Bruce A. McClenaghan

Spectral characteristics of aging postural control

Abstract The purpose of this study was to apply techniques of spectral analysis to the study of postural control and determine if aging results in changes to spectral parameters obtained from postural forces. Subjects were young adults and elderly who live independently and had no difficulty performing tasks of daily living. Ground reaction forces were obtained from a measurement plat-form during repeated trials of static standing. Forces were analyzed using spectral analysis and selected parameters (central tendency and dispersion) were extracted from averaged spectral data. Significant differences were observed between age groups in all parameters extracted from spectra obtained from medial-lateral postural forces. Similar results were not obtained for data in the anterior-posterior direction. Results suggest that aging affects the spectral characteristics of postural forces used to maintain stability in the m-l direction.

Effects Of Seat‐Surface Inclination On Postural Stability And Function Of The Upper Extremities Of Children With Cerebral Palsy

This study investigated the effects of seat‐surface inclination on parameters of postural stability and functional use of the upper extremity. 10 non‐impaired children and 10 children with cerebral palsy, aged between four and 15 years, were studied. Seat‐suface inclinations of 0d̀, 5d̀ anteriorly and 5d̀ posteriorly were used as the experimental conditions. Significant differences were observed on most dependent measures between the two groups. The results suggest that anteriorly tilting the seats of children with cerebral palsy may disturb postural stability, without improving performance of the upper extremity.

Effects of Feldenkrais Exercises on Balance, Mobility, Balance Confidence, and Gait Performance in Community-Dwelling Adults Age 65 and Older

BACKGROUND Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls. OBJECTIVE The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults. METHODS Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted. RESULTS After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067). CONCLUSIONS These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.

Spectral characteristics of ageing postural control

Abstract The purpose of this study was to apply techniques of spectral analysis to the study of postural control and determine if ageing results in changes to spectral parameters obtained from postural forces. Subjects were young adults and elderly who live independently and had no difficulty performing tasks of daily living. Ground reaction forces were obtained from a measurement platform during repeated trials of static standing. Forces were analysed using spectral analysis and selected parameters (central tendency and dispersion) were extracted from averaged spectral data. Significant differences were observed between age groups in all parameters extracted from spectra obtained from medial-lateral postural forces. Similar results were not obtained for data in the anterior-posterior direction. Results suggest that ageing affects the spectral characteristics of postural forces used to maintain stability in the m-I direction.

are Measures Employed in the Assessment of Balance Useful for Detecting Differences among Groups that Vary by Age and Disease State

Purpose: This study explored the usefulness of measures commonly employed in the examination of persons with balance impairment to discriminate between performances of young and older adults and older adults with and without neurological disease. Methods: Eighteen young adults, 22 healthy older adults, 12 individuals with Parkinson disease, and 20 older adults with peripheral neuropathy were recruited from the community. Performances on the following measures were compared: Mini Mental State Exam, grip strength, timed chair rise, semitandem and tandem stance, Timed Up and Go (TUG), and Berg Balance Scale (BBS). Survival analysis was used to analyze semitandem and tandem stance. Grip strength and other tests were analyzed using analysis of variance. Tukey multiple comparison procedure was employed to assess differences in performance among groups. Results: Significant differences in performance were found for all measures. Grip and timed chair rise discriminated young and older adult groups. Timed chair rise, tandem stance, TUG, and BBS detected differences between healthy individuals and those with disease. Semitandem stance and BBS discriminated between individuals with disease conditions. Conclusions: When examining individuals with balance difficulty, combinations of measures are needed to discriminate between clinically distinct groups.

Counting Repetitions: An Observational Study of Video Game Play in People With Chronic Poststroke Hemiparesis

Background and Purpose: The use of video gaming as a therapeutic intervention has increased in popularity; however, the number of repetitions in comparison with traditional therapy methods has yet to be investigated. The primary purpose of this study was to document and compare the number of repetitions performed while playing 1 of 2 video gaming systems for a time frame similar to that of a traditional therapy session in individuals with chronic stroke. Methods: Twelve participants with chronic stroke (mean age, 66.8 ± 8.2 years; time poststroke, 19.2 ± 15.4 months) completed video game play sessions, using either the Nintendo Wii or the Playstation 2 EyeToy. A total of 203 sessions were captured on video record; of these, 50 sessions for each gaming system were randomly selected for analysis. For each selected record, active upper and lower extremity repetitions were counted for a 36-minute segment of the recorded session. Results: The Playstation 2 EyeToy group produced an average of 302.5 (228.1) upper extremity active movements and 189.3 (98.3) weight shifts, significantly higher than the Nintendo Wii group, which produced an average of 61.9 (65.7) upper extremity active movements and 109.7 (78.5) weight shifts. No significant differences were found in steps and other lower extremity active movements between the 2 systems. Discussion and Conclusions: The Playstation 2 EyeToy group produced more upper extremity active movements and weight shifting movements than the Nintendo Wii group; the number and type of repetitions varied across games. Active gaming (specifically Playstation 2 EyeToy) provided more upper extremity repetitions than those reported in the literature by using traditional therapy, suggesting that it may be a modality to promote increased active movements in individuals poststroke. Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A50) for more insights from the authors.

Duration of muscle activity during standing in normally and slowly developing children

Research in motor control indicates that there are fixed patterns of activity which occur in certain muscle groups involved in standing in adults. The purpose of this study was to assess patterns of duration of muscle activity during quiet standing with and without superimposed arm movement in young children with normal and delayed motor development. Thirty-three children 4, 6, 8 and 10 years of age were screened for level of motor development and classified as either normally or slowly developing. Children performed two tasks: standing and standing with a superimposed 90 degree shoulder abduction movement. Using surface electrodes, EMG activity was monitored in Gastrocnemius, Tibialis Anterior and Erector Spinae muscle groups. The percentage of time activity was present in individual muscle groups was analyzed as a function of age and developmental level. Results indicated that quiet standing in children with delayed motor development was characterized by greater duration of activity in trunk than in leg muscles while in normal children, there was a more equal distribution of muscle activity between the legs and trunk. Both groups of children accommodated superimposed arm movement by increasing the percentage of time Erector Spinae activity was present. Patterns of duration of muscle activity in the legs were, however, different for the two groups of children.

Feasibility of Intensive Mobility Training to Improve Gait, Balance, and Mobility in Persons With Chronic Neurological Conditions: A Case Series

Background and Purpose: Intensive mobility training (IMT) is a rehabilitative approach aimed at improving gait, balance, and mobility through the incorporation of task-specific, massed practice. The purpose of this case series was to examine the feasibility and benefits of the IMT protocol across a sample of 4 individuals with diverse chronic neurological diagnoses, including incomplete spinal cord injury, Parkinsons disease, stroke, and cerebral hemispherectomy. Methods: The 4 participants enrolled in the IMT protocol and followed an intensive treatment schedule of 3 h/d sessions for 10 consecutive weekdays totaling 30 hours. Each session allocated 1 hour each to (1) body weight–supported treadmill-based locomotor training, (2) balance interventions, and (3) activities to improve coordination, strength, and range of motion. Interventions emphasized repetitive, task-specific training of lower-extremity movements in a massed practice schedule. Pain, fatigue, and time in activity were used to assess feasibility of the treatment. Temporal-spatial gait parameters, Berg Balance Scale, Dynamic Gait Index, Timed Up and Go test, and 6-Minute Walk test were used to assess changes in performance. Results: Participants were able to complete an average of 144 of 180 minutes of activity per day for 10 days. Participants demonstrated modest improvements after the intervention on at least one outcome measure for each target area of gait, mobility, and balance. Some improvements were maintained for 1 to 6 months after participation. Discussion: Despite differences in diagnosis among these participants with chronic neurological disorders, on average they were able to complete 80% of an intensive treatment schedule of 3 hours/day for 10 days with no adverse effects. It appears that some gains made during participation are maintained for a period of time after the end of training. IMT is a feasible intervention incorporating an intensive training approach to improve gait, balance, and mobility; however, a randomized trial is needed to further investigate the effects of the intervention.

The Steps to Health Randomized Trial for Arthritis A Self-Directed Exercise Versus Nutrition Control Program

BACKGROUND Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. PURPOSE To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. DESIGN Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. SETTING/PARTICIPANTS Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating). INTERVENTION Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. MAIN OUTCOME MEASURES Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. RESULTS Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity. CONCLUSIONS The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.

Participants' Perspectives on the Feasibility of a Novel, Intensive, Task-Specific Intervention for Individuals With Chronic Stroke: A Qualitative Analysis

Background Evidence-based practice promotes patient-centered care, yet the majority of rehabilitative research fails to take patient perspectives into consideration. Qualitative research provides a unique opportunity for patients to express opinions and provide valuable insight on intervention processes. Objective The purpose of this study was to assess the feasibility of a novel, intensive, task-specific intervention from the patients perspective. Design A phenomenological approach to qualitative inquiry was used. Methods Eight individuals with chronic stroke participated in an intensive intervention, 3 hours per day for 10 consecutive days. Participants were interviewed twice regarding their impressions of the therapy, and a focus group was conducted with participants and family members. Data analysis included an analytical thematic approach. Results Five major themes arose related to the feasibility of the intervention: (1) a manageable amount of fatigue; (2) a difficult, yet doable, level of intensity; (3) a disappointingly short therapy duration; (4) enjoyment of the intervention; and (5) muscle soreness. Conclusions The findings suggest that participants perceived this novel and intensive, task-specific intervention as a feasible therapeutic option for individuals with chronic stroke. Despite the fatigue and muscle soreness associated with intensive rehabilitation, participants frequently reported enjoying the therapy and stated disappointment with the short duration (10 days). Future research should include a feasibility trial of longer duration, as well as a qualitative analysis of the benefits associated with the intervention.