Ayelet Dunsky

Home-Based Motor Imagery Training for Gait Rehabilitation of People With Chronic Poststroke Hemiparesis

OBJECTIVE To test the feasibility and efficacy of a home-based motor imagery gait training program to improve walking performance of individuals with chronic poststroke hemiparesis. DESIGN Nonrandomized controlled trial. SETTING Local facility. PARTICIPANTS Participants (N=17) were community-dwelling volunteers with hemiparesis caused by a unilateral stroke that occurred at least 3 months before the study. INTERVENTION Participants received 15 minutes of supervised imagery gait training in their homes 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training. Walking ability was evaluated by kinematics and functional scales twice before the intervention, 3 and 6 weeks after the intervention began, and at the 3-week follow-up. MAIN OUTCOME MEASURES Spatiotemporal, kinematic, and functional walking measurements. RESULTS Walking speed increased significantly by 40% after training, and the gains were largely maintained at the 3-week follow-up. The effect size of the intervention on walking speed was moderate (.64). There were significant increases in stride length, cadence, and single-support time of the affected lower limb, whereas double-support time was decreased. Improvements were also noted on the gait scale of the Tinetti Performance-Oriented Mobility Assessment as well as in functional gait. Sixty-five percent of the participants advanced 1 walking category in the Modified Functional Walking Categories Index. CONCLUSIONS Although further study is recommended, the findings support the feasibility and justify the incorporation of home-based motor imagery exercises to improve walking skills for poststroke hemiparesis.

‘The Multiple-Sit-to-Stand’ Field Test for Older Adults: What Does It Measure?

Background: The need to predict decline in functional status in a large number of older adults has brought researchers and clinicians to develop easy-to-administer field tests. One of them is the ‘multiple-sit-to-stand’ (MSTS), which claims to measure leg strength. Objective: To assess the extent to which the MSTS is a leg strength, leg endurance or general endurance test. Methods: 49 independently functioning women (72.2 ± 6.4 years) were assessed on the MSTS, on a submaximal stress test, and on strength and endurance of knee extensors measured by isokinetics. The knee extensors were selected, more than in other muscle groups responsible for movement of the lower extremity, as the largest range of motion, and the largest torques required while performing activities of daily living (ADL) is found in this group. Results: The correlation of the MSTS with the stress test was moderate and significant but very low and nonsignificant with the isokinetic measurements. Conclusions: The MTST is not able to predict strength of knee extensors, the leading group of leg muscles in ADL. If at all, it predicts general endurance rather than any measure – muscle strength or muscle endurance – of lower extremities. Longitudinal studies assessing the potential of the MSTS to predict deterioration in ADL in older adults are recommended, as well as studies assessing other factors related to both MSTS and ADL, such as muscle-nerve coordination affecting multiple joint activities.

Adolescents' physical activity habits--results from a national health survey.

BACKGROUND   The MABAT Youth National Health and Nutrition Survey was conducted in Israel by the Ministry of Health and the Center for Disease Control. This article presents results of physical activity (PA) habits in Israel, in relation to recommendations by world health organizations. METHODS   Participants were 6274 adolescents, grades 7-12, enrolled in a cross-sectional, representative, school-based survey. Sufficient level of PA was defined as any moderate and vigorous level of PA that adds up daily to 60 min/day. Light PA was considered to be an insufficient level of PA. RESULTS   Only 10.5% of the participants reported performing sufficient PA. Large gender differences were found, with 17.7% of boys versus only 4.6% of girls meeting the guidelines. CONCLUSIONS   Results highlight the need to develop programmes for school children in Israel to promote PA. Such programmes have been initiated in many countries that have a large percentage of adolescents with a sedentary lifestyle.

Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home

Purpose. To demonstrate the feasibility of an innovative program of physical activity using a standing-support device targeted towards adult residents of a nursing home who are unable to transfer or stand independently. Method. Intervention study. Participants. Thirteen residents, age 82 ± 11 years, at the Beit Bayer Nursing Home, Jerusalem, Israel, who were unable to transfer or stand independently. Intervention. Eight-week observational period followed by 12-week physical activity performed while standing in a Standing-Support Device. Measurements. Manual Muscle Testing, joint range of motion, forward and lateral reach, time to stand independently, distance walked with a walker, Functional Independence Measure. Results. Compared to the observational period, significant post-intervention improvements were noted particularly in lower extremity muscle strength. Improvements in the Functional Independence Measure were noted in sphincter control, locomotion, mobility, motor score, and total score. Over 60% of those previously requiring assistance in standing became able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker. Conclusion. A pilot program of physical activity using a Standing-Support Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement. Future studies of the device with a concurrent examination of healthcare costs, functional improvement, and staff burden, are recommended.

Physical activity and sport in advanced age: is it risky? a summary of data from articles published between 2000-2009.

BACKGROUND The benefits of physical activity in old age are well documented. However, studies have shown that older adults are insufficiently active. One of the reported barriers to physical activity is fear of injuries. OBJECTIVE To review available data on the rate of injuries related to sport and purposeful physical activity in advanced aged. METHODS A systematic review of reports published in English, identified by searching four data bases and the reference lists of reviewed articles. Eligible reports were full articles in a peer-reviewed journal, and the study report had to include the injury rate of individuals aged 45 and above and the kind of activities that led to the injury. Seven reports met the inclusion criteria. RESULTS Studies on injuries in advanced age are scarce, and lack information on the rate of injuries relative to the extent of exercise. The rate of injuries occurring during physical activity in advanced age, based on existing data, is very low compared to other ages. The injury rate of men is almost twice that of women. Men tend to get injured while engaging in ball games and bicycling, while women mostly during exercise. The most frequent reported injuries in the general population including older adults are strains and sprains, followed by fractures in the lower and upper extremities. CONCLUSIONS Since older adults are being encouraged to increase their habitual physical activity even beyond the basic recommended guidelines, more studies are needed to assess the risk of injuries relative to the extent of exercise.

Arm-Curl Field Test for Older Women: Is it a Measure of Arm Strength?

Ayelet Dunsky, A, Ayalon, M, and Netz, Y. Arm-curl field test for older women: is it a measure of arm strength? J Strength Cond Res 25(1): 193-197, 2011-The facilitative effect of physical activity on age-related decline is well documented. Specifically, it has been found to reduce the risk of dependency. However, physical activity programs for older adults should be carefully designed so that improvements in all aspects of movement and physical capacities are achieved. This means that efficient fitness measurements should be made available for coaches and trainers. The arm-curl test is a common field test known for measuring the strength of upper extremities in older age. The objective of the current study was to determine to what extent this test indeed assesses arm strength as well as other fitness aspects such as arm muscle endurance or general endurance. Scores of the arm-curl test were compared with strength and endurance of elbow flexors measured by an isokinetic dynamometer and general endurance measured by a stress test in 48 independently functioning women (age 72.04 ± 6.28 yr). Significant correlations were indicated between the arm-curl scores and both isokinetic endurance (r = 0.452) and general endurance (r = 0.437); however, a very low nonsignificant correlation was found between the arm-curl and isokinetic maximal strength scores. Coaches must be aware of the fact that the repetitive arm-curl exercise contains a significant aerobic component and thus may contribute to aerobic fitness and arm muscle endurance but not necessarily to arm strength.

The effects of a resistance vs. an aerobic single session on attention and executive functioning in adults

[This corrects the article DOI: 10.1371/journal.pone.0176092.].

Balance Training Using an iPhone Application in People With Familial Dysautonomia: Three Case Reports

Background and Purpose Familial dysautonomia (FD) is a rare genetic autosomal recessive disease that impairs vital functions and causes neural and motor deficiency. These motor deficits often are characterized by static and dynamic instability and an ataxic gait. As a result, people with FD are at risk for significant physical impairment and falls and pose unique challenges for delivering rehabilitation exercise. Consequently, there is a need for challenging ways to safely and feasibly deliver active exercise rehabilitation to these individuals. Case Description This case report describes 3 people with FD (ages 11, 12, and 22 years) with gait and stability problems who attended rehabilitation exercises augmented by the use of an iPhone application specifically developed for the program. Outcomes The Berg Balance Scale and the Four Square Step Test were conducted prior to training, after training, and after 2 months of follow-up without training. Two patients showed improvements on both measures at the posttest, which were maintained throughout follow-up testing. Discussion Although greater experience is needed to more fully evaluate the efficiency of the iPhone application used in this program for people with FD, the results of these initial cases are encouraging. Systematically and prospectively tracking motor abilities and other functional outcomes during rehabilitation of individuals with FD who use the suggested application in balance training is recommended in order to provide greater evidence in this area.

Level of physical activity and anthropometric characteristics in old age—results from a national health survey

Advanced age is associated with degenerative changes in body composition. There is evidence suggesting that changes may vary upon differences in lifestyle, environment, or gender. Physical activity engagement is considered an important component of lifestyle definition. There are suggestions that engaging in physical activity might alleviate degenerative body compositional changes. The objective is to assess the relationship between adherence to recommended guidelines of physical activity and anthropometric parameters in Israeli older adults. Anthropometric measures, including height, weight, and waist circumference, were taken, and BMI was calculated, from a random sample of 1,663 elderly adults (799 men and 864 women), aged 74.31 (±6.05) years old. Participants reported their physical activity habits and, based on official guidelines recommendations, they were divided into sufficiently active, insufficiently active, and inactive groups. One-way ANOVA (level of physical activity) for both genders was conducted for each anthropometric variable. In both genders, an association between level of physical activity and weight, waist circumference, and BMI was found, with lower values among the sufficiently active. In addition, a relationship between level of physical activity and height was indicated among women, implying that the more active women were taller than the less active. In addition to the already known health benefits of physical activity in old age, it is possible that adherence to recommended guidelines of physical activity is associated with favorable anthropometric characteristics.

Psychological functioning and adherence to the recommended dose of physical activity in later life: results from a national health survey

BACKGROUND Official health organizations have established the dose of physical activity needed for preserving both physical and psychological health in old age. The objective of this study was to explore whether adherence to the recommended criterion of physical activity accounted for better psychological functioning in older adults in Israel. METHODS A random sample of 1,663 (799 men) Israelis reported their physical activity routine, and based on official guidelines were divided into sufficiently active, insufficiently active, and inactive groups. The General Health Questionnaire (GHQ) was used for assessing mental health and the Mini-Mental State Examination (MMSE) for assessing cognitive functioning. RESULTS Factor analysis performed on the GHQ yielded two factors - positive and negative. Logistic regressions for the GHQ factors and for the MMSE were conducted for explaining their variance, with demographic variables entered first, followed by health and then physical activity. The explained variance in the three steps was Cox and Snell R2 = 0.022, 0.023, 0.039 for the positive factor, 0.066, 0.093, 0.101 for the negative factor, and 0.204, 0.206, 0.209 for the MMSE. CONCLUSIONS Adherence to the recommended dose of physical activity accounted for better psychological functioning beyond demographic and health variables; however, the additional explained variance was small. More specific guidelines of physical activity may elucidate a stronger relationship, but only randomized controlled trials can reveal cause-effect relationship between physical activity and psychological functioning. More studies are needed focusing on the positive factor of psychological functioning.