Jane R. Marone

Task-specific Training Reduces Trip-related Fall Risk in Women

PURPOSE The potential of task-specific training as a fall-prevention intervention was studied. The primary purpose of the study was to determine the extent to which a task-specific training protocol decreased the number of falls by middle-age and older women after a laboratory-induced trip. Secondary purposes were to explore the ability of trunk kinematics during the initial recovery step and the length of the initial recovery step to correctly classify the trip outcome and to quantify the extent to which the training protocol affected these variables. METHODS Healthy community-dwelling women (n = 52) were assigned to either a training group or a control group that received no training. Training group women participated in an individually tailored, task-specific training protocol during which forward-directed stepping responses were necessary to avoid a fall after treadmill-delivered postural disturbances. Following the protocol, the ability to avoid a fall after a laboratory-induced trip was assessed. The primary outcome variable was the success (recover) or failure (fall) of the posttrip stepping response. RESULTS Compared with the control group, there were fewer falls by the trained women after the laboratory-induced trip (P < 0.001; odds ratio = 0.13). Using logistic regression, falls and recoveries after the trip were sensitively classified by trunk flexion angle at the completion of the initial recovery step and the length of the initial recovery step (sensitivity = 0.67, specificity = 0.98), the former of which improved as a result of the task-specific training protocol. CONCLUSIONS The task-specific training protocol significantly reduced the number of falls after a laboratory-induced trip. Prospective study is required to determine whether this task-specific training reduces falls in the community and, consequently, may complement currently used exercise-based fall prevention intervention methods.

Modifiable performance domain risk-factors associated with slip-related falls

Falls are a major source of injury in older adults. Many falls occur after slipping. This study determined performance-related factors that both contribute to slip-related falls and that may be effectively and efficiently modified through targeted intervention. Thirty-five young adults and 21 healthy older adults (age: 70.9+/-5.1 years) were slipped in a laboratory using a slippery surface. The biomechanics of the 18 older adults who fell and the 30 younger adults who recovered following slips were analyzed. A set of potentially modifiable variables, initially based on significant between-groups differences, was further analyzed using stepwise discriminant analysis and logistic regression. The discriminant analysis correctly categorized 93.8% of the falls and recoveries based on two variables; the velocity of the slipping foot relative to the velocity of the whole body center of mass (COM), and the lateral placement of the recovery foot relative to the COM. The logistic regression determined the expected change in the odds of a recovery following a slip given a hypothesized intervention-induced improvement of these variables. Decreased velocity of the slipping foot relative to the COM, or decreased lateral placement of the recovery foot relative to the COM to zero, increased the odds of recovery by 17% and 27%, respectively. This suggests that intervention targeted at improving these specific lower extremity control variables following the onset of a slip has the potential to significantly decrease slip-related fall risk.

Preventing Trip-Related Falls by Community-Dwelling Adults:: A Prospective Study

Conflict of Interest: Dr. Lin was supported by a grant from the National Institutes of Health (1K23DC011279), a Triological Society/American College of Surgeons Clinician Scientist Award, and the Eleanor Schwartz Charitable Foundation. Dr. Lin has served as a consultant to Cochlear Corp and Autifony, serves on the scientific advisory board for Autifony, and is speaker for Amplifon and Cochlear Corp. Author Contributions: All authors contributed to the study concept and design, analysis and interpretation of data, and preparation of the final manuscript. Sponsor’s Role: None.

Clay Modeling versus Written Modules as Effective Interventions in Understanding Human Anatomy.

The effectiveness of clay modeling to written modules is examined to determine the degree of improvement in learning and retention of anatomical 3D relationships among students with different learning preferences. Thirty‐nine undergraduate students enrolled in a cadaver dissection course completed a pre‐assessment examination and the VARK questionnaire, classifying learning preference as visual, auditory, read/write, or kinesthetic. Students were divided into clay, module, and control groups with preference for learning style distributed among groups. The clay and module groups participated in weekly one‐hour classes using either clay models or answering written questions (modules) about anatomical relationships, respectively. The control group received no intervention. Post‐assessment and retention examinations were administered at the end of the semester, and three months later, respectively. Two variables (Δ1, Δ2) represented examination score differences between pre‐ and post‐assessment and between post‐assessment and retention examinations, respectively. The Δ1 for clay and module groups were each significantly higher than controls (21.46 ± 8.2 vs. 15.70 ± 7.5, P ≤ 0.05; and 21.31 ± 6.9 vs. 15.70 ± 7.5, P ≤0.05, respectively). The Δ2 for clay and module groups approached but did not achieve significance over controls (−6.09 ± 5.07 vs. −8.80 ± 4.60, P = 0.16 and −5.73 ± 4.47 vs. −8.80 ± 4.60, P = 0.12, respectively). No significant differences were seen between interventions or learning preferences in any group. However, students of some learning styles tended to perform better when engaging in certain modalities. Multiple teaching modalities may accommodate learning preferences and improve understanding of anatomy. Anat Sci Educ.

Fear of falling does not alter the kinematics of recovery from an induced trip: a preliminary study

OBJECTIVE To provide preliminary information about the relationships between self-reported fear of falling (FOF) in healthy community-dwelling women, number of falls, and recovery kinematics in response to a laboratory-induced trip. DESIGN Cohort study. SETTING Clinical research laboratory. PARTICIPANTS A subset of community-dwelling older women (N=33) recruited from studies of laboratory-induced trips and fall prevention. INTERVENTION A laboratory-induced trip. MAIN OUTCOME MEASURES Number of fallers in the FOF group versus the control group. Recovery kinematics of FOF group falls versus control group falls, and FOF group recoveries versus control group recoveries were compared. Degree of FOF was assessed by using the Activities-Specific Balance Confidence (ABC) Scale. RESULTS Falls occurred in 6 of 14 (43%) FOF and 4 of 16 (25%) control subjects (P=.26). The kinematics of FOF group falls were similar to those of control group falls. At completion of the initial recovery step, the FOF group showed significantly greater trunk extension velocity than controls (-82.1°/s ± -66.1°/s vs -25.0°/s ± -53.0°/s, respectively; P=.05). All other variables were not significantly different. ABC Scale scores of FOF subjects did not differ significantly between fallers and those who recovered (mean, 75.2 ± 5.6, 71.1 ± 11.8, respectively; P=.84). CONCLUSION Healthy community-dwelling older adults would benefit from fall prevention regardless of the presence of self-reported FOF.

Learning Style versus Time Spent Studying and Career Choice: Which Is Associated with Success in a Combined Undergraduate Anatomy and Physiology Course?.

The VARK learning style is a pedagogical focus in health care education. This study examines relationships of course performance vs. VARK learning preference, study time, and career plan among students enrolled in an undergraduate anatomy and physiology course at a large urban university. Students (n = 492) from the fall semester course completed a survey consisting of the VARK questionnaire, gender, academic year, career plans, and estimated hours spent per week in combined classroom and study time. Seventy‐eight percent of students reported spending 15 or fewer hours per week studying. Study time and overall course score correlated significantly for the class as a whole (r = 0.111, P = 0.013), which was mainly due to lecture (r = 0.118, P = 0.009) performance. No significant differences were found among students grouped by learning styles. When corrected for academic year, overall course scores (mean ± SEM) for students planning to enter dentistry, medicine, optometry or pharmacy (79.89 ± 0.88%) were significantly higher than those of students planning to enter physical or occupational therapies (74.53 ± 1.15%; P = 0.033), as well as nurse/physician assistant programs (73.60 ± 1.3%; P = 0.040). Time spent studying was not significantly associated with either learning style or career choice. Our findings suggest that specific career goals and study time, not learning preferences, are associated with better performance among a diverse group of students in an undergraduate anatomy and physiology course. However, the extent to which prior academic preparation, cultural norms, and socioeconomic factors influenced these results requires further investigation. Anat Sci Educ 9: 121–131.

Performance of an attention-demanding task during treadmill walking shifts the noise qualities of step-to-step variation in step width

BACKGROUND The fractal scaling evident in the step-to-step fluctuations of stepping-related time series reflects, to some degree, neuromotor noise. RESEARCH QUESTION The primary purpose of this study was to determine the extent to which the fractal scaling of step width, step width and step width variability are affected by performance of an attention-demanding task. We hypothesized that the attention-demanding task would shift the structure of the step width time series toward white, uncorrelated noise. METHODS Subjects performed two 10-min treadmill walking trials, a control trial of undisturbed walking and a trial during which they performed a mental arithmetic/texting task. Motion capture data was converted to step width time series, the fractal scaling of which were determined from their power spectra. RESULTS Fractal scaling decreased by 22% during the texting condition (p < 0.001) supporting the hypothesized shift toward white uncorrelated noise. Step width and step width variability increased 19% and five percent, respectively (p < 0.001). However, a stepwise discriminant analysis to which all three variables were input revealed that the control and dual task conditions were discriminated only by step width fractal scaling. SIGNIFICANCE The change of the fractal scaling of step width is consistent with increased cognitive demand and suggests a transition in the characteristics of the signal noise. This may reflect an important advance toward the understanding of the manner in which neuromotor noise contributes to some types of falls. However, further investigation of the repeatability of the results, the sensitivity of the results to progressive increases in cognitive load imposed by attention-demanding tasks, and the extent to which the results can be generalized to the gait of older adults seems warranted.