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Our pilot study investigated if children with Down syndrome engaged in the recommended 60 min of moderate to vigorous physical activity (MVPA) every day. Twenty-three children with Down syndrome (7 girls, 16 boys; mean age 11.7 years, SD = 3.1) wore a triaxial accelerometer for 7 consecutive days to measure their activity levels. The average daily MVPA undertaken was 104.5 min (SD = 35.3 min). Only 8 of 19 children (42.1%) completed at least 60 min of MVPA each day. Lower amounts of activity were associated with older children (r = -0.67, p less than 0.01). Parents, teachers, and health professionals need to encourage children with Down syndrome to take part in more frequent MVPA. (Contains 1 table and 2 figures.)

To explore the effects that impaired ability to sit-to-stand has on upright mobility and self-care in children with cerebral palsy and how this in turn may affect their caregivers. A mixed methods research design was conducted with 25 children who had cerebral palsy with moderate to high mobility limitations (GMFCS levels III and IV) and their caregivers. Caregivers were interviewed about their child's mobility and self-care. The independence of each child's activities was rated using the mobility and self-care domains of the Functional Independence Measure for Children (WeeFIM). Two themes were identified from qualitative analyses: Difficulty in sit-to-stand was perceived by caregivers to reduce their child's ability to independently and safely perform mobility and some self-care tasks; and negatively impacted the caregivers physically and psychologically. Mobility and self-care WeeFIM scores showed that these children required moderate assistance, and that self-care tasks involving sit-to-stand (toileting and bathing) required more assistance than self-care tasks that would not be expected to involve sit-to-stand (eating and grooming). Qualitative and quantitative findings were convergent. The ability to sit-to-stand independently may be an important precursor skill for independence in upright mobility and self-care for children with moderate to severe mobility limitations. [ABSTRACT FROM AUTHOR]

To determine if eccentric exercise was effective, safe and feasible in increasing function and quality of life in people with heart failure compared to usual care and a waitlist control group. A prospective, three-armed, parallel-design, assessor-blind, pilot randomised controlled trial with 1:1:1 allocation. Forty-seven participants (16 female; mean age 66 years) with mild to moderate heart failure were randomly allocated to either eccentric exercise, concentric exercise or a waitlist control group. Participants in the exercise groups completed twice-weekly exercise for eight weeks. Primary outcome was walking capacity. Secondary outcomes were quality of life, leg strength and fatigue. Outcomes were assessed at baseline, post intervention and three-month follow-up. Attendance, tolerability and adverse events were used to determine safety and feasibility. Intention-to-treat analysis showed no differences between eccentric exercise and either concentric exercise or waitlist for any outcome. Per-protocol analysis found improvements identified by the Minnesota living with heart failure questionnaire were significantly greater post-intervention for eccentric exercise compared to concentric exercise (−17.99 units, 95% confidence interval −35.96 to −0.01). No major adverse events were reported. In this small trial, eccentric exercise did not demonstrate superior outcomes to concentric exercise or a waitlist control group. The protocol for this trial was registered at clinicaltrials.gov, registration number: NCT02223624, registration date: 22 August 2014. Regular physical activity and referral to rehabilitation is recommended for people with chronic heart failure, however exercise can be challenging for this group. Eccentric exercise was safe and tolerable for participants with heart failure. Documentation of exercise progression is important to demonstrate a dose–response relationship. In this study there were no differences between groups who received eccentric exercise, concentric exercise or no exercise. [ABSTRACT FROM AUTHOR]

Abstract Background In young people with spastic diplegic cerebral palsy weakness of the hip extensor muscles are associated with limitations in activity. It is important that clinicians can reliably measure hip extensor muscle strength to monitor changes over time and the effects of any interventions. Previous research has demonstrated high reliability for measuring strength of all muscles of the lower limb, with the exception of the hip extensors. Therefore the aim of this study was to examine the retest reliability of measuring hip extensor strength in young people with cerebral palsy. Methods Using a test-retest reliability research design, 19 participants with spastic diplegic cerebral palsy (Gross Motor Function Classification System Levels II and III) (mean 19 y 2 mo [S D 2 y 5 mo]) attended two testing sessions held 12 weeks apart. Three trials with a hand-held dynamometer were taken at each testing session in supine, prone and standing. Retest reliability was calculated with Intraclass Correlation Coefficients (ICC(2,1)) and with units of measurement (kilograms) converted to a percentage strength change. Results ICC values ranged from .74 to .78 in supine, .75 to .80 in prone, and .73 to .75 in standing. To be 95% confident that real change had occurred, an individual's strength would need to increase 55 to 60% in supine, 86 to 102% in prone, and 102 to 105% in standing. To be 95% confident that real change had occurred across groups, strength would need to increase 4 to 8% in supine, 22 to 31% in prone, and 32% to 34% in standing. Higher ICC values were observed when three trials were used for testing. Conclusions The supine testing position was more reliable than the prone or standing testing positions. It is possible to measure hip extensor strength with sufficient reliability to be able monitor change within groups using the supine position provided three trials are used during testing. However, there is insufficient reliability to monitor changes in hip extensor strength in individuals with cerebral palsy unless they exhibit very large strength increases.

Abstract Background Balance dysfunction and falls are common problems in later stages of dementia. Exercise is a well-established intervention to reduce falls in cognitively intact older people, although there is limited randomised trial evidence of outcomes in people with dementia. The primary objective of this study is to evaluate whether a home-based balance exercise programme improves balance performance in people with mild to moderate severity Alzheimer's disease. Methods/design Two hundred and fourteen community dwelling participants with mild to moderate severity Alzheimer's disease will be recruited for the randomised controlled trial. A series of laboratory and clinical measures will be used to evaluate balance and mobility performance at baseline. Participants will then be randomized to receive either a balance training home exercise programme (intervention group) from a physiotherapist, or an education, information and support programme from an occupational therapist (control group). Both groups will have six home visits in the six months following baseline assessment, as well as phone support. All participants will be re-assessed at the completion of the programme (after six months), and again in a further six months to evaluate sustainability of outcomes. The primary outcome measures will be the Limits of Stability (a force platform measure of balance) and the Step Test (a clinical measure of balance). Secondary outcomes include other balance and mobility measures, number of falls and falls risk measures, cognitive and behavioural measures, and carer burden and quality of life measures. Assessors will be blind to group allocation. Longitudinal change in balance performance will be evaluated in a sub-study, in which the first 64 participants of the control group with mild to moderate severity Alzheimer's disease, and 64 age and gender matched healthy participants will be re-assessed on all measures at initial assessment, and then at 6, 12, 18 and 24 months. Discussion By introducing a balance programme at an early stage of the dementia pathway, when participants are more likely capable of safe and active participation in balance training, there is potential that balance performance will be improved as dementia progresses, which may reduce the high falls risk at this later stage. If successful, this approach has the potential for widespread application through community based services for people with mild to moderate severity Alzheimer's disease. Trial registration The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000040369).

Purpose: To determine the effects of sit-to-stand exercise programs on patient-related outcomes in people with physical impairments due to health conditions. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. Seven electronic databases were systematically searched for relevant articles. Inclusion and exclusion criteria were used to screen the titles and abstracts of articles identified using the key search terms of sit-to-stand and exercise. Only randomized controlled trials were included. The methodological quality of papers was assessed using the Cochrane risk of bias tool. Results: A total of eight trials were included. A meta-analysis was conducted using four of the trials that focused on patients with neurological conditions. There was moderate-quality evidence that sit-to-stand exercise programs improve sit-to-stand performance, but no evidence from another meta-analysis that sit-to-stand training improved balance for patients with neurological conditions. There was also no evidence from individual trials that positive changes occurred in the outcomes of gait speed and distance, lower limb muscle strength, falls, or participation. Conclusions: Sit-to-stand training could be a useful intervention when patients have limited sit-to-stand function and the aim of treatment is to improve this performance. Sit-to-stand training could be a useful intervention for patients when the aim is to improve sit-to-stand performance. Sit-to-stand training may not be a useful intervention when the aim is to improve other functions such as balance. [ABSTRACT FROM AUTHOR]

Our pilot study investigated if children with Down syndrome engaged in the recommended 60 min of moderate to vigorous physical activity (MVPA) every day. Twenty-three children with Down syndrome (7 girls, 16 boys; mean age 11.7 years, SD = 3.1) wore a triaxial accelerometer for 7 consecutive days to measure their activity levels. The average daily MVPA undertaken was 104.5 min (SD = 35.3 min). Only 8 of 19 children (42.1%) completed at least 60 min of MVPA each day. Lower amounts of activity were associated with older children (r = -.67, p < .01). Parents, teachers, and health professionals need to encourage children with Down syndrome to take part in more frequent MVPA. [ABSTRACT FROM AUTHOR]

Purpose: To examine the validity and reliability of an activity monitor to estimate upper limb activity.Methods: Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test-retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences.Results: There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r = 0.82, r = 0.73, respectively] and floor sweeping activities [r = 0.54, r = 0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC(2,1) = 0.91, ICC(2,1) = 0.88, respectively], grocery shelving [ICC(2,1) = 0.83, ICC(2,1) = 0.89, respectively], and table dusting activities [ICC(2,1) = 0.77, ICC(2,1) = 0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed.Conclusions: There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture. Implications for Rehabilitation Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions.After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels.Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence.Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture. [ABSTRACT FROM AUTHOR]

Purpose: Primary purpose to determine if cultural and linguistic diversity affects health-related outcomes in people with stroke at discharge from hospital and secondary purpose to explore whether interpreter use alters these outcomes. Method: Systematic search of: Cochrane, PEDro, CINAHL, Medline, Pubmed, Embase, PsycINFO and Ageline databases. Publications were classified into whether they examined the impact of diversity in culture, or language or culture and language combined. Quality of evidence available was summarized using Best Evidence Synthesis. Results: Eleven studies met inclusion criteria and were reviewed. Best Evidence Synthesis indicated conflicting evidence about the impact of culture alone and language barriers alone on health-related outcomes. There was strong evidence that hospital length of stay does not differ between groups when the combined impact of culture and language was investigated. Conflicting evidence was found for other outcomes including admission, discharge and change in FIM scores, and post-hospital discharge living arrangements. It is unknown if interpreter use alters health-related outcomes, because this was infrequently reported. Conclusion: The current limited research suggests that cultural and linguistic diversity does not appear to impact on health-related outcomes at discharge from hospital for people who have had a stroke, however further research is needed to address identified gaps. The different language, culture and beliefs about health demonstrated by patients with stroke from minority groups in North America do not appear to significantly impact on their health-related outcomes during their admission to hospital. It is not known whether interpreter use influences outcomes in stroke rehabilitation because there is insufficient high quality research in this area. Clinicians in countries with different health systems and different cultural and linguistic groups within their communities need to view the results with caution as further investigation is required outside North America to ensure optimal and equitable care for these groups. In the absence of clear outcomes from high quality research, clinicians should ensure patients and their families have an optimal understanding of the health condition, the rehabilitation process and the service system, irrespective of language or cultural differences. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether English proficiency and/or the frequency of interpreter use impacts on health outcomes for inpatient stroke rehabilitation.Method: Study design: Retrospective case–control study.Participants: People admitted for inpatient stroke rehabilitation. A high English proficiency group comprised people with native or near native English proficiency (n = 80), and a low English proficiency group comprised people who preferred a language other than English (n = 80). Outcome measures: Length of stay (LOS), discharge destination and Functional Independence Measure (FIM).Results: The low English proficiency group showed a greater improvement in FIM from admission to discharge (p = 0.04). No significant differences were found between groups in LOS, discharge destination and number of encounters with allied health professionals. Increased interpreter usage improved FIM efficiency but did not significantly alter other outcomes.Conclusion: English proficiency does not appear to impact on health outcomes in inpatient rehabilitation with a primarily in-house professional interpreter service. However, there is a need for a larger powered study to confirm these findings.Implications for rehabilitationPeople with low English proficiency undergoing inpatient stroke rehabilitation in a setting with a primarily in-house professional interpreter service, achieved similar outcomes to those with high English proficiency irrespective of frequency of interpreter usage.A non-significant increase of 4 days length of stay was observed in the low English proficiency group compared to the high English proficiency group.For patients with low English proficiency, greater change in Functional Independence Measure efficiency scores was observed for those with higher levels of interpreter use relative to those with low interpreter use. Clinicians should optimise use of interpreters with patients with low English proficiency when possible. [ABSTRACT FROM PUBLISHER]

Purpose: To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP).Method: Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12 weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12 weeks and 24 weeks.Results: From the 36 participants with complete data at 12 weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8 kg; 95% CI −1.4 to 25.0). No significant adverse events occurred during training.Conclusions: A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP.Implications for RehabilitationProgressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities.Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities. [ABSTRACT FROM PUBLISHER]