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Low-frequency Fahræus-Lindqvist-driven oscillations in the small vessels are crucial because oscillations in small vessels support nutrient supply. Understanding of this is critical in type 2 diabetes mellitus (T2DM) to develop therapeutic measures in order to prevent Alzheimer's Disease Related Dementias. Indeed, vascular factors are known to contribute to cerebrovascular disease as well as mild cognitive impairment and dementia, which are predicted to affect 152 million people by 2050 (Alzheimer's Disease International London, UK, 2019). In this clinical study, we performed functional near-infrared spectroscopy (fNIRS) of the forehead to investigate the effect of the Mini-Cog with three-item recall test on the prefrontal cortex (PFC) activation and the relative oscillatory power in the 0.01-0.02-Hz (FahræΣus-Lindqvist effect) and 0.021-0.052 Hz (smooth muscle autonomic innervation) frequency bands in elderly (60 years and older) T2DM and age-matched controls. We found a significant (p<0.01) difference in the PFC activation between elderly subjects with T2DM and age-matched elderly controls. Moreover, power spectral density (PSD) analysis revealed a significantly lower relative power in 0.021-0.052 Hz (smooth muscle autonomic innervation) frequency band in elderly subjects with T2DM during the Mini-Cog three-item recall test. Furthermore, a drop in the oscillatory power in the 0.01-0.02 Hz frequency band during Mini-Cog three-item recall test was found more pronounced in the elderly subjects with T2DM. Therefore, our study highlighted portable brain imaging to capture cerebrovascular reactivity to cognitive load that may provide a biomarker of cerebrovascular dysfunction in T2DM. Clinical Relevance-Our study establishes forehead portable brain imaging under cognitive load for monitoring cerebrovascular function in T2DM.

Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Using a pre-experimental design with a 6-week intervention, 28 participants were assessed twice on use of upper extremity via subjective and objective measures. For the Motor Activity Log, the amount of use and quality of use were significant for Groups 1 and 2. Significant improvements were shown on the Wolf Motor Function Test (WMFT), the Fugl-Meyer UE, and the Functional Independence Measure (FIM) for both groups except for the strength subtest on the WMFT and the timed portion for Group 1. Percentages of attendance for telehealth and in-person sessions were also compared. Telehealth sessions had a higher attendance rate (84.5%) than in-person sessions (75.3%) (p=.004). The combined mCIMT program of telerehabilitation and in-person group sessions was effective in improving functional ability after a stroke., (Copyright © 2020 Mary Ann Smith; Machikio R.Tomita.)

Aims: The aim of the study was to determine whether increased physical activities (PA) affect frailty for old women, 75 years and older (OO), compared to 60-74 years old (YO)., Methods: This crosssectional study measured 19 frailty indicators (muscle strength and endurance, balance, gait characteristics, and function), using 46 community-dwelling women. PA were divided into three levels by caloric expenditure per week (<2,000 kcal/week, 2,000-3,999 kcal/week,>4,000 kcal/week)., Results: As PA level increased, a gap (=difference) between OO and YO narrowed for step length and function, but for quadriceps strength and endurance, a gap widened., Conclusions: Frailty progresses with aging but older women who engage in a high level of physical activity (>4,000 kcal/week) can increase mobility and functional capacity, but not for muscle strength and endurance. Starting regular resistance training activities early in the aging process is critical to improve or maintain muscle quality to offset age-related frailty.

Background: The gold standards for assessing ambulation are the Expanded Disability Status Scale (EDSS) and the Timed 25-Foot Walk (T25FW) test. In relation with these measures, we assessed the reliability and validity of four clinical gait measures: the Timed Up and Go (TUG) test, the Dynamic Gait Index (DGI), the 2-Minute Walk Test (2MWT), and the 6-Minute Walk Test (6MWT). Patient self-report of gait was also assessed using the 12-item Multiple Sclerosis Walking Scale (MSWS-12)., Methods: Individuals 20 years or older with a diagnosis of multiple sclerosis (MS) and an EDSS score of 2.0 to 6.5 completed the MSWS-12, T25FW test, TUG test, DGI, 2MWT, and 6MWT. All the tests were repeated 2 weeks later at the same time of day to establish their reliability and concurrent validity. Predictive validity was established using the EDSS., Results: Forty-two patients with MS were included. All measures showed high test-retest reliability. The TUG test, 2MWT, and 6MWT were significantly correlated with the T25FW test (Spearman ρ = -0.902, -0.919, and -0.905, respectively). The EDSS was also significantly correlated with all the walking tests. The MSWS-12 demonstrated the highest correlation to the EDSS (ρ = 0.788)., Conclusions: The TUG test, the DGI, the 2MWT, and the 6MWT exhibited strong psychometric properties and were found to be significant predictors of the EDSS score. Use of these tests to prospectively monitor the effects of medical and rehabilitation treatment should be considered in the comprehensive care of patients with MS., Competing Interests: Dr. Bennett has received honoraria for speaking from Acorda Therapeutics, Biogen Idec, and Medtronic Inc; is on the advisory board and has received research funding from Acorda Therapeutics; and is on the Clinical Events Committee of Innovative Neurotronics. Dr. Bromley has received honoraria for speaking and research funding from Acorda Therapeutics. The other authors have no conflicts of interest to disclose.

This case report describes a unique long-term functional recovery process to promote successful community reintegration for a woman with Guillain-Barré syndrome (GBS), a rare autoimmune disease. Her main symptoms were very limited mobility and depressive symptoms due to the unknown cause of and cure for the illness. Holistic occupational strategies helped the client stabilize her emotional state, create a safe home environment, improve a communication method, increase physical activity, and promote social participation. Participation in a fall prevention clinical trial lowered her risk of falling; at 9 mo, she reached 75% of the maximum Social Integration score; at 13 mo, she reached near-normal level for activities of daily living (ADLs) and her fastest time for the Timed Up and Go test; and at 2 yr, she achieved a 100% score in instrumental ADLs. For community integration of clients with GBS, a comprehensive strategic self-management approach should be prescribed for long-term recovery., (Copyright © 2016 by the American Occupational Therapy Association, Inc.)

Objectives: Uptake of new knowledge by diverse and diffuse stakeholders of health-care technology innovations has been a persistent challenge, as has been measurement of this uptake. This article describes the development of the Level of Knowledge Use Survey instrument, a web-based measure of self-reported knowledge use., Methods: The Level of Knowledge Use Survey instrument was developed in the context of assessing effectiveness of knowledge communication strategies in rehabilitation technology. It was validated on samples representing five stakeholder types: researchers, manufacturers, clinician-practitioners, knowledge brokers, and consumers. Its structure is broadly based on Rogers' stages of innovation adoption. Its item generation was initially guided by Hall et al's Levels of Use framework. Item selection was based on content validity indices computed from expert ratings (n 1 = 4; n 2 = 3). Five representative stakeholders established usability of the web version. The version included 47 items (content validity index for individual items >0.78; content validity index for a scale or set of items >0.90) in self-reporting format. Psychometrics were then established for the version., Results: Analyses of data from small (n = 69) and large (n = 215) samples using the Level of Knowledge Use Survey instrument suggested a conceptual model of four levels of knowledge use-Non-awareness, Awareness, Interest, and Use. The levels covered eight dimensions and six user action categories. The sequential nature of levels was inconclusive due to low cell frequencies. The Level of Knowledge Use Survey instrument showed adequate content validity (≈ 0.88; n = 3) and excellent test-retest reliability (1.0; n = 69). It also demonstrated good construct validity (n = 215) for differentiating among new knowledge outputs (p < 0.001) and among stakeholder types (0.001 < p ≤ 0.013). It showed strong responsiveness to change between baseline and follow-up testing (0.001 < p ≤ 0.002; n = 215)., Conclusion: The Level of Knowledge Use Survey instrument is valid and reliable for measuring uptake of innovations across diffuse stakeholders of rehabilitation technologies and therefore also for tracking changes in knowledge use.

Objectives: To estimate age- and sex-specific prognostic values of eight electrocardiographic repolarization descriptors to predict various mortality endpoints., Background: Using electrocardiographic markers for risk stratification is well studied; however, the prognostic value of many markers is controversial, and their clinical utility remains debatable. No meta-analyses exist that address the prognostic value of ECG markers., Methods: Data were synthesized from 106 primary studies using a random-effect variance model. Age and sex subgroups were analyzed using sensitivity analysis., Results: Four classic (i.e., duration, amplitude, inversion, and ST-T changes) and four novel (i.e., axis, loop, wavefront direction, and waveform complexity) repolarization descriptors were studied. These novel descriptors were particularly useful in predicting sudden death. Abnormal repolarization duration, vectors, and loops have greater impact on negative cardiovascular outcomes in women compared to men; additionally, ischemic repolarization changes have greater impact on negative cardiovascular outcomes in younger versus older adults., Conclusions: Assessing repolarization abnormalities is particularly helpful in women and younger adults. Researchers need to further explore the clinical utility of these abnormalities in management algorithms., (Copyright © 2014 Elsevier Inc. All rights reserved.)

OBJECTIVE. To identify psychometric properties of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults. METHOD. We tested content validity, test-retest reliability, interrater reliability, construct validity, convergent and discriminant validity, and responsiveness to change. RESULTS. The content validity index was .98, the intraclass correlation coefficient for test-retest reliability was .97, and the interrater reliability was .89. The difference on identified risk factors between the use and nonuse of the HSSAT was significant (p = .005). Convergent validity with the Centers for Disease Control and Prevention Home Safety Checklist was high (r = .65), and discriminant validity with fear of falling was very low (r = .10). The responsiveness to change was moderate (standardized response mean = 0.57). CONCLUSION. The HSSAT is a reliable and valid instrument to identify fall risks in a home environment, and the HSSAT booklet is effective as educational material leading to improvement in home safety., (Copyright © 2014 by the American Occupational Therapy Association, Inc.)

Objective: Difficulties in communication and social relationships present a formidable challenge for many people after traumatic brain injury (TBI). These difficulties are likely to be partially attributable to problems with emotion perception. Mounting evidence shows facial affect recognition to be particularly difficult after TBI. However, no attempt has been made to systematically estimate the magnitude of this problem or the frequency with which it occurs., Method: A meta-analysis is presented examining the magnitude of facial affect recognition difficulties after TBI. From this, the frequency of these impairments in the TBI population is estimated. Effect sizes were calculated from 13 studies that compared adults with moderate to severe TBI to matched healthy controls on static measures of facial affect recognition., Results: The studies collectively presented data from 296 adults with TBI and 296 matched controls. The overall weighted mean effect size for the 13 studies was -1.11, indicating people with TBI on average perform about 1.1 SD below healthy peers on measures of facial affect recognition. Based on estimation of the TBI population standard deviation and modeling of likely distribution shape, it is estimated that between 13% and 39% of people with moderate to severe TBI may have significant difficulties with facial affect recognition, depending on the cut-off criterion used., Conclusion: This is clearly an area that warrants attention, particularly examining techniques for the rehabilitation of these deficits.

OBJECTIVES: To develop and test the effectiveness of an Internet-based self management program by multidisciplinary health care professionals for patients with heart failure (HF). METHODS: The comprehensive educational material for HF was created and posted on a website. A computer with Internet connection and computer training were provided first. A secure and simple web-based recording system of vital signs and health behaviors and a mechanism for feedback regarding each participant's record were developed. A randomized controlled trial with a one-year intervention was conducted using a total of 40 patients who were assessed three times in their homes. An intention-to-treat analysis used multivariate statistics. RESULTS: The treatment group had a high (85%) adherence to the intervention. Only the treatment group showed a significant improvement in the knowledge level (p < 0.001), amount of exercise (p = 0.001), and quality of life (p = 0.001), and reduction in HF related symptoms (dyspnea, p = 0.001; fatigue, p = 0.003; functional emotion, p < 0.001), blood pressure (systolic, p = 0.002; diastolic, p < 0.001), frequency of emergency room visit, and length of hospital stay (both p = 0.001). CONCLUSIONS: An effective program to change one's behaviors in managing HF takes a multidisciplinary approach to create and provide feedback regarding a patient's daily record, which can be accomplished through Internet use.

This article describes how older persons perceive and use personal emergency response systems (PERSs), including issues related to device design, and report reasons for nonuse of PERSs. Data for this study were collected through a semistructured questionnaire that included fixed and open-ended response questions. Six hundred six participants 60 years and older were surveyed. Descriptive statistics were used to report sample characteristics. The most often-stated reason for using a PERS was related to concerns with falling (40% of responses). Asked how a PERS has been helpful, 75.6% of participants expressed an enhanced feeling of security with their PERS. Lack of perceived need (57.0% of responses), cost (37.0%), and lack of knowledge of the device (23.7%) were the most frequently stated reasons for not using a PERS. This study found that, while PERSs provide benefits for many elders, there appear to be many older persons who could benefit who do not have one. Only 16% of participants in this study, all of whom had disabilities, used a PERS.

With the steady growth in numbers of older persons, the number of elders who have impairments impacting on functional performance also increases. Many assistive devices are available that have the potential to help elders with impairments to maintain or regain independence. Reachers offer a good example of an inexpensive and useful assistive device for elders. A needs assessment study of the University at Buffalo Rehabilitation Engineering Research Center on Aging (RERC-Aging) found that 22% of elder owners of reachers were dissatisfied with at least one of the reachers they owned. This study sought to explore the reasons for this dissatisfaction by, first, determining the tasks for which older persons use reachers and, second, testing performance in these tasks with three reachers selected on their potential to most satisfactorily meet the needs of older persons with disabilities. In the first study component, 16 older people were selected randomly from the RERC-Aging study sample pool for telephone interviews. In the second component, 30 elders were selected randomly for an evaluation of reachers. All study participants were 60 years old or older, lived at home, and used one or more reachers in their daily tasks. Consumer criteria for evaluating reachers included adjustable length, one-hand use, life-time guarantee, lock system for grip, forearm support, light weight, and lever action trigger. The Winchester reacher was rated highest by consumers who actually tested three reachers that best met the consumer criteria.

This study compared differences in coping strategies, such as the use and ownership of assistive devices and home modifications, for 64 black and 441 white frail elders from the University at Buffalo Consumer Assessment Study. Controlling age, income, and education, there was no difference between black and white elders on health and functional status. Black elders on average own and use fewer assistive devices than white elders. There is no difference between the two groups in the number of home modifications, although black elders experience more home environmental problems than white elders. The majority of black elders rent their residence and thus lack the authority and ability to make the necessary adjustments to their home environmental problems. Predictor variables for assistive device use and environmental problems varied for black and white elders.

The University at Buffalo Rehabilitation Engineering Research Center on Aging (RERC) developed two prototype television remote control devices (remotes), designed to address the needs of older persons with some visual and/or fine motor impairment. The prototype remotes have large buttons, large numbers and characters on the buttons, and high color contrast between the buttons and background. One remote has 15 buttons, and one has 6 buttons. The purpose of this study was to test these prototype remotes against two commercially available remotes for user speed, accuracy, and satisfaction. One of the commercially available remotes has small buttons and small print but more features than the prototype remotes; this device came with the television used in the study. The second commercially available remote has somewhat larger buttons, but still smaller than the ones on the RERC prototypes. Thirty elders with impairments participated in testing the remotes in a simulated living room setting. The order in which the remote devices were presented to the subjects was randomly determined. Results indicated a significant difference among remotes in number of errors made; subjects made the fewest number of errors on the 15-button prototype remote. There was no significant difference among remotes in speed. There were significant differences in user satisfaction: users preferred the 15-button prototype device. Subjects were asked if they would rather have more features and small buttons on their remote, or fewer features and larger buttons; almost three-fourths of the sample desired fewer features and larger buttons.