aid in this process, we mapped county-level diabetes-related rates and resources/use using publicly available secondary data to identify Michigan counties with high diabetes prevalence and low or no medical and/or community resources. Methods. We collected county-level diabetes-related rates and resources from Web-based sources and mapped them using geographic information systems (GIS) software. Data included age-adjusted county diabetes rates, diabetes-related medical resource and resource use (i.e., the number of endocrinologists and percentage of Medicare patients with diabetes who received hemoglobin A1c testing in the past year), community resources (i.e., the number of certified diabetes self-management education and diabetes support groups), as well as population estimates and demographics (e.g., rural residence, education, poverty, and race/ethnicity). We created GIS maps highlighting areas that had higher-than-median rates of disease and lower-than-median resources. We also conducted linear, logistic, and Poisson regression analyses to confirm GIS findings. Results. There were clear regional trends in resource distribution across Michigan. The 15 counties in the Upper Peninsula were lacking in medical resources but higher in community resources compared with the 68 counties in the Lower Peninsula. There was little apparent association between need (diabetes prevalence) and diabetes-related resources/use. Specific counties with high diabetes prevalence and low resources were easily identified using GIS mapping. Conclusion. Using public data and mapping tools identified diabetes health-service shortage areas for targeted public health programming.

Longitudinal follow-up of factors associated with food selectivity in children with autism spectrum disorders

The objective of this study was to examine food selectivity in children with autism spectrum disorders longitudinally. Additionally explored were the stability of the relationship between food selectivity and sensory over-responsivity from time 1 to time 2 and the association between food selectivity and restricted and repetitive behavior at time 2. A total of 52 parents of children with autism were surveyed approximately 20 months after completing an initial questionnaire. First and second surveys each contained identical parent-response item to categorize food selectivity level and a scale to measure sensory over-responsivity. A new scale to measure restricted and repetitive behaviors was added at time 2. Results comparing time 1 to time 2 indicated no change in food selectivity level and a stable, significant relationship between food selectivity and sensory over-responsivity. The measure of restrictive and repetitive behavior (time 2) was found to significantly predict membership in the severe food selectivity group. However, when sensory over-responsivity and both restricted and repetitive behaviors were included in the regression model, only sensory over-responsivity significantly predicted severe food selectivity. These results support conclusions about the chronicity of food selectivity in young children with autism and the consistent relationship between food selectivity and sensory over-responsivity.

Grip strength values stratified by age, gender, and chronic disease status in adults aged 50 years and older.

Background and Purpose:Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases. Methods:A cross-sectional analysis was conducted using data collected from adults aged 50 years or older (n = 5877) from the Health and Retirement Study survey administered in 2008. Grip strength values (in kilograms) were determined and stratified on the basis of the number of self-reported chronic diseases (0, 1, 2, ≥3) and stratified by age (decades) and gender. Results:Consistent with previously published values, males demonstrated higher mean hand grip strength than females and grip strength values decreased with age. Adults with multimorbidity demonstrated decreased grip strength as compared with those without chronic conditions (males/females with 0 chronic diseases right grip strength = 44.2/26.8 kg as compared with males/females with 3 or more chronic disease right grip strength = 36.1/21.7 kg). Conclusions:The grip strength values presented can serve as a standard of comparison for the large proportion of adults who have multimorbidity. Clinicians should consider grip strength as a component of a comprehensive physical assessment to identify decreased grip strength and recommend increased physical activity as an appropriate intervention.

Associations of Physiological Factors, Age, and Sensory Over-Responsivity with Food Selectivity in Children with Autism Spectrum Disorders

PURPOSE: The aim of this study was to investigate the relationship among physiological factors, age, sensory over-responsivity (SOR) and food selectivity in children with autism spectrum disorders (ASD). METHODS: One hundred forty-one parents of children with ASD were recruited through a national autism organization, Autism Speaks, to fill out a survey regarding their child’s mealtime behavior. Survey contained items to measure the severity of food selectivity behavior, the presence of physiological factors (i.e., reflux, constipation, food allergies and the need for a specialized diet) and sensory over-responsivity (SOR). Results were analyzed using Chi Square, ANOVA and logistic regression. RESULTS: No relationship between physiological factors and level of food selectivity was found. Older children in the 3-9 year old range did not have more foods in their diet repertoire than younger children. Finally, children with fewer than 10 and those with 11-20 foods in their diet (i.e., severe food selectivity and moderate food selectivity respectively) were found to have significantly higher scores on a measure of SOR when compared to children with 21+ foods (typical selectivity). CONCLUSIONS: When addressing food selectivity in children with ASD, consideration of the possibility that the child may not outgrow restricted diets is warranted. Also, treatment for food selectivity may be more effective if SOR is included in protocol.

Is There an Association between Risk Perception and Disaster Preparedness in Rural US Hospitals

INTRODUCTION This study examined disaster preparedness, risk perception, and their association in rural hospitals in the United States. The focus of disaster preparedness largely has been centered on urban areas, in part because of the perception that more concentrated areas have an increased risk of a disastrous event. Therefore, it was hypothesized that risk perception may be a contributing factor for adequate preparedness in rural areas. This research was a component of a larger study of rural hospital preparedness. The objective of this study was to describe the perceived risk of disaster events and the status of disaster preparedness in rural hospitals. It was hypothesized that there is a positive association between risk perception and preparedness. METHODS Secondary data analysis was conducted using the National Study of Rural Hospitals (2006-2007) from Johns Hopkins University. The study, based on a regionally stratified, random sample of rural hospitals, consisted of a mailed questionnaire and a follow-up telephone interview with each hospitals Chief Executive Officer (n = 134). A model of disaster preparedness was utilized to examine seven elements of preparedness. Risk perception was examined through seven perceived risk threats. RESULTS The results indicated that rural hospitals were moderately prepared, overall, (78% prepared on average), with higher preparedness in education/training (89%) and isolation/decontamination (91%); moderate preparedness in administration/planning (80%), communication/notification (83%), staffing/support (66%, and supplies/pharmaceuticals/laboratory support (70%); and lower preparedness in surge capacity (64%). The respondents reported greater perceived risk from disasters due to natural hazards (79% reported moderate to high risk) and vehicular accidents (77%) than from humanmade disasters (23%). Results obtained from logistic regression models indicated that there was no statistically significant difference in the odds of a hospital being prepared overall when comparing high versus low risk perception (OR = 0.61; 95% CI = 0.26-1.44). Positive associations were identified only between higher perceived risk overall and the subcategory of education/training preparedness (OR = 1.24; 95% CI = 1.05-1.27). CONCLUSIONS Rural hospitals reported being moderately prepared in the event of a disaster with a low perception of risk for human-made disasters. Further research should be conducted to identify predictors of preparedness in rural hospitals in order to optimize readiness for potential disaster events.

Using GIS Mapping to Target Public Health Interventions: Examining Birth Outcomes Across GIS Techniques

With advances in spatial analysis techniques, there has been a trend in recent public health research to assess the contribution of area-level factors to health disparity for a number of outcomes, including births. Although it is widely accepted that health disparity is best addressed by targeted, evidence-based and data-driven community efforts, and despite national and local focus in the U.S. to reduce infant mortality and improve maternal-child health, there is little work exploring how choice of scale and specific GIS visualization technique may alter the perception of analyses focused on health disparity in birth outcomes. Retrospective cohort study. Spatial analysis of individual-level vital records data for low birthweight and preterm births born to black women from 2007 to 2012 in one mid-sized Midwest city using different geographic information systems (GIS) visualization techniques [geocoded address records were aggregated at two levels of scale and additionally mapped using kernel density estimation (KDE)]. GIS analyses in this study support our hypothesis that choice of geographic scale (neighborhood or census tract) for aggregated birth data can alter programmatic decision-making. Results indicate that the relative merits of aggregated visualization or the use of KDE technique depend on the scale of intervention. The KDE map proved useful in targeting specific areas for interventions in cities with smaller populations and larger census tracts, where they allow for greater specificity in identifying intervention areas. When public health programmers seek to inform intervention placement in highly populated areas, however, aggregated data at the census tract level may be preferred, since it requires lower investments in terms of time and cartographic skill and, unlike neighborhood, census tracts are standardized in that they become smaller as the population density of an area increases.

Integrated Dual Disorder Treatment Implementation in a Large State Sample.

Individuals with co-occurring illnesses are at risk for poor outcomes related to criminal justice, hospitalization, housing, and employment. High fidelity evidence-based models, including integrated dual disorder treatment (IDDT), are associated with significant outcome improvements. A descriptive analysis of secondary datasets including the full sample of IDDT fidelity reviews completed from 2006 to 2012 in one state was completed. Total IDDT fidelity significantly improved from baseline fidelity review (68) to second review (40) [t(38) = 35.00, p < .001], and from second review to third review (13) [t(12) = 22.60, p < .001], with adequate inner-rater reliability by the second review. Individual items that were lower across reviews included practice penetration and family interventions, and higher individual items included multi-disciplinary team, integrated treatment specialist, and time-unlimited services, and treatment measures are higher than organizational measures in baseline and subsequent reviews. In this large state-wide sample, IDDT took time to implement, and improved fidelity occurred from baseline to third review, and variance between components of the practice was significant.