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Background: Stroke survivors find it difficult to participate in daily activities, despite their improvement throughout the rehabilitation process. Thus, it has been questioned whether day-rehabilitation services provide adequate preparation for participation and reintegration into the community. Self-management programs can improve survivors' self-efficacy to manage their condition and participation. Improving Participation After Stroke Self-Management program (IPASS) is an occupational therapy-based group intervention developed in the United States, which has been effective in improving participation outcomes.Objective: To evaluate the feasibility and effectiveness of the IPASS adapted for an Israeli population of individuals admitted to a day-rehabilitation center after stroke.Methods: A single-center, randomized, assessor-blind study was conducted. Eligible participants were randomized to receive the IPASS (intervention group), in addition to standard individual therapy or standard care only (control group). Feasibility was based on attendance rate and a feedback questionnaire. Effectiveness was evaluated with the Functional Independence Measure (FIM), the Reintegration to Normal Living Index (RNLI) and self-efficacy questionnaires.Results: Sixty participants were included, of which 39 completed baseline and post-intervention evaluations. The intervention group improved significantly in the FIM scores (p .05). Moderate effect sizes (≥0.35) were found for the FIM and RNLI, and large effect sizes (≥0.65) for two subcategories in the participation self-efficacy questionnaire.Conclusions: The results support the feasibility of the adapted IPASS, and show a trend for positive effects in improving participation and self-efficacy in managing participation in home and community activities, for an Israeli post-stroke population.

Study Design: Cross-sectional and follow-up nested study.Purpose: To assess the reliability of the L5-kyphosis apex line (L5-KAL) evaluation and determine the association between changes in L5-KAL, changes in radiological parameters, and changes in clinical symptoms.Overview of Literature: Scheuermann’s disease is the most common cause of hyperkyphosis of the thoracolumbar and thoracic spine during adolescence. Scheuermann’s disease patients usually show compensatory hyperlordosis of the lumbar spine, which is usually flexible, and express an anterior translation of the lumbar section. The L5-KAL was developed on the basis of our clinical experience, displaying the horizontal distance between the thoracic and lumbar curves.Methods: In the cross-sectional segment, 150 initial lateral X-rays of patients with Scheuermann’s disease and postural kyphosis were analyzed, and 80 additional X-rays were analyzed in the follow-up segment. The data taken from the X-rays of the whole spinal column included the thoracic kyphosis angle, the C7 plumb line, and the L5-KAL. Clinical data included a numerical rating scale of self-perceived body image, pain, and a Scoliosis Research Society-22 questionnaire (SRS-22).Results: Significant positive associations were observed in a cross-sectional study between the L5-KAL and thoracic kyphosis, lumbar lordosis, C7 line, and self-perceived body image. In the follow-up nested study, in a mixed analysis of variance, the main effect of time was significant for the L5-KAL, kyphotic deformity and SRS-22, which indicated a change in these parameters after treatment of Scheuermann’s disease patients. Significant positive associations were observed between the changes in L5-KAL and the changes in thoracic kyphosis.Conclusions: Our evidence suggests that the L5-KAL can serve as an indicator of the thoracic curve change in Scheuermann’s disease and postural kyphosis patients and should be considered in clinical practice.

Sarcopenia has become of great interest and focus of many studies since this phenomenon affects many people. Moreover, sarcopenia is associated with two more pandemic phenomena: frailty and obesity. These health-related conditions are increasing in western countries in general and in the older population in particular. Each of such health conditions relates to functional decline, yet the combination of two or three of them in one person severely affects quality of life and longevity. Aged individuals who are less physically active are more likely to develop sarcopenic obesity, and those who are obese with muscle weakness and inactive are disposed to become frail individuals. Hence, frailty and obesity overlap profoundly with the physical manifestations of sarcopenia of aging. These “unhappy” triads encompasses a wider range of geriatric decline that also includes cognitive, psychology and social deterioration associated with adverse outcomes. Nevertheless, this chapter focuses only on sarcopenia and will review the pathophysiological background of age-related decline in muscle mass and strength.

STUDY DESIGN Cross-sectional analytical study. PURPOSE To evaluate the spinal radiological features in patients with Scheuermann's disease and the association between the thoracic kyphosis angle and clinical presentation. Overview of the Literature: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine in adolescents; however, literature is limited in this area. METHODS Data regarding 150 successive X-ray images of 95 males and 55 females diagnosed with Scheuermann's disease were retrieved from the digital archives of the Maccabi Healthcare Services in Tel Aviv. Data included thoracic kyphosis angle (T3-T12), cervical lordosis (C2-C7), lumbar lordosis (L1-S1), sacral slope (SS), number and location of the anterior wedged vertebrae (AWV, minimum 5°), and C7 plumb line. Other data included age, sex, height, family history, Risser sign, self-perceived body image (rated by the Numeric Rating Scale [NRS]), and back pain during the previous week (rated by the Numeric Pain Rating Scale [NPRS]). RESULTS Significant positive associations were observed between the Cobb angle of thoracic kyphosis and age (r =0.186, p =0.023), cervical lordosis (r =0.263, p

Compression therapy is the only conservative treatment that has been shown to be effective for patients with lymphedema in randomized controlled trials. A commonly used classification system divides pressure into four categories ranging from mild to very strong. For lower limb edema, bandages with strong pressure were shown to be most effective. Recent studies indicate that many health care professionals use inadequate pressure. No study thus far has focused on therapists who are trained in lymphatic treatment.Thirty-seven physiotherapists trained in lymphatic treatment were recruited. Each participant received a questionnaire concerning their competence in compression bandaging. The subjects were asked to apply bandages using strong and medium pressure in two practical trials. Using a PicoPressMost of the physiotherapists were successful, at least once, in applying bandages with the proper amount of pressure. It is possible that the nature of the lymphatic treatment contributes to their success. Participants were most accurate in applying moderate pressure; however, it is unclear what impact this pressure has on a leg with lymphedema.

Study Design A cross-cultural adaptation and reliability study. Objective To perform cross-cultural adaptation and evaluate the reliability and validity of the Hebrew version of the Scoliosis Research Society–22 (SRS-22) questionnaire. Summary of Background Data The SRS-22 validated in different languages is used in assessing health-related quality of life of patients with scoliosis. Methods The English SRS-22 was translated/retranslated and a cross-cultural adaptation was performed. The Hebrew SRS-22 was administered twice, a week apart, to 45 patients with idiopathic scoliosis and 15 with Scheuermann kyphosis. The Cobb angle of the thoracic curvature, the numeric rating scale (NRS) of pain and of the self-perceived cosmetic defect, were evaluated. Internal consistency was determined by the Cronbach α coefficient. Intraclass correlation was used for test-retest reliability. Concurrent validity of the SRS-22 domains with the Cobb angle, NRS pain, and NRS cosmetic defect was evaluated by Pearson correlation. Results The mean age of the subjects was 17.3 ± 7.42 years. The Cobb angle was 39.43 ± 17.52, NRS pain during the last 24 hours was 4.35 ± 3.42, and the NRS cosmetic defect was 3.80 ± 3.57. The mean overall Cronbach α of the Hebrew SRS-22 was 0.75. Two domains, function/activity (α = 0.63) and satisfaction (α = 0.66), showed a questionable internal consistency, self-image (α = 0.72) showed acceptable, pain (α = 0.80) good, and mental health (α = 0.92) excellent internal consistency. The intraclass correlation for five domains ranged from 0.71 to 0.95, demonstrating good test-retest reproducibility. The concurrent validity of the SRS-22 in scoliosis subjects with the Cobb angle was moderate (r = 0.37), and with NRS pain (r = 0.62) and NRS cosmetic defect (r = 0.54) good. In kyphosis subjects, the only significant high correlation was found between the self-image domain of SRS-22 and the NRS cosmetic defect (r = 0.84). Conclusion The Hebrew version of the SRS-22 can be used to assess the outcome of treatment among Hebrew-speaking patients with idiopathic scoliosis and Scheuermann disease. Level of Evidence Level 2.

The aim of this study was to quantify clearance mechanics during gait. Seventeen children diagnosed with hemiplegic cerebral palsy underwent a three-dimensional gait analysis evaluation. Dynamic leg lengths were measured from the hip joint center to the heel, to the ankle joint center and to the forefoot throughout the gait cycle. Significant asymmetry was observed during stance, initial and terminal swing phases, where the hemiplegic limb was found shorter by using a paired t-test at 51 sample points (p

Functional tasks of the upper extremity can be executed by a variety of muscular patterns, independent of the direction, speed and load of the task. This large number of degrees of freedom imposes a significant control burden on the CNS. Previous studies suggested that the human cortex synchronizes a discrete number of neural functional units within the brainstem and spinal cord, i.e. muscle synergies, by linearly combining them to execute a great repertoire of movements. Further exploring this control mechanism, we aim to study whether a single set of muscle synergies might be generalized to express movements in different directions. This was implemented by using a modified version of the non-negative matrix factorization algorithm on EMG data sets of the upper extremity of healthy people. Our twelve participants executed hand-reaching movements in multiple directions. Muscle synergies that were extracted from movements to the center of the reaching space could be generalized to synergies for other movement directions. This finding was also supported by the application of a weighted correlation matrix, the similarity index and the results of the K-means cluster analysis. This might reinforce the notion that the CNS flexibly combines a single set of small number of synergies in different amplitudes to modulate movement for different directions.

Controversy still exists as to the clinical significance of leg length discrepancy (LLD) in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and LLD. The objectives of our study were to review the available research with regard to LLD as a cause of clinically significant gait deviations, to determine if there is a relationship between the magnitude of LLD and the presence of gait deviations and to identify the most common gait deviations associated with LLD. In line with the PRISMA guidelines, a literature search was carried out throughout the Medline, CINAHL and EMBASE databases. Twelve articles met the predetermined inclusion criteria and were included in the review. Quality assessment using the Methodological Index for Non-Randomized Studies (MINORS) scale was completed for all included studies. Two main methodologies were found in 4 studies evaluating gait asymmetry in patients or healthy participants with anatomic LLD and 8 studies evaluating gait deviations while simulating LLD by employing artificial lifts of 1–5 cm on healthy subjects. A significant relationship was found between anatomic LLD and gait deviation. Evidence suggests that gait deviations may occur with discrepancies of >1 cm, with greater impact seen as the discrepancy increases. Compensatory strategies were found to occur in both the shorter and longer limb, throughout the lower limb. As the discrepancy increases, more compensatory strategies occur. Sagittal plane deviations seem to be the most effective deviations, although, frontal plane compensations also occur in the pelvis, hip and foot.

Background Physical exercise, particularly resistance training (RT), is proven treatment to reduce the accelerated decline in muscle strength exhibited by older adults, but its effect is hindered by low adherence rate, even under well-structured programs. Objective and data sources We investigated the efficacy of circuit resistance training (CRT) on muscle strength, lean mass and aerobic capacity in older adults based on report in MEDLINE, EMBASE, ClinicalTrials.gov and Cochrane electronic (through 8/2016). Study eligibility criteria: middle and older aged men and/or women who followed a structured program, assigned to CRT. Study appraisal and synthesis methods: Out of 237 originally identified articles, 10 articles were included with a total of 362 patients with mean: age −64.5 ± 7.4 years; 3 ± 1.15 sessions/week; session duration 41.8 ± 15.9 min. Results Upper body strength modestly increased, by 1.14 kg (95% CI; 0.28–2.00), whereas larger increment was seen in lower body strength (11.99; 2.92–21.06). Higher program volume (>24 sessions) positively influenced upper body strength and aerobic capacity. Limitations (1) variability in the studies’ validity; (2) relatively low number of studies. Conclusion CRT is a valid alternative to conventional RT. Its shorter duration and lower intensity relative to traditional RT, may increase adherence to training in older adults.

Leg length discrepancy (LLD) has been a controversial issue among researchers and clinicians for many years. Its presence obviously is not in doubt, however, there is little consensus as to its many aspects, including the extent of LLD considered to be clinically significant, the prevalence, reliability and validity of the measuring methods, the effect of LLD on function and its role in various neuromusculoskeletal conditions.1 LLD can be caused by structural deformities originating from true bony leg length differences.2, 3, 4 Nevertheless, it can also be due to functional deformity derived from abnormal hip, knee, ankle and foot movements in each of the three planes of motion.2, 3, 5 LLD has been found to be a significant factor influencing several pathological and physiological conditions which affect function and quality of life.6, 7 For example, it has been suggested that LLD has a significant effect on pelvic and lower limb biomechanics, may cause pelvic obliquity in the frontal plane thus leading to functional scoliosis, posture deformation, gait asymmetry and low back pain, as well as gonarthrosis or coxarthrosis and other lower limbs symptoms.4, 8, 9, 10, 11, 12, 13, 14 Moreover, LLD has also been correlated with gait deviations.15 The inconsistency in the literature regarding the effect and role LLD plays in several pathological conditions is due to poor reliability and validity of the measurement methods. In addition, it is impossible to confine the effect of LLD to pathological conditions where several other abnormal findings are also present. 1.1. Definition of LLD 1.1.1. There are basically two definitions of LLD True leg length discrepancy (TLLD) is defined as the anatomical difference between the lengths of the two limbs between the proximal edge of the femoral head to the distal edge of the tibia which can be congenital or acquired. Congenital conditions include mild developmental abnormalities found at birth or childhood, whereas acquired conditions include trauma, fractures, orthopedic degenerative diseases and surgical disorders such as joint replacement. A systemic review evaluating the prevalence of LLD by radiographic measurements revealed that 90% of the normal population had some type of variance in bony leg length, with 20% exhibiting a difference of >9 mm.16 Functional leg length discrepancy (FLLD) is defined as a condition of asymmetrical leg length, not necessarily a result or compensation of a true bony length difference. FLLD may be caused by an alteration of lower limb mechanics, such as joint contracture, static or dynamic mechanical axis malalignment, muscle weakness or shortening. It is impossible to detect these faulty mechanics using a non-functional evaluation, such as radiography. FLLD can develop due to an abnormal motion of the hip, knee, ankle or foot in any of the three planes of motion.

Movement synergies, muscle co-contraction, and decreased motor drive to muscle agonists were suggested to be major factors in motor impairments after stroke. The purpose of this study was to investigate the major muscle mechanisms contributing to motor impairment after stroke. Twelve healthy and 13 post-stroke patients participated in this observational study. Both groups participated in a single experimental session, performing hand pointing movements in multiple directions, during which EMG was assessed. Additionally, the patients underwent the Fugl-Meyer assessment. A set of features from the electromyography (EMG) signal and co-contraction ratios were used to compare the capacity to modulate the muscle activity between the two groups of participants. A correlation analysis was applied between the Euclidian distances of each target and the Fugl-Meyer scoring assessment in the post-stroke patients. We found that impaired modulation of muscle activity in post-stroke patients was characterized by significantly increased Euclidian distances between the EMG features of different target directions and by a higher variability between muscle activation compared to healthy subjects. Impaired capacity to modulate muscle activity significantly correlated with the impairment status. In conclusion, impaired motor performance post-stroke systematic disturbance in the control signal to limb muscles, which manifests as decreased capacity to modulate muscle activity, rather than co-contraction of muscle antagonists or stereotyped movement patterns.

This narrative review investigated imaging parameters of the paraspinal muscles and their association with spinal degenerative features and low back pain (LBP) found in the literature. Three principal signs of muscle degeneration were detected on imaging: decreased muscle size, decreased radiographic density, and increased fat deposits. Men have a higher density of paraspinal muscles than women, younger individuals have a higher density than older ones, and lean individuals have a higher density than those with an increased body mass index. Fatty infiltration appears to be a late stage of muscular degeneration and can be measured noninvasively by an MRI scan. Fatty infiltration in the lumbar multifidus is common in adults and is strongly associated with LBP, especially in women, independent of body composition. Fatty infiltration develops in areas where most degenerative changes are found. MR spectroscopy studies have corroborated that the lumbar multifidus in LBP subjects has a significantly higher fat content than asymptomatic controls. There is a strong need for establishing uniform methods of evaluating normal parameters and degenerative changes of the paraspinal muscles. Additional imaging studies are needed to improve the understanding of the association and causal relationships between LBP, spinal degeneration, and changes in the paraspinal muscles.

Background: The ability to maintain static and dynamic balance is a prerequisite for safe walking and for obtaining functional mobility. For this reason, a reliable and valid means of screening for risk of falls is needed. The functional reach test (FRT) is used in many countries, yet it does not provide some kinematic parameters such as shoulder or pelvic girdles translation. The purpose was to analyze video records measuring of distance, velocity, time length, arm direction and girdles translation while doing FRT. Methods: A cross-sectional, descriptive study was conducted where the above variables were correlated to the mini-mental state examination (MMSE) for mental status and the Tinetti balance assessment test, which have been validated, in order to computerize the FRT (cFRT) for elderly patients with neurological disorders. Eighty patients were tested and 54 were eligible to serve as experimental group. The patients underwent the MMSE, the Tinetti test and the FRT. LAB view software was used to record the FRT performances and to process the videos. The control group consisted of 51 healthy subjects who had been previously tested. Results: The experimental group was not able to perform the tests as well as the healthy control subjects. The video camera provided valuable kinematic results such as bending down while performing the forward reach test. Conclusions: Instead of manual measurement, we proposed to use a cheap with fair resolution web camera to accurately estimate the FRT. The kinematic parameters were correlated with Tinetti and MMSE scores. The performance values established in this study indicate that the cFRT is a reliable and valid assessment, which provides more accurate data than “manual” test about functional reach. J Clin Med Res. 2016;8(10):715-720 doi: http://dx.doi.org/10.14740/jocmr2652w

Assaf Buch,1–3 Lital Keinan-Boker,4,5 Ofer Kis,1 Eli Carmeli,1,6 Elena Izkhakov,1,2 Maya Ish-Shalom,1,2 Yitshal Berner,2,7 Gabi Shefer,1,2 Yonit Marcus,1,2 Naftali Stern1,2 1The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; 2The Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel; 3Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel; 4School of Public Health, University of Haifa, Haifa, Israel; 5Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel; 6The Department of Physical Therapy, University of Haifa, Haifa, Israel; 7Meir Medical Center, Kfar Saba, Israel Purpose: Unwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting.Patients and methods: A preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65–75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models.Results: The prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P

Reducing the effect of leg length discrepancy (LLD) on gait abnormalities while other abnormal conditions such as spasticity, joint contractures or weak muscle strength are exhibited is challenging. This study aimed to evaluate the impact of mild LLD on lower limb biomechanics, on participants with anatomic LLD with and without other clinical abnormalities. A motion capture system was utilized on 32 participants to measure lower limb kinematics and dynamic leg length (DLL) throughout the gait cycle, calculated as the absolute distance from the hip joint center, either to the heel, ankle joint center, or forefoot. The Pearson correlation coefficient found that LLD was associated with 5 kinematic variables only when LLD appeared with no other clinical abnormalities present (r = 0.574 – 0.846, p &lt, 0.05). When clinical abnormalities were present, the random forest classification accuracy was lower (64% versus 80%), implying that the used kinematics are low predictors for anatomic LLD, revealing a higher asymmetrical clearance index (the difference between the maximal stance phase and the minimal contra-lateral swing phase DLL) and a different kinematic variable importance index. Clinical abnormalities in pathological gait will in all probability significantly affect gait deviations, affirming mild anatomic LLD as inconsequential. A functional measurement can offer a better estimate as to the side and extent of the functional discrepancy.

Study design Randomized controlled single-blinded clinical trial. Purpose To evaluate the efficacy of Schroth therapy on thoracic curve angle, pain, and self-perceived body image (SPBI) of the back in Scheuermann's patients in comparison with the efficacy of classic anti-gravitation exercises. Overview of literature Scheuermann disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence. However, very few studies evaluated the effect of exercises on the progression of kyphosis in Scheuermann patients. Schroth three-dimensional exercise therapy was found in several studies to be effective in the treatment of adolescent scoliosis, however, we found no randomized controlled trials that evaluated the efficacy of this method in Scheuermann patients. Methods A total of 50 young adults (males and females) with Scheuermann's disease were randomly divided into either the experimental group (Schroth therapy treatment, n=25) or the control group (classic anti-gravitation exercises, n=25). Participants in both the groups were provided a course of individual treatment sessions during few weeks, with one appointment per week. They were required to perform the exercises daily throughout the study period (12 months) and fill their performance in a research log. We evaluated the thoracic Cobb angle (main outcome measure), pain, SPBI, flexion of the shoulder (supine), flexion of the shoulder (standing), kyphotic deformity measured using inclinometer, and L5 kyphosis apex line (L5-KAL) as well as administered the Scoliosis Research Society-22 Questionnaire for the participants before the treatment, after 6 months, and 1 year postoperatively. These results were then compared. Results In the mixed analysis of variance, the main effect of time was significant in the thoracic kyphosis (F [1]=5.72, p=0.02), and in the L5-KAL (F [1]=5.76, p=0.02). The main effect of time on the kyphotic deformity, measured using an inclinometer, did not reach the significance level; however, it showed the tendency (F [1]=2.80, p=0.07). In the group-by-time interaction, a significant difference was found in the thoracic kyphosis (F [1]=4.91, p=0.03) and in the kyphotic deformity, measured using an inclinometer (F [1]=4.05, p=0.02). Thus, the Schroth therapy group showed significantly greater improvement than the classic anti-gravitation exercises group. Conclusions The present findings indicate that back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptomatic representation in Scheuermann's patients.

Background Increasing longevity presents new social and medical challenges in developed countries. The prevalence of frailty is of interest because of its association with health prognosis and outcomes, but so far there is no single best diagnostic tool for this entity. Therefore, estimated prevalence of frailty in countries varies considerably and ranges between 5% and 58%. In Israel, the nation-wide prevalence of frailty in the elderly population is presently unknown. The objective of our study was to assess the rate of the frailty in elderly Israelis. Methods A post-hoc analysis based on the results of a national Health and Nutrition Survey in Israeli elderly (MABAT Zahav). A non-direct model to estimate frailty was based on five components that were most similar to the common frailty assessment suggested by Morley et al. The frailty state was then reclassified according to different explanatory variables. Results Data collected from 1619 subjects (F/M = 52.9/47.1%) with an average age of 74.6 years were analyzed. Estimated frailty prevalence in the elderly population was 4.9%. Frail people were more likely to have a lower income, be unemployed and have a lower education level. Frailty rates were higher in women, in Jews and in subjects more prone to low physical function. Conclusions The estimated frailty prevalence in the Israeli elderly population, while relatively low, is comparable to some of the rates suggested in the literature. The factors associated with frailty in the Israeli population are in accordance with the existing literature. The suggested model may be helpful in identifying frailty in Israeli elderly.

Purpose: A muscle synergies model was suggested to represent a simplifying motor control mechanism by the brainstem and spinal cord. The aim of the study was to investigate the feasibility of such control mechanisms in the rehabilitation of post-stroke individuals during the execution of hand-reaching movements in multiple directions, compared to non-stroke individuals. Methods: Twelve non-stroke and 13 post-stroke individuals participated in the study. Muscle synergies were extracted from EMG data that was recorded during hand reaching tasks, using the NMF algorithm. The optimal number of synergies was evaluated in both groups using the Variance Accounted For (VAF) and the Mean Squared Error (MSE). A cross validation procedure was carried out to define a representative set of synergies. The similarity index and the K-means algorithm were applied to validate the existence of such a set of synergies, but also to compare the modulation properties of synergies for different movement directions between groups. The similarity index and hierarchical cluster analysis were also applied to compare between group synergies. Results: Four synergies were chosen to optimally capture the variances in the EMG data, with mean VAF of 0.917 ± 0.034 and 0.883 ± 0.046 of the data variances, with respective MSE of 0.007 and 0.016, in the control and study groups, respectively. The representative set of synergies was set to be extracted from movement to the center of the reaching space. Two synergies had different muscle activation balance between groups. Seven and 17 clusters partitioned the muscle synergies of the control and study groups. The control group exhibited a gradual change in the activation in the amplitude in the time domain (modulation) of synergies, as reflected by the similarity index, whereas the study group exhibited consistently significant differences between all movement directions and the representative set of synergies. The study findings support the existence of a representative set of synergies, which are modulated to execute movements in different directions. Conclusions: Post-stroke individuals differently modulate the activation of synergies to different movement directions than do non-stroke individuals. The conclusion was supported by different muscle activation balances, similarity values and different classifications of synergies among groups.

Objective To evaluate whether specific obesity phenotypes in community-dwelling elderly: (a) affect differently the relationship between frailty and functional impairment and (b) are related to cognitive impairment. Study design A post-hoc cross-sectional analysis of the last Israeli national health and nutrition survey of the elderly (≥ 65 yrs.; n = 1619). Main outcome measures We implemented a previously validated frailty model based on frailty-related variables that were obtained in the survey. Mild cognitive impairment was defined using the Mini-Mental State Examination (a score 17). The Katz's scale of activities of daily living was used for functional assessment. Data were clustered according to different obesity phenotypes using measured body mass index (BMI) and waist circumference (WC). Results The link between frailty and disability was most prominent in subjects with abdominal obesity who were non-obese by BMI: compared with non-obese subjects as defined by WC and BMI, the odds ratio (OR) for functional limitations in this phenotype was 8.34 (95 % CI, 2.14–32.48) for pre-frail subjects and 69.26 (10.58–453.55) for frail subjects. The rate of cognitive impairment was 3.3 times higher (p = .023) in women who were obese by WC but not by BMI. Conclusions In elderly people with a large WC and BMI

Literature reports on the very high frequency (VHF) range of 0.4–0.9 Hz in heart rate variability (HRV) are scanty. The VHF presence in cardiac transplant patients and other conditions associated with reduced vagal influence on the heart encouraged us to explore this spectral band in healthy subjects and in patients diagnosed with cardiac autonomic neuropathy (CAN), and to assess the potential clinical value of some VHF indices. The study included 80 healthy controls and 48 patients with spinocerebellar ataxia type 2 (SCA2) with CAN. The electrocardiographic recordings of short 5-min duration were submitted to three different spectral analysis methods, including the most generally accepted procedure, and the two novel methods using the Hilbert-Huang transform. We demonstrated the presence of VHF activity in both groups of subjects. However, VHF power spectral density, expressed in relative normalized units, was significantly greater in the SCA2 patients than that in healthy subjects, amounting to 36.1 ± 17.4% vs. 22.9 ± 14.1%, respectively, as also was the instantaneous VHF spectral frequency, 0.58 ± 0.05 vs. 0.64 ± 0.07 Hz, respectively. These findings were related to the severity of CAN. We conclude that VHF activity of HRV is integral to the cardiovascular autonomic control.

With more of the world’s population surviving longer, individuals often face age-related neurology disorders and decline of function that can affect lifestyle and well-being. Despite neurophysiological changes affecting the brain function and structure, the aged brain, in some degree, can learn and relearn due to neuroplasticity. Recent advances in rehabilitation techniques have produced better functional outcomes in age-related neurological conditions. Physical therapy (PT) of the elderly individual focuses in particular on sensory–motor impairments, postural control coordination, and prevention of sarcopenia. Geriatric PT has a significant influence on quality of life, independent living, and life expectancy. However, in many developed and developing countries, the profession of PT is underfunded and understaffed. This article provides a brief overview on (a) age-related disease of central nervous system and (b) the principles, approaches, and doctrines of motor skill learning and point out the most common treatment models that PTs use for neurological patients.

A man aged 77 years sustained a left-hemisphere stroke with right hemiparesis. After spending 10 days in the hospital, he was referred to an area rehabilitation centre. There he carried out daily physical, occupational and speech therapy, with an emphasis on task-oriented treatment. The patient9s upper-extremity motor performance was evaluated at admission to the rehabilitation centre and before leaving the hospital by 3 different measurement tools: the upper-extremity motor part of the Fugl-Meyer assessment scale, electromyography in hand-reach and grasp and object manipulation and handwriting tasks. Significant improvement in hand function was observed in proximal as well as in distal skills. Significant improvement in handwriting skills and decreased impairment level of the upper extremity had considerable effects on the quality of life of the patient. The case report emphasises the importance of intensive task-oriented training during the first 3 months after stroke to support the natural recovery of the lesioned area.

Objective: Dynamic visual inputs can cause visual vertigo (VV) in patients with vestibulopathy, leading to dizziness and falls. This study investigated the influence of VV on oculomotor responses. Methods: In this cross-sectional, single-blind study, with experimental and control groups, 8 individuals with vestibulopathy and VV, 10 with vestibulopathy and no VV, and 10 healthy controls participated. Oculomotor responses were examined with 2-dimensional video-oculography. Participants were exposed to dynamic visual inputs of vertical stripes sweeping across a screen at 20 deg/sec, while seated or in Romberg stance, with and without a fixed target. Responses were quantified by optokinetic nystagmus frequency (OKNf) and gain (OKNg). Results: Seated with no target, VV participants had higher OKNf than controls (37 ± 9 vs. 24 ± 9 peaks/sec; P< 0.05). In Romberg stance with no target, they had higher OKNf than controls (41 ± 9 vs. 28 ± 10 peaks/sec; P< 0.05). With a target, OKNf was higher in VV participants compared to controls (7 ± 7 vs. 1 μ 2 peaks/sec; P< 0.05). In Romberg with no target, OKNg was higher in the VV group (0.8 ± 0.1) compared to controls (0.6 ± 0.2; P=0.024). OKNf and OKNg did not differ according to VV status. Conclusions: VV participants had increased OKNf and OKNg compared to healthy participants. Visual dependency should be considered in vestibular rehabilitation.

Objectives The aim of this study was to evaluate the effect of an intensive physical therapy protocol in patients who contract 'intensive care unit-acquired weakness' (ICUAW), in terms of muscle strength, breathing and functional indices. Methods This was a prospective, single-blinded study in a general hospital intensive care unit (ICU). Patients who required mechanical ventilation longer than 48 h and who were expected to remain mechanically ventilated for at least another 48 h were randomly divided into two intervention groups: group I (n = 9) - the routine care group, received physical therapy according to our daily custom protocol; and group II (n = 9) - the intensive treatment group, were treated by the same protocol twice a day. The main outcome measures included the Medical Research Council (MRC) physical strength examination, maximal inspiratory pressure (MIP), hand grip dynamometer and sitting balance test. Results Significant strength improvement from first (T1) to second (T2) measurements was demonstrated for variables MIP and MRC physical strength examination in favor of the intensive treatment group (P Conclusions It is possible that an intensive therapy protocol may facilitate the initial recovery process in patients who suffer from ICUAW.

Dizziness is one of the most troublesome symptoms of vestibular disorders, although its description remains somewhat imprecise, encompassing vertigo, lightheadedness, disequilibrium and giddiness. Symptoms include sensitivity to motion stimuli and discomfort with open spaces, such as empty streets and bridges. It is accompanied by varying degrees of anxiety and phobic behaviors. Several tools have been developed in an attempt to quantify the degree of disability, self-perceived health status and quality of life in patients with dizziness. This review focuses on the University of California, Los Angeles Dizziness Questionnaire (UCLA-DQ), which is used to assess the effect of dizziness on quality of life. This paper also includes a summary of the advantages and disadvantages of the UCLA-DQ and compares it to other instruments used to assess dizziness. In spite of a few disadvantages, we believe that this multidimensional questionnaire is an appropriate tool for evaluating patients with vestibular impairment. It should be used during the acute phase of symptoms, as well as during and after rehabilitative therapy, to assess patient improvement.

Adults over the age of 70 are at risk of falls. Early detection of risk of falls can suggest early interventions. In this study, we attempted to determine valid clinical tests that can differentiate older individuals who are at risk of falling. Older adults from an independent-living community volunteered to participate in this descriptive, cohort study. They were administered the Berg Balance Scale (BBS), Zur Balance Scale (ZBS), Head Shaking Nystagmus Head Impulse Test, Dynamic Visual Acuity, and the Hallpike maneuver for evaluating benign paroxysmal positional vertigo (BPPV); a questionnaire including sociodemographics and a health characteristics survey. Multivariate analysis indicated that a ZBS score 6 medications, and history of falls were a benchmark for high-risk of falling.

An estimated 19% of the adult population in western countries lives with chronic pain. Pain management lies mainly within the primary care and community setting. We evaluated the outcome of a new model of secondary care clinics, conducted by primary care physicians with specialized training in pain medicine. Data on referral patterns, prevalence of pain diagnosis, and medication consumption were recorded at five secondary pain management clinics in the community setting. In total, 997 patients with pain attended 2,652 visits (average 2.7 visits per patient) during 12 mo. Patients’ age ranged from 18 to 92 yr (mean 59 ± 19). Mean pain intensity on the first visit, evaluated by the visual analogue scale was 7.7/10. Myofascial pain syndrome was the most common diagnosis (82%). Treatment included dry needling or trigger point injection (82%), manual myofascial release (23%), and pharmacotherapy (38%). Significant short-term improvement after treatment was reported by 75% of patients, and 72% reported long-term improvement. Four percent were referred to tertiary care pain clinics, 5% were referred to other specialists, and 5% to imaging. Secondary, community-based pain clinics, run by specially-trained primary physicians, demonstrated feasibility. The vast majority of patients referred to the clinics were treated using simple, inexpensive modalities, while sparing referrals to unnecessary consultation visits, imaging tests, and medications.

Increasing longevity, coupled with rising frailty and sarcopenia of aging, significantly affects function and quality of life of older adults. This review discusses the definition, assessment, and management of frailty and sarcopenia, and examines the relationship between them. Medline, Scopus and Psychoinfo databases were searched using the keywords frailty, sarcopenia, aging, and functional disability. The findings are that frailty and sarcopenia are often assessed clinically with such methods such as DeXA, CT scan, MRI, bioelectrical impedance, or anthropometry. Frailty and sarcopenia differentially affect older adults. Both conditions are characterized by decreased energy reserves and resistance to external and internal stressors, resulting in susceptibility to fatigue, comorbidity, sedentary life style, functional decline, hospitalization, quality of life, and even death. The estimated prevalence of frailty with sarcopenia is relatively low; however, the condition requires early detection and careful management.

Background : Ethanolic extract of licorice root has been shown to reduce low-density lipoprotein (LDL) oxidation in atherosclerotic mice and in both hypercholesterolemic and normal lipidemic humans. Objective : This study examined the effect of licorice-root extract on carotid intima-media thickness (CIMT) in individuals with hypercholesterolemia. Design : Individuals with hypercholesterolemia (total cholesterol ≥6.18 mmol/L [240 mg/dL]) and without significant stenosis were randomly allocated to two groups: an experimental group that consumed 0.2 g/day of ethanolic extract of licorice root for 12 months, and a control group that received a placebo. Results : Of 110 eligible participants, 94 (41–80 years old) completed the study. A significant CIMT decrease from 0.92±0.25 mm to 0.84±0.21 mm was observed in the experimental group compared with an increase from 0.85±0.17 mm to 0.88±0.19 mm in the control group. Mean plasma total cholesterol levels and LDL cholesterol decreased, at the range baseline to 1 year, from 284±32 mg/dl to 262±25 mg/dl and from 183±8.5 mg/dl to 174±9.1 mg/dl, respectively, for the experimental group ( p

Background: Many adults with intellectual disabilities (ID) have low physical activity (PA). Lack of PA is a risk factor for metabolic and cardiovascular diseases, and some types of cancer. The objective of this study was to investigate the rate of PA in healthy older adults with ID. Methods: A cross-sectional analysis of baseline data. Participants were caregivers of persons with ID who were over 50 years old and living in a residential care center. A PA questionnaire and a daily rapport form were used to gather information about the type and rate of daily PA of persons with ID for 12 consecutive days. The Katz Index of Independence in Activities of Daily Living (ADL) was used to assess functional dependency. Results: Healthy older adults with ID do not engage in adequate regular PA as recommended by the US Department of Health and Human Services. Conclusion: The low participation in PA for persons with ID may be related to lack of appreciation of the benefits of PA, lack of support from their caregivers and difficulty finding experienced personnel to train them.

Objective: To examine the feasibility, safety and effectiveness of an early aerobic rehabilitation program for patients after minor ischemic stroke. Design: Randomized control trial. Methods: Twenty-eight patients, 1-3 weeks post minor ischemic stroke (modified Rankin scale; mRS 6 2), were randomly assigned to intervention or control groups. Measures were taken at weeks 1 and 6. All participants were instructed in home practice to achieve strength and flexibility, and were asked to continue their normal community routine. Intervention group participants performed a supervised exercise training program twice a week for 6 weeks. Exercise capacity was evaluated by the 6-minute walk distance test (6MWD), and the modified Bruce tr eadmill test. Results: Eight subjects out of 14 participated in all 12 training sess ions, one at less than 50% of the sessions, while five reached the highest stage of the program. No adverse events were noted during the intervention period. In the intention to treat a nalysis a significant improvement over time was seen for the function al parameters only. No interaction (group*time) was found. According to the per protocol analysis a significant interac tion effect was found; only the intervention group participants showed a significant clinical change in the 6MWD test (412 ± 178 meters to 472 ± 196 meters, vs the control group 459 ± 116 meters to 484 ± 122 meters, p < 0.01). Conclusions: An early supervised aerobic training after minor ischemic stroke is feasible and well tolerated and, in a per-protocol analysis, was associated with improved walking endurance. Further studies with a larger sample size are needed to assess the effect of such a program on functional abilities, preventio n of risk factors, and recurrent stroke.

Objectives To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme. Design A parallel randomised single-blind clinical trial. Participants Fifty patients aged 65 years or over with knee osteoarthritis. Interventions The study group ( n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls ( n = 25) were given a brief course in short-wave diathermy treatment. Main outcome measures Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test. Results At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4). Conclusion A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.

The rate of injuries resulting from physical exercise in sport centers as well as related factors has not yet been described. The aims of this study were to describe the prevalence of self-reported activity-specific injuries, to identify the relations between injury profile and different types and patterns of physical activity and to assess whether gender is a modifying variable in that connection. Four hundred and fifty-seven men and women aged 20-35 years participated in this cross-sectional study. A questionnaire was used to evaluate the types and patterns of physical activity performed in the 12 months preceding the study and sports injuries sustained during that time. One hundred and ninety of the 457 subjects reported an injury as a result of exercising (41.6%). A relationship was found between weight training and injuries of the upper extremity (UE) for men and between spinning classes and knee injuries for women. Among those who participated in weight-training exercises, more frequent and longer duration exercise was associated with UE injury, and among those who participated in spinning classes more frequent exercise was associated with knee injury. Future injury prevention programs in sport centers should pay special attention to men who participate in weight training and to women who participate in spinning classes. Language: en

Arm swing in human walking is an active natural motion involving the upper extremities. Earlier studies have described the interrelationship between arms and legs during walking, but the effect of arm swing on energy expenditure and dynamic parameters during normal gait, is inconclusive. The aim of this study was to investigate the effect of restricted arm swing during walking on energy expenditure and spatio-temporal parameters. Fifteen healthy men (aged 19–29 years, height 158–192 cm, weight 50–80 kg) volunteered to walk on a Woodway (Hamburg, Germany) treadmill for 10 min at four different, random velocities, customary walking speed (CWS=100%), slow walking speed (80% CWS), fast walking speed (120% CWS) and very fast walking speed (140% CWS). Participants walked twice at each velocity: once with a natural arm swing and once with restricted arms. Sensor Medics Vmax29 (California, USA), a metabolic system machine measured oxygen consumption. Heart rate was also recorded. Concurrently, selected spatial-temporal parameters were taken. Walking with restricted arms resulted in a significant increase in VO2 consumption (VO2C) (8–34%), heart rate (8–17%) and O2 cost (8–20%). A significant increase in cadence (F=674.71; P Armbewegungen beim menschlichen Gang sind aktive naturliche Bewegungen unter Beteiligung der oberen Extremitaten. Fruhere Studien haben zwar den Zusammenhang von Armen und Beinen beim Gehen beschrieben, die Wirkung der Armbewegung auf den Energieaufwand und die dynamischen Parameter beim normalen Gang aber nicht beweiskraftig genug aufzeigen konnen. Ziel der vorliegenden Studie war die Untersuchung der Wirkung von eingeschrankten Armbewegungen beim Gehen auf den Energieaufwand und raumlich-zeitliche Parameter. Im Rahmen der Hamburger Studie gingen 15 gesunde mannliche Probanden (im Alter von 19–29 Jahren, Korpergrose: 158–192 cm, Gewicht: 50–80 kg) zehn Minuten lang auf einem Woodway-Laufband bei vier verschiedenen, randomisiert eingestellten Geschwindigkeiten: ubliche Gehgeschwindigkeit (CWS=100%), langsame Gehgeschwindigkeit (SWS=80% CWS), schnelle Gehgeschwindigkeit (FWS=120% CWS) und sehr schnelle Gehgeschwindigkeit (VFWS=140% CWS). Die Probanden gingen bei jeder Geschwindigkeit zweimal: einmal mit naturlicher Armbewegung und einmal mit eingeschrankter Armbewegung. Mit Sensor Medics Vmax29 (California, USA), einem Gerat zur Stoffwechselmessung, wurde der Sauerstoffverbrauch gemessen. Die Herzfrequenz wurde ebenso aufgezeichnet. Gleichzeitig wurden ausgewahlte raumlich-zeitliche Parameter gemessen. Gehen mit eingeschrankter Armbewegung hatte eine signifikante Steigerung des VO2-Verbrauchs (VO2C) (8–34%), der Herzfrequenz (8–17%) und der O2-Kosten (8–20%) zur Folge. Eine signifikante Steigerung der Kadenz (F=674.71; P La oscilacion de los miembros superiores de los humanos al andar es un movimiento natural activo. Estudios anteriores han descrito la interrelacion entre los miembros superiores y los inferiores durante la marcha; sin embargo, no se ha logrado precisar aun los efectos de la oscilacion de los miembros superiores en el gasto de energia y en los patrones dinamicos de la marcha normal. El objetivo de este estudio fue investigar los efectos de la restriccion de la oscilacion de los miembros superiores durante la marcha en el gasto de energia y en los aspectos espaciales y temporales de la marcha. Quince varones sanos (edad: 19–29 anos, estatura: 158–192 cm, peso: 50–80 kg) se ofrecieron como voluntarios para caminar en una rueda de andar de marca Woodway (Hamburgo, Alemania) durante 10 minutos a cuatro velocidades diferentes seleccionadas al azar: velocidad normal (VN=100%), velocidad lenta (VL=80% de la VN), velocidad acelerada (VA=120% de la VN) y velocidad muy acelerada (VMA=140% de la VN). Cada sujeto anduvo dos veces a cada una de estas velocidades: una vez haciendo uso de la oscilacion natural de los miembros superiores y otra vez con restriccion de los movimientos oscilatorios de los miembros superiores. Se utilizo un dispositivo de valoracion de parametros metabolicos, de marca Medics Vmax29 (California, EE.UU.) para medir el consumo de oxigeno (CO). Ademas, se midio la frecuencia cardiaca y se valoraron los aspectos espaciales y temporales de la marcha seleccionados para este estudio. Andar mientras estan restringidos los movimientos de oscilacion de los miembros superiores dio lugar a un aumento importante del consumo de oxigeno (VCO2) (8–34%), de la frecuencia cardiaca (8–17%) y del gasto de oxigeno (8–20%). Se produjo un aumento importante, ademas, en la cadencia de la marcha (F=674.71; P Chez l'homme, le balancement des bras lors de la marche est un mouvement naturel actif des membres superieurs. Des etudes precedentes ont decrit le rapport entre les bras et les jambes pendant la marche ; cependant les resultats concernant l'effet du balancement des bras sur la depense d'energie et les parametres dynamiques pendant la marche normale sont peu concluants. Cette etude avait pour objet d'etudier les effets d'un balancement de bras limite pendant la marche sur la depense d'energie et les parametres spatio-temporels. Quinze sujets masculins en bonne sante (âge : 19–29 ans, taille : 158–192 cm, poids : 50–80 kg) se sont portes volontaires pour marcher sur un marcheur Woodway (Hambourg, Allemagne) pendant 10 minutes a quatre vitesses differentes : marche ordinaire (CWS=100), marche lente (SWS=80 CWS), marche rapide (FWS=120 CWS) et marche tres rapide (VFWS=140 CWS). Les sujets ont marche deux fois a chaque vitesse : une fois avec un balancement naturel des bras, l'autre avec les bras restreints. Un capteur Medics Vmax29 (California, USA), appareil d'etude du systeme metabolique, a mesure de la consommation d'oxygene (CO). Le rythme cardiaque a egalement ete enregistre. Certains parametres spatiaux temporels ont ete simultanement enregistres. La marche bras restreints resulte dans une augmentation significative de la consommation VO2 (VO2C) (8–34%), du rythme cardiaque (8–17%) et de la consommation d'O2 (8–20). Une augmentation significative dans la cadence (F=674.71; P

Peripheral artery disease (PAD) is one of the many unhealthy conditions that may get worse with age. Its most common symptom is intermittent claudication (IC). Intermittent claudication is the exercise-induced ischemic pain caused by the reduced blood flow to the lower extremities.To investigate the effects of low intensity treadmill walking on the functional capacity of PAD patients with IC. Walking ability (time, rate, and distance), heart rate, and blood pressure responses were recorded before, during, and after each exercise session. Only the initial and final values recorded were used for data analysis. This 6-week program of low-intensity, pain-free endurance training was designed to keep the exercise level low enough to minimize ischemic leg pain.Thirteen PAD patients volunteered for twice weekly exercise sessions for 6 consecutive weeks. Each session consisted of a 10-minute warm-up consisting of routine, pain-free static and proprioceptive neuromuscular facilitation stretching. Each patient exercised for 10 to 20 minutes as tolerated on the treadmill. Proprioceptive neuromuscular facilitation was conducted following walking.As a group the patients with PAD had an average 148% improvement in distance, 34% in rate, and 94% in duration of walking. Five of the 13 patients had over 100% improvement in distance, with the maximum being 525%. One of the 13 patients had a 100% improvement in rate. Four of the 13 patients had over 100% improvement in duration, with the maximum being 500%.This study introduces a new method of low-intensity treadmill walking exercise, which seems to be an effective nonpharmacologic treatment even within a 6-week period for patients with IC due to PAD. It also supports the benefits of walking exercise to increase the mobility of these patients, thus improving functional capacity of life.

Symptoms of intermittent claudication (IC) can be relieved by lifestyle modification, medications, and walking exercises. The intensity of the walking exercise is still debatable. The goal of this study was to determine the effects of accommodating pain-free walking exercise therapy program length on pain-free walking. A descriptive, longitudinal study with repeated measures of exercise capacity was conducted. An IC questionnaire was administered to assess IC signs, symptoms, and lifestyle. Walking was performed on a treadmill for 30 to 50 minutes below the participant's individualized walking pain threshold. The study included patients diagnosed with IC due to peripheral arterial disease. All participants were randomly assigned to three groups. Group A (n = 28) participated in the walking program for 2-9 weeks, group B (n = 30) for 10-14 weeks, and group C (n = 26) for 15-94 weeks. The main outcome measure of the study was to determine changes in exercise capacity: walking distance (miles), walking duration (minutes), and walking speed (mph). Group A increased the amount of distance, duration, and speed walked from pretest to posttest by 80% (P.001), 27% (P.001), and 37% (P.001), respectively. Group B increased the amount of distance, duration, and speed walked from pretest to posttest by 122% (P.001), 56% (P.001), and 43% (P.001), respectively. Group C increased the amount of distance, duration, and speed walked from pretest to posttest by 26% (P = .002), 22% (P = .002), and 5% (P = .541) respectively. We reached the conclusion that a walking program of 10-14 weeks is optimal for achieving the best improvements in walking distance, duration, and speed.

Patients with intermittent claudication due to peripheral arterial disease (PAD) experience muscle aching during walking secondary to ischemia. The purpose of this study was to examine the effects of low-intensity pain-free exercise (LIPFE) on functional capacity of individuals with PAD. A total of 12 participants with PAD underwent training on treadmill for 6 weeks, twice a week, for about 45 minutes. Outcome measures included walking distance (WDI), walking duration (WDU), mean walking rate (WR), estimated oxygen consumption (EVO2), metabolic equivalent (MET), estimated total energy expenditure (ETEE), and estimated rate of energy expenditure (EREE). Mean improvement of WDI, WDU, and MWR were 104% (an addition of 1.0 km), 55% (an addition of 13.3 minutes), and 41% (0.9 km/h faster), respectively. Mean improvement of EVO2, MET, ETEE, and EREE, were 20%, 20%, 80%, and 20%, respectively. In conclusion, it appears that LIPFE training is an effective intervention for individuals presenting with PAD.

Low serum B12 level is a common occurrence in patients with type 2 diabetes (T2DM) treated with metformin. There is lack of evidence concerning blood testing of vitamin B12 and current clinical guidelines make no recommendations on the detection or prevention of vitamin B-12 deficiency during metformin treatment. Our objective was to examine the current practice and clinical determinants of vitamin B12 testing in metformin treated T2DM patients. Data were collected from health maintenance organization patients, and consisted of T2DM patients who were newly prescribed metformin from 2008 to 2013. Patients were randomly divided into two subgroups: referred for a vitamin B12 blood test, and did not receive a referral. The demographic data and medical characteristics were analyzed. 5131 patients began taking metformin during the study period. Of these 2332 (44.5 %) had vitamin B12 tested. Significant differences were found between the groups in regard to glycosylated hemoglobin, low density lipoprotein, systolic blood pressure, dyslipidemia, chronic renal failure, and disease duration. A significant positive association (p .05) was found between vitamin B12 testing and insulin treatment, retinopathy, neuropathy and hypertension. Vitamin B12 in elderly (75 years) patients was significantly lower (p .01). Insulin treatment, hypertension, and chronic diabetic complications in metformin treated T2DM patients are associated with higher rates of vitamin B12 testing. T2DM patients 75 years and above were less likely to be tested for B12 deficiency.

Anxiety and vestibular disorders appear to be intimately related. Anxiety can be a symptom of underlying health problems, such as dizziness, and vice versa. Both sets of symptoms can deprive patients of social interactions, social encounters, and participation in daily activities.

Background and aim In western countries, the proportion of people over age 60 is increasing faster than any other group. This is linked to higher rates of obesity. Older age, co-morbidities and obesity are all associated with frailty syndrome. In the core of both frailty and sarcopenia there are dysfunction and deterioration of the muscle and the fat tissues. This overview interlinks the phenotypes presented in older adults such as sarcopenia and frailty—alone and with relation to obesity, muscle function and fat tissue accumulation. Recent findings Observational studies have well described the loss of muscle mass and strength through the years of adult life, both components of frailty and sarcopenia. They have shown that these changes are associated with dysmetabolism and functional deterioration, independent of common explanatory variables. In the metabolic mechanism core of this link, insulin resistance and higher ectopic fat accumulation may play a role. Basic experiments have partially validated this hypothesis. Whether there is a synergistic effect of obesity and frailty phenotype on morbidity risk is still questionable and currently under investigation; however, few cohort studies have shown that the frail–obese or sarcopenic–obese group have higher probability for metabolic complications. Summary Muscle mass loss and fat accumulation in the muscle in the elderly, with or without the presence of obesity, may explain some of the functional and metabolic defects shown in the frail, sarcopenic population.

Blood pressure (BP) variability (BPV) contributes to target organ damage independent of BP. The authors examined the effect of a 1-year multidisciplinary intervention on BPV in patients with the metabolic syndrome (MetS) as defined by criteria from the Third Report of the Adult Treatment Panel. Forty-four nondiabetic patients underwent clinical and biochemical profiling, 24-hour ambulatory BP monitoring (ABPM), body composition, carotid intima-media thickness, and carotid-femoral pulse wave velocity (PWV). The intervention targeted all MetS components. BPV was assessed by the standard deviation of daytime systolic BP derived from ABPM. Patients with low and high BPV (lower or higher than the median daytime standard deviation of 11.6 mm Hg) did not differ in regards to systolic and diastolic BP, age, fasting glucose, glycated hemoglobin, and body mass index, but the high-variability group had higher values of low-density lipoprotein and leg fat. The 1-year intervention resulted in weight reduction but not BP-lowering. BPV declined in the high-variability group in association with lowering of PWV, C-reactive protein, glycated hemoglobin, alanine aminotransferase, asymmetric dimethylarginine, and increased high-density lipoprotein cholesterol. A multidisciplinary intervention independent of BP-lowering normalized BPV, lowered PWV, and enhanced metabolic control.

Objective To examine vestibular function following falls in the elderly. Design A case-controlled study to compare vestibular function in elderly people with hip fractures and elderly people with no prior hip fractures. Participants One hundred and sixty-nine people aged 65 years or older took part in the study. Study Group A consisted of 84 hospitalised volunteers who had received hip surgery due to a fall and who were undergoing rehabilitation. Control Group B consisted of 85 volunteers from retirement homes with no prior history of hip fracture. Intervention All participants underwent four clinical tests to determine their level of vestibular functioning in order to allow comparison between the groups. Three methods were used to test the vestibulo-ocular reflex (VOR), and one method was used to test benign paroxysmal positional vertigo. Results Thirty-eight percent of the participants in Study Group A and 11% of the participants in Control Group B demonstrated a positive visual acuity test ( P Conclusions Study Group A exhibited greater VOR impairment than Control Group B. Therefore, impairment of this reflex may be considered as a risk factor for falls.

This study aimed to investigate whether any physiological changes might have a clinically significant effect on function in sedentary, institutionalized, older adults treated by a passive training program. A total of 18 subjects (mean age 60.7 ± 3.4) with intellectual disability (ID) participated. We measured SpO2 (arterial oxygen saturation) before, during, and after passive training, and used Barthel Index to measure daily living activities. The general trend indicated that inactive people with ID evidenced a continual increase in SpO2% levels and some functional gains during passive treatment, with superiority to manual passive treatment compared to mechanical active passive training. For current clinical practice, most sedentary patients who experience clinically significant deconditioning and desaturation can benefit from passive treatment.

Rett syndrome is a genetic disorder primarily affecting females. One of its most disabling features is the severe and rapid progression of scoliosis. So far, only surgical intervention has succeeded in reversing the development of scoliosis in Rett syndrome.The present study describes a new management approach implemented with a girl with Rett syndrome. The core of the management regime was intensive: asymmetrical activation of trunk muscles through equilibrium reactions. The X-rays accompanying the article (evaluated by four experienced orthopedic surgeons blinded to the intervention process) suggested that the intervention was successful in reversing the progress of the scoliosis for the above-mentioned child. Discontinuation of treatment led to severe and rapid deterioration of the spinal curve.Due to the fact that this was a case study, generalization is limited, but we suggest further investigation and studies with this method.

Policy makers and the welfare system need to respond to the unique needs and expectations of ageing people with a lifelong intellectual disability (ID). Lack of physical activity, along with functional decline, may result in falls – yet little attention has been paid to the balance capability of older adults with ID. A total of 27 participants, chosen from a sample of foster home residents in Haifa, Israel, were assigned to two groups for this study: group A underwent a 6-month balance training programme and group B underwent a 6-month muscle strengthening programme. The evaluation procedures included the short-form health survey questionnaire, a physical performance test and a functional reach test. The results showed improvements in function between baseline tests and post-training programme tests in both groups, yet group A demonstrated a more significant improvement in balance capability and general health.

The purpose of this study was to evaluate the efficacy of a pain-free treadmill walking program in intellectually disabled (ID) adults with arterial occlusive disease. Fourteen participants with mild ID participated in the walking program. Six patients showed stable intermittent claudication. A control (nontreadmill, n = 12) group consisted of 4 individuals with intermittent claudication. Noninvasive determinations of lower-limb hemodynamics included photoplethysmography and ankle-brachial pressure. Pain levels were measured according to a pain pathophysiology index. The treadmill program consisted of individually prescribed low-endurance walking at a 0% incline done at a comfortable speed 3 times per week. All participants completed the 15-week walking program and showed significant improvements (p < 0.05) in walking speed, distance, and duration. Pain levels were reduced in individuals suffering from intermittent claudication. Blood hemodynamic parameters also showed significant improvements. In conclusion, low-intensity treadmill walking significantly improved the functional capacities of adult individuals with mild ID with vascular occlusion and reduced pain levels.