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Melzer I.,Ben - Gurion University of the Negev | Liebermann D.G.,Tel Aviv University | Krasovsky T.,McGill University | Oddsson L.I.E.,Sister Kenny Rehabilitation Institute
Journals of Gerontology - Series A Biological Sciences and Medical Sciences

Background. Quick step execution may prevent falls when balance is lost; adding a concurrent task delays this function. We investigate whether push-off force-time relations during the execution of rapid voluntary stepping is affected by a secondary task in older and young adults. Methods Nineteen healthy older adults and 12 young adults performed rapid voluntary stepping under single-and dual-task conditions. Peak power, peak force, and time to peak force during preparatory and swing phases of stepping were extracted from center of pressure and ground reaction force data. Results For dual-task condition compared with single-task condition, older adults show a longer time to reach peak force during the preparation and swing phases compared with young adults (∼25% vs ∼10%, respectively). Peak power and peak force were not affected by a concurrent attention-demanding task. Conclusion Older adults have difficulty allocating sufficient attention for fast muscle recruitment when concurrently challenged by an attention-demanding task. © The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. Source

Melzer I.,Boston University | Melzer I.,Ben - Gurion University of the Negev | Oddsson L.I.E.,Boston University | Oddsson L.I.E.,Sister Kenny Rehabilitation Institute
Clinical Rehabilitation

Objectives: To evaluate the effect of a group-based functional and specific balance training programme that included dual-task exercises on balance function in healthy older adults. Design: A single-blind randomized controlled trial. Setting: General community. Participants: Sixty-six community-dwelling older adults (age 77.0 ± 6.5 years), without functional balance impairment were recruited and allocated at random to an intervention group (n = 33) or a reference group (n = 33). Intervention: The intervention group received 24 training sessions over three months that included perturbation as well as dual-task exercises. The reference group received no intervention. Outcome measures: The voluntary step execution times during single- and dual-task conditions, stabilogram-diffusion analysis in upright standing, and self-reported physical function; all were measured assessed at baseline and at the end of intervention. The intervention group was retested after six months. Results: Compared with the reference group, participation in group-based functional and specific balance training led to faster voluntary step execution times under single-task (P = 0.02; effect size (ES) = 0.34) and dual-task (P = 0.036; ES = 0.55) conditions; lower transition displacement and shorter transition time of the stabilogram-diffusion analysis under eyes-closed conditions (P = 0.007, ES = 0.30 and P = 0.08, ES = 0.44, respectively); and improved self-reported lower extremity function (P = 0.006, ES = 0.37). Effects were lost at six-month follow-up. Conclusions: Functional and specific balance training can improve voluntary stepping and balance control in healthy older non-fallers, parameters previously found to be related to increased risk of falls and injury in older adults. © 2012 The Author(s). Source

Melzer I.,Ben - Gurion University of the Negev | Kurz I.,Ben - Gurion University of the Negev | Shahar D.,Ben - Gurion University of the Negev | Oddsson L.I.E.,Sister Kenny Rehabilitation Institute
Aging Clinical and Experimental Research

Background and aims: Stepping reactions play a critical role in responding to balance perturbations, whether they are a consequence of external perturbation or self-induced in nature. The aim of the present study was to determine prospectively the capacity of voluntary stepping performance in single-and dual-task conditions, to predict future falls among older community-dwelling persons. We also aimed to assess whether dual task conditions have an added value over single tasks for fall prediction. Methods: A total of 100 healthy old volunteers (mean age 78.4±5.7 yrs), from two self-care protected retirement homes for older adults, performed the Voluntary Step Execution Test in single- and dual-task conditions as a reaction time task while standing on a single force platform. Step initiation, preparatory and swing phases, and foot-contact time were extracted from data on center of pressure and ground reaction force. One-year fall incidences were monitored. Results: Ninety-eight subjects completed the one-year follow-up, 49 non-fallers, 32 one-time fallers, and 17 recurrent fallers (two or more falls). Recurrent fallers had significantly slower voluntary step execution times in both single- and dual-task conditions, especially due to a slower preparation phase. Two stepwise (backward) logistic regression models showed that longer step execution times have strong predictive value for falls in both single- and dual-task conditions (odds ratio (OR) 8.7 and 5.4, respectively, p<0.05). Conclusions: Voluntary Step Execution Test in both single- and dual-task conditions is a simple and safe examination which can potentially and effectively predict future falls, with no added value to dual- over single-task condition. ©2010, Editrice Kurtis. Source

Schaefer P.T.,University of Minnesota | Speier J.,Sister Kenny Rehabilitation Institute
Current Sports Medicine Reports

The fields of sports medicine and performing arts medicine have begun recent initiatives to collaborate more closely and to share information pertinent to the treatment of athletes and performing artists. This article provides a review of the common musculoskeletal and neurological problems encountered among performing artists who play instruments. Approaches to history, examination, diagnosis, and treatment are offered, based on literature reviews, expert opinion, and the authors' own experiences in a musician's clinic. Treatments focus on conservative management within a multidisciplinary framework, and indications are given for appropriate surgical referral. Providers are encouraged to build an understanding of the unique issues affecting instrumental athletes. Copyright © 2012 by the American College of Sports Medicine. Source

Schmitz M.,Abbott Laboratories | Finkelstein M.,Sister Kenny Rehabilitation Institute
Topics in Stroke Rehabilitation

Purpose: To study the perspectives and experiences of stroke survivors and partners of stroke survivors regarding sexual issues and perceived rehabilitation needs.Methods: Using semi-structured interviews, 15 stroke survivors and 14 partners of stroke survivors (median age of 65 years, range 29 to 85) provided information about sexual issues experienced after stroke and their perspectives on how to address sexual concerns in a rehabilitation setting. A qualitative thematic analysis was applied to transcribed interviews to identify and describe common themes within the data relevant to the aim of the study. A quantitative analysis was utilized to elucidate the frequency of themes by demographic characteristics that were not readily apparent using a qualitative method alone.Results: Seven themes were identified. Two related to the effects of stroke on sexual life: physical/functional changes and relationship changes. Five related to addressing sexual issues in the process of rehabilitation: (1) difficulty in patients and providers talking about sexual matters, (2) little to no discussion of poststroke sexuality, (3) need for tailoring education to an individual or couple's unique needs, (4) provider rapport and competence, and (5) timing of poststroke sexual education. Conclusions: Poststroke sexual issues are complex and suggest the need for the development of a biopsychosocial model of education and treatment intervention. Rehabilitation programs need to evaluate the level of training and services provided to address poststroke sexual issues. Development of clinically useful poststroke sexual adjustment assessment tools and interventions is warranted. © 2010 Thomas Land Publishers, Inc. Source

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