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Questions: In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? Design: A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. Participants: A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. Intervention: For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. Outcome measures: The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). Results: After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI –1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. Conclusion: This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations.

Purpose To investigate the use of electronic patient-reported outcomes (PROs) to assess symptoms and how they can provide opportunities to clinicians to address symptoms in a timely manner to improve clinical care. As part of a larger study to evaluate whether providing standardized symptom reports to the medical team would decrease the time to treatment of reported symptoms in hematopoietic stem-cell transplant recipients, we assessed nurses��� and providers��� perceptions of electronic symptom reporting. Methods Semistructured interviews of RNs, MDs, NPs and PAs were conducted at an academic cancer center in the southeastern United States. Nurses��� and providers��� perceptions of electronic symptom reporting were explored. Interviews were audio-recorded, transcribed, and coded by two investigators to identify major themes. Results Fourteen RNs and seven providers (MDs, PAs, and NPs) participated in the interviews. Three main themes emerged from the interviews: electronic symptom reporting may improve assessment and care, integrating symptom reporting into nurse workflow presents difficulties, and there are barriers for completion of surveys. Conclusion The majority of nurses and providers believed that the inclusion of electronic symptom reporting in bone marrow transplantation inpatient units has the potential to improve care but that barriers to implementation remain.

K. TANIGUCHI, A. TAKANISHI. Design proposal for walking cane handle grips. Gerontechnology 2014;13(2):287; doi:10.4017/gt.2014.13.02.087.00 Purpose Many countries have an aging society, making the prevention of falls in older people an important issue and the danger of falls a primary concern for the elderly. Many studies have investigated the influence of patient activity while using different types of canes. However, very few studies have analyzed the grips of the handles of walking canes. The grip on a cane handle can easily be thought of as the most important part of the human/device interface in the prevention of falls. Many people have pain in their wrist that is caused by using incompatible handle grips. The handle grip shape is very important if the user is to obtain the most functionality and benefit from the cane1. We hypothesized that dorsi-flexion of the wrist causes increased loads on the wrist and decreases the efficiency of power. This study aims to elucidate a design for walking cane handle grips that is able to reduce dorsi-flexion of the wrist and is able to improve efficiency in power. We made a prototype (P-type) of a handle grip that has a different from the standard S-type grip. The P-type shape is positioned along the carpal bone (grayish color bone in Figure 1). Method Eleven elderly subjects (aged 38 to 75 years old) were recruited. Each subject was asked to put the walking cane on random places on a force plate (the Nintendo Wii Balance Board WBB, a portable, inexpensive, and a reliable technologically-advanced device) with his right hand, while individual load was measured. This load was constant throughout testing. Many studies have reported that the WBB produces valid results for assessing balance while standing2. The Center of Pressure (COP) sway was recorded (sampling frequency, 50Hz) for 10 seconds. Informed consent was obtained from all participants. Three trials were tested for each subject, and the difference was calculated from the mean of the trial data that were derived from the COP values. Results & Discussion Table 1 shows the variation between the two types of cane grips (P-type minus S-type). To evaluate the efficiency of power and stability in the P-type grip, we used the floor reaction force and the locus length of the COP. Table 1 shows that the P-type grip provides more stability and has greater efficiency of power than the S-type for most of the subjects. These results show that the design for a walking cane handle grip that considered carpal bone shape was effective in improving the stability and efficiency of power of the cane. In future analysis, we plan to explain the relevant parameters of the handle grip and the appropriate height for the handle for individual subjects. References 1. Chiou-Tan FY, Magee KN, Krouskop TA. Journal of Rehabilitation Research and Development 1999:36(2):94-99 2. Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M. Gait & Posture 2010;31(3):307-310; doi: 10.1016/j.gaitpost.2009.11.012

K. TANIGUCHI, A. TAKANISHI. The influence of aging on human postural control mechanisms. Gerontechnology 2014;13(2):288; doi:10.4017/gt.2014.13.02.123.00 Purpose This study aims to reduce the risk of falls in older people by elucidating the mechanisms of human postural control. Postural balance, which was measured by stabilometer, was suggested as an important risk factor for falls1. It has been proposed that intermittent control provides a framework to explain human postural control2, usually together with continuous control. We suggest that an event trigger for intermittent control is related to behaviour of the Center of Pressure (COP) movement around Root Mean Squared area (RMS). We investigated whether those COP parameters were influenced by aging. Method Subjects were 41 middle and old age (aged 37-85 years, mean=64.5 years (SD=12.6)). The subjects stood on a stabilometer (the Nintendo Wii Balance Board: WBB). The WBB is a portable, inexpensive, and reliable device that has been reported by many to have good validity for assessing standing balance3. The COP sway was recorded (sampling frequency, 50Hz) for 30s. The participants stood with their feet together, eyes open, and hands at their sides. Informed consent was obtained from all participants. The parameters were derived from the COP values (Figure 1). They were evaluated both for intra-RMS (IRMS) and extra-RMS (ERMS). Originally 12 parameters were translated by Principal component analysis (PCA). In this study, we show a comparison with principal component scores for IRMS and ERMS. Results & Discussion Table 1 shows the highest factor loading on each principal component. The SDVEL (x-axis) is significant factor of the COP (factor loading>0.95). To explain the difference in behaviour between IRMS and ERMS, we evaluated the differential value of principal component score. Figure 2 shows the distance of three dimensional coordinates(x=PC1, y=PC2, z=PC3) between IRMS and ERMS versus the age. These results show an age-related increase in the distance of parameters between intra-RMS and extraRMS for the COP. These distance measures are significantly related to postural control. The value of distance may be one of the indicators of fall risk. References 1. Piirtola M, Era P. Gerontology 2006;52(1):1-16; doi:10.1159/000089820 2. Gawthrop P, Loram I, Lakie M, Gollee H. Biological Cybernetics 2011;104(1/2):31-51; doi:10.1007/s00422-010-0416-4 3. Clark RA, Bryant AL, Pua YH, McCrory P, Bennell K, Hunt M. Gait & Posture 2010;31(3):307-310; doi:10.1016/j.gaitpost.2009.11.012

OBJECTIVES AND BACKGROUND The digital patient is a powerful tool that permits an “offline” consultation of the patient and creates medical case studies for medical students [1]. The main objective is to create a digital representation of the scoliotic patient in order to show precise gait and posture. The digital representation can be later analyzed without the presence of the actual patient. MATERIALS AND METHODS A digital version of the real life patient is created using the Microsoft Kinect program that captures both the gait and the posture. RESULTS The created digital patient can be viewed and analyzed using MatLab software. The overall position of the patient along with patient movements such as adduction, rotation and flexion of the joints can be viewed. CONCLUSIONS The digital patient is a powerful tool that permits the medical doctor to consult the patient even when the patient is not present. Graphical abstract: The Digital Patient shown in the MatLab Viewer. REFERENCES 1. Botezatu M, Hult H, Kassaye TM, Fors U. Virtual patient simulation for learning and assessment: superior results in comparison with regular course exams. Med Teach. 2010;32:845-850. 2. Ross AC, Pua YH, Fortin K, Callan R, Webster KE, Denehy L, Bryant AL. Validity of the Microsoft Kinect for assessment of postural control. Gait and posture. 2012;1:372-377.

Pua Y-H, Clark RA, Bryant AL. Physical function in hip osteoarthritis: relationship to isometric knee extensor steadiness. Objective To evaluate, in a community hip osteoarthritis sample, the cross-sectional associations of isometric strength and steadiness of the knee extensors and their interaction with physical performance measures of physical function. Design Cross-sectional. Setting Human movement laboratory of a university. Participants Sixty-seven adults (27 men and 40 women; age, 61±10y) with radiographically confirmed symptomatic hip osteoarthritis. Interventions Not applicable. Main Outcome Measures Participants performed isometric knee extensor steadiness and strength testing on a dynamometer. Physical function was assessed by using the habitual timed walk test and the self- and fast-paced stair-climbing tests. Results In the hierarchical regression models, although there were clear main effects of knee extensor steadiness on fast-paced stair performance, greater knee steadiness predictively associated with faster stair-climbing performance particularly in individuals with high knee extensor strength. In contrast, knee extensor steadiness was not related to gait speed regardless of knee extensor strength levels. Conclusions In patients with hip OA, knee extensor steadiness was positively associated with stair-climbing performance, particularly in those with high levels of knee extensor strength. These findings are of importance in developing intervention strategies, but they call for further study.