Christopher Ray

Effects of home-based exercise on postural control and sensory organization in individuals with Parkinson disease

Loss of function and postural instability occur in Parkinson disease (PD). Dynamic exercise interventions are successful in improving motor control and physical function. However, most programs are based in a health facility or physical therapy setting and involve travel. With the limitations associated with PD (e.g. health care and medication cost as well as travel limitations) these therapies may be inaccessible and exclude some individuals from maintaining or increasing their function. The purpose of this study was to evaluate the effectiveness of a home-based exercise intervention on postural control in individuals with PD. Multivariate analysis of covariance was performed on individuals with PD (N = 10) and healthy aged-matched controls (N = 10). Participants were assessed utilizing computerized dynamic posturography (CDP) before and after a 10-week exercise intervention. Participants were instructed on proper technique prior to the intervention, were given an illustrated home program, and were monitored weekly concerning their progress. Pre-intervention assessment demonstrated that individuals with PD had statically lower scores on a Sensory Organization Test (p < .05). Following the intervention, results indicated no statistical difference between individuals with PD and aged match controls (p > .05). This initial study indicates that a home exercise intervention is an effective method of improving postural control in individuals with PD. Results from this investigation support further study to determine the extent to which both preventative and restorative home-based programs can improve postural control.

Review of intrinsic factors related to fall risk in individuals with visual impairments

Abundant information in the geriatric literature emphasizes the factors relevant to maintenance of independent mobility and reduction of fall risk. However, while some researchers have attempted to identify the relationship between chronic health and visual impairment, few studies have systematically explored the impact of physical interventions that aim to remediate reduced health and function in adults with visual impairments. This review identifies intrinsic physical factors that negatively affect health and independence in adults with visual impairments. By highlighting these factors, we hope to provide a basis for future exercise interventions that will target reductions in the rate of physiological decline while preserving and potentially restoring independent functioning. Because the aging population is increasing and the basis for and subsequent formulation of exercise programs for maintaining mobility and quality of life have not been definitively ascertained for individuals with declining vision, exploring the intrinsic physical factors most amenable to physical rehabilitation becomes relevant.

Fear-Avoidance Beliefs and Chronic Pain

Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and treat pain-related FA.

Biopsychosocial Characteristics, Using a New Functional Measure of Balance, of an Elderly Population with CLBP

This study examined the biopsychosocial characteristics of chronic low back pain (CLBP) in an understudied but increasingly larger part of the population: the elderly (i.e., 65 years and older). A new innovative physical functioning measure (postural control, which is a proxy for the common problem of slips and falls in the elderly) was part of this biopsychosocial evaluation. Also, the National Institutes of Health (NIH)-developed Patient-Reported Outcome Measurement Information System (PROMIS) was also part of this comprehensive evaluation. Two demographically-matched groups of elderly participants were evaluated: one with CLBP (n = 24); and the other without (NCLBP, n = 24). Results revealed significant differences in most of these measures between the two groups, further confirming the importance of using a biopsychosocial approach for future studies of pain and postural control in the elderly.

Easy-to-use, general, and accurate multi-Kinect calibration and its application to gait monitoring for fall prediction

Falls are the most-common causes of unintentional injury and death in older adults. Many clinics, hospitals, and health-care providers are urgently seeking accurate, low-cost, and easy-to-use technology to predict falls before they happen, e.g., by monitoring the human walking pattern (or “gait”). Despite the wide popularity of Microsofts Kinect and the plethora of solutions for gait monitoring, no strategy has been proposed to date to allow non-expert users to calibrate the cameras, which is essential to accurately fuse the body motion observed by each camera in a single frame of reference. In this paper, we present a novel multi-Kinect calibration algorithm that has advanced features when compared to existing methods: 1) is easy to use, 2) it can be used in any generic Kinect arrangement, and 3) it provides accurate calibration. Extensive real-world experiments have been conducted to validate our algorithm and to compare its performance against other multi-Kinect calibration approaches, especially to show the improved estimate of gait parameters. Finally, a MATLAB Toolbox has been made publicly available for the entire research community.

Fitness, Balance Efficacy, and Postural Control in Community-Dwelling Older Adults

Age-related declines in postural control and physical fitness are strong risk factors for falls in older adults. Balance efficacy has been utilized to identify poor postural control, reduced physical function, and fall risk. However, it is not clear as to whether balance efficacy is truly a better predictor of functional fitness outcomes or postural control. Distinguishing these associations is an important step in the future derivation of physiotherapeutic programming to remediate acute and chronic decline. Therefore, the purpose of this cross-sectional study was to partition which measures are more associated with balance efficacy, fitness, or postural control. One hundred eleven community-dwelling older adults participated and were asked to complete the Balance Efficacy Scale (BES), a functional fitness measure (the Senior Fitness Test [SFT]), and a measure of postural control (the Sensory Organization Test [SOT]).We found that the SFT was more significantly associated with balance efficacy (R2 = .37) than the SOT (R2 = .08) in older adults. Overall, aerobic endurance, functional mobility in the SFT, and the vestibular score on the SOT were significantly associated with balance efficacy. We concluded that clinicians utilizing the BES as a preliminary screen should recommend physiotherapy follow-up activities that build endurance (walking), lower extremity functional mobility (sit-to-stand), and vestibular function (head movement while walking). Understanding the links between a preliminary screening tool and the physiological needs of the patient will allow for targeted activities to be prescribed.

The effects of a Nintendo Wii exercise intervention on gait in older adults.

Gait characteristics serve as indicators of fall risk. Exercise interventions have been shown to improve gait. However, the use of interactive video games with biofeedback to reduce fall risk has not been well explored. Eighty-two older adults were randomly assigned to either a traditional fitness or Wii group. Both 10-week interventions involved 45-minute exercise sessions (3 days per week). Pre- and post-testing gait measurements were taken. Both groups significantly improved velocity, stride length, cadence, swing time, and decreased double support time (p < .05). Interactive video games offer a promising alternative to traditional group exercise for older adults.