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PubMed1985

Reconstruction of a balanced thumb through tendon transfers.

The ability to use the thumb determines its functional relation to the fingers and the resulting dexterity of the hand. Median palsy results in a failure of abduction and pronation. Ulnar palsy results in loss of adduction and flexion at the metacarpophalangeal joint. Following median, ulnar, and even radial palsy, the thumb can develop adduction deformity. Thumb contracture must be released prior to tendon transfers. Abduction and pronation are best substituted by transfer of the extensor indicis proprius. Adduction is best substituted by transfer of the extensor carpi radialis brevis and arthrodesis of the metacarpophalangeal joint. Median cutaneous sensibility should be reconstructed after appropriate tendon transfers are functional.

Arthrodesis↗

PubMedDate not supplied

Antihypertensive effect of riboflavin analogs in rats with mineralocorticoid-induced hypertension.

This study investigated whether the riboflavin analogs, 7,8-dimethyl-10-formylmethyl isoalloxazine (FMI) and 7,8-dimethyl-10-(2'-hydroxyethyl) isoalloxazine (HEI), are effective antihypertensive agents in mineralocorticoid-induced or deoxycorticosterone acetate (DOCA)-salt hypertension. These studies are based on our previous observation tht aldosterone enhances the biosynthesis of renal flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) from riboflavin, and that FMI and HEI competitively inhibit conversion of riboflavin to FMN and reabsorption of Na+ in the kidney of adrenalectomized rats. When 1.6 mg of FMI or HEI were administered simultaneously with 3.0 mg of DOCA, the tail systolic blood pressure (SBP) of unanesthetized rats rose only to 136 +/- 5 mm Hg (standard error of the mean, SEM) compared to 163 +/- 5 mm Hg during DOCA therapy alone (p less than 0.0005). This hypotensive effect of FMI or HEI was noted after the fourth week of treatment and persisted through the ninth week. The rats tolerated the medication well and had no signs of riboflavin deficiency. DOCA administration alone resulted in a 24% increase in iliopsoas muscle Na+ concentration (p less than 0.0005), and a 0.8% increase in the water content of the muscle (p less than 0.025), suggesting a positive Na+ balance. Administration of FMI or HEI blunted the ability of DOCA to increase muscle Na+ concentration (p less than 0.025), water content (p less than 0.01). HEI treatment of the Kyoto strain of spontaneously hypertensive rats (SHR) did not lower their mean SBP. Thus it appears that the hypotensive actions of FMI or HEI are closely associated with their ability to modify the effects of mineralocorticoids on NA+ balance.

Animals↗

PubMed2007

Determinants of walking function after stroke: differences by deficit severity.

OBJECTIVES: To investigate the relationship of cardiovascular fitness (Vo(2)peak), neurologic deficits in balance and leg strength, and body composition to ambulatory function after stroke and to determine whether these relationships differ between those with milder versus more severe gait deficits. DESIGN: Cross-sectional correlation study. SETTING: Outpatient clinic of an academic medical center. PARTICIPANTS: Seventy-four people (43 men, 31 women; mean age +/- standard deviation, 64+/-10y) with chronic hemiparetic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thirty-foot (9.1-m) walk velocity, 6-minute walk distance, Vo(2)peak, Berg Balance Scale score, bilateral quadriceps eccentric torque, total and regional lean mass, and percentage of fat mass. RESULTS: Short-distance walking correlated significantly with cardiovascular fitness, balance, paretic leg strength, nonparetic leg strength, percentage of body fat, and paretic lean mass but not with nonparetic lean mass. Long-distance walking correlated significantly with cardiovascular fitness, balance, paretic leg strength, nonparetic leg strength, and paretic lean mass but not with percentage of body fat or nonparetic lean mass. Stepwise regression showed that cardiovascular fitness, balance, and paretic leg strength were independently associated with long-distance walking (r(2)=.60, P<.001). Variance in long-distance walking was largely explained by balance for those who walked more slowly (<.48m/s) for short distances (r(2)=.42, P<.001) and by cardiovascular fitness for those who walked more quickly (>.48m/s) for short distances (r(2)=.26, P=.003). CONCLUSIONS: Short-distance walking after stroke is related to balance, cardiovascular fitness, and paretic leg strength. Long-distance walking ability differs by gait deficit severity, with balance more important in those who walk more slowly and cardiovascular fitness playing a greater role in those who walk more quickly. Improved understanding of the factors that predict ambulatory function may assist the design of individualized rehabilitation strategies across the spectrum of gait deficit severity in those with hemiparetic stroke.

Adult↗

PubMedDate not supplied

Interference resolution in the elderly: evidence suggestive of differences in strategy on measures of prepotent inhibition and dual task processing.

The ability to effectively resolve interference was investigated in young and elderly participants using a test of inhibition and a dual task measure. The tasks stressed the ability to suppress prepotent responding, and balance primary and secondary task demands, respectively. Successful performance on both measures hinged on the ability to minimize the distraction generated between competing aspects of each task. Increasing demands resulted in performance decrements despite titration for individual differences in span size and generalized slowing. These were more pronounced on the hardest condition of each task, especially in older participants. Furthermore, the nature of the decrements suggested the use of different strategies between groups. It is argued that a fundamental source of the age-associated variability in cognition is due to compromised ability to effectively resolve interference, and cannot be sufficiently explained by memory span differences or generalized slowing.

Adult↗

PubMed2001

Relationship of motor and cognitive abilities to functional performance in stroke rehabilitation.

This study explored the relationships between the motor and cognitive abilities, and the functional performance of patients with stroke. Motor and cognitive abilities were measured by the Fugl-Meyer Assessment (FMA) and the Neurobehavioural Cognitive Status Examination (NCSE), and functional performance was measured by the Functional Independence Measure (FIM). All assessments were conducted at admission, after 2 and 4 weeks, and at discharge. A total of 37 patients with first stroke at mean age 62.3 years (SD=5.4) participated in the study. Results indicated that the lower extremity and balance scores on the FMA were highly correlated with the FIM (motor subscale) on all occasions (r = 0.65--0.92), whereas upper extremity and hand scores on the FMA were moderately correlated (r = 0.53--0.73). Cognitive abilities such as judgement, comprehension and repetition had moderate positive relationships with functional performance (r = 0.35--0.62). Consistent with previous studies, motor functional performance at discharge was best predicted by balance and judgement abilities at admission, or lower extremity abilities and balance at 2-weeks, or lower extremity and repetition abilities at 4-weeks. At admission, lower extremity and cognitive abilities were found to be the best predictors of patients' length of stay. The results from this study substantiated the fact that motor impairment, including balance and lower limb ability, strongly accounts for functional recovery in the rehabilitation of patients with stroke staying in hospital. This study provided good data for rehabilitation professionals on monitoring neurological recovery, especially balance and lower extremity abilities, to enhance the functional recovery of patients after stroke. More intensive intervention in these aspects should be provided to patients to promote more efficient functional regain and shortening of the length of stay.

Activities of Daily Living↗

PubMed1997

Balance retraining after stroke using force platform biofeedback.

Balance is a somewhat ambiguous term used to describe the ability to maintain or move within a weight-bearing posture without falling. Balance can further be broken down into three aspects: steadiness, symmetry, and dynamic stability. Steadiness refers to the ability to maintain a given posture with minimal extraneous movement (sway). The term symmetry is used to describe equal weight distribution between the weight-bearing components (eg, the feet in a standing position, the buttocks in a sitting position), and dynamic stability is the ability to move within a given posture without loss of balance. All of these components of balance (steadiness, symmetry, and dynamic stability) have been found to be disturbed following stroke. Balance testing of patients with hemiparesis secondary to stroke has revealed a greater amount of postural sway during static stance, asymmetry with greater weight on the nonparetic leg, and a decreased ability to move within a weight-bearing posture without loss of balance. Furthermore, research has demonstrated moderate relationships between balance function and gait speed (r = -.67 and .42, respectively), independence (r = .62), appearance (defined as "significantly abnormal," "slightly abnormal," and "nearly normal") (r = .50), dressing (r.55-.69), wheelchair mobility (r = .51), and reaching (r = .49-.78). Thus, a principal construct within physical therapy practice is the reestablishment of balance function in patients following stroke. Recent advances in technology have resulted in the commercial availability of numerous force platform systems for the retraining of balance function in patient populations, including patients with stroke. These systems are designed to provide visual or auditory biofeedback to patients regarding the locus of their center of force (COF) or center of pressure (COP), as well as training protocols to enhance stance symmetry, steadiness, and dynamic stability. Typical force platform biofeedback systems consist of at least two force plates to allow the weight on each foot to be determined, a computer and monitor to allow visualization of the COF or COP, and software that provides training protocols and data analysis capabilities. Some units allow auditory feedback in addition to the visual feedback in response to errors in performance.

Biofeedback, Psychology↗

PubMed2002

[Physical training as treatment of reduced functional ability in frail 75+ year-olds living at home. A randomized intervention study in general practice with technological assessment elements].

INTRODUCTION: The aim of this study was to establish the value of physical training as a treatment of reduced physical ability in frail, elderly patients living at home. MATERIAL AND METHODS: 46 community-dwelling frail elderly patients (> 74 years) participated in a randomised, controlled intervention study. The intervention group was transported to training, whilst the control group was not activated. All had their physical functional ability determined using SF-36, Berg's Balance Scale, 10 m walking test and muscle strength test. RESULTS: The intervention group had a significant improvement in functional ability measured by means of Berg's Balance Scale, walking test, muscle strength test and SF-36 (p < 0.01) compared with the control group. The average cost per patient was estimated at 121 DKK per training session, equivalent to 1452 DKK for a 12-week training period. DISCUSSION: The establishing of a "multi-component-training" as a treatment offer, to which general practitioners could refer their patients, would involve some costs, but savings due to reduced nursing care can be expected.

Activities of Daily Living↗

PubMed2006

Single leg balance test to identify risk of ankle sprains.

BACKGROUND: Ankle sprains are a common and potentially disabling injury. Successful prediction of susceptibility to ankle sprain injury with a simple test could allow ankle sprain prevention protocols to be initiated and help prevent disability in the athletic population. OBJECTIVE: To investigate the ability of the single leg balance (SLB) test, carried out at preseason physical examination, to predict an ankle sprain during the autumn sports season. DESIGN: Prospective cohort study SETTING: High school varsity athletics and intercollegiate athletics. MAIN OUTCOME MEASURE: Ankle sprains in athletes with positive SLB tests. RESULTS: The association between a positive SLB test and future ankle sprains was significant. Controlling for confounding variables, the relative risk for an ankle sprain with a positive SLB test was 2.54 (95% confidence interval, 1.02 to 6.03). Athletes with a positive SLB test who did not tape their ankles had an increased likelihood of developing ankle sprains. The relative risk for ankle sprain for a positive SLB test and negative taping was 8.82 (1.07 to 72.70). A history of previous ankle injury was not associated with future ankle sprains in this study. The kappa value for interrater reliability for the SLB test was 0.898 (p<0.001). CONCLUSIONS: An association was demonstrated between a positive SLB test and ankle sprain. In athletes with a positive SLB test, not taping the ankle imposed an increased risk of sprain. The SLB test is a reliable and valid test for predicting ankle sprains.

Adolescent↗

PubMed2000

Energy metabolism and obesity.

Over the long-term, most adult humans are able to maintain body energy stores through the process of energy balance, which regulates how much energy is consumed to match how much energy is expended. Energy expenditure is required for resting metabolic rate to maintain basic physiologic functions (e.g., heart beat, muscle function, respiration) and metabolize, digest, and store food that is consumed as well as for physical activity. Resting metabolic rate is the largest component of daily energy expenditure, and physical activity-related energy expenditure is the most variable. Cross-sectional studies in children and adults have shown that energy expenditure, including physical activity-related energy expenditure, are similar in lean versus obese subjects, especially after controlling for differences in body composition. A major limitation for most studies that have examined the role of energy expenditure in the cause of obesity is their cross-sectional design. Some longitudinal studies support the idea that reduced energy expenditure is a risk factor for the development of obesity, but most do not. There are several possibilities that could account for such discrepant findings. First, the ambiguous findings in the literature might be explained by the possibility that differences in energy expenditure and physical activity and their impact on the development of obesity are different at the various stages of maturation. Second, there could be individual differences in the impact of altered energy expenditure on the regulation of energy balance. The impact of energy expenditure on the cause of obesity could vary among different subgroups of the population (e.g., boys versus girls and different ethnic groups) and could have a differential effect within individuals at different stages of development. A specific example is the lower energy expenditure in Pima Indians, which predisposes to increased risk of obesity. It remains to be seen whether the lower metabolic rates that have been observed in African-Americans will relate to subsequent weight gain. It is conceivable that susceptible individuals fail to compensate for periodic fluctuations in energy expenditure. Third, given that obesity can arise as a result of a small energy balance over time, it is unlikely that existing techniques are capable of measuring such small differences. Finally, it can be argued that a focus on energy metabolism as a possible explanation of obesity is unlikely to yield interesting information because of the wide range in energy expenditure in the population even after adjusting for body composition. The major dependent variable that needs to be examined in relation to the cause of obesity is not energy expenditure but change in energy balance over time and the ability to regulate body energy stores. Given that the sudden change in obesity prevalence has occurred during a time of rapid environmental and cultural changes, additional focus on the behavioral and environmental effects on regulation of energy balance is warranted.

Adult↗

PubMed2001

The balance of the autonomic nervous system is normal in colicky infants.

UNLABELLED: Excessively crying, hard-to-soothe infants are described as colicky. The self-limiting course of infantile colic during early infancy suggests an etiology of transient developmental dysmaturation. It has been proposed that emotional characteristics such as temperament and self-soothing ability are correlated with the balance of the autonomic nervous system. Heart rate variability (HRV) analysis was used for evaluating the balance of the autonomic nervous system in colicky and control infants during and after the colicky period. HRV analysis was carried out on 12 colicky infants and 14 control infants at the age of 2 mo, and repeated on 10 colicky and 11 normal infants at the age of 7 mo. Measurements were performed during polygraphically confirmed slow-wave sleep (sleep stages 3 and 4). Three HRV frequency bands were defined, including a high (0.2-1.0 Hz), middle (0.12-0.2 Hz) and low (0.025-0.12 Hz) frequency variability. There were no differences between the study groups in any of the three HRV frequency bands analyzed. The high frequency variability increased significantly with age in both study groups (p = 0.009). CONCLUSION: The findings suggest that imbalance between the parasympathetic and the sympathetic nervous system is not associated with infantile colic and that, in accordance with previous findings, control of HRV shifts in a parasympathetic direction with increasing age during the first year of life.

Autonomic Nervous System↗

PubMed2004

Relationship between loss of pedal sensibility, balance, and falls in patients with peripheral neuropathy.

: The purpose of this study was to describe the relationship between balance and foot sensibility in a population of patients with impaired lower extremity sensation. The hypothesis was that increasing impairment of sensation correlates with impaired balance. To date, no report has investigated the relationship between loss of balance with the degree of sensibility in the foot in a population with neuropathy. Ten control subjects and 35 patients with sensory abnormalities and balance problems related to a neuropathy were evaluated. The MatScan Measurement System was used to measure their ability to stand still, maintaining their balance with their eyes open and then with their eyes shut. The degree to which the person moves while attempting to stand still is defined as "sway," which was recorded for normal and neuropathy patients. Sensibility of the foot was measured with the Pressure-Specified Sensory Device, which is noninvasive and nonpainful. The 1- and 2-point static touch thresholds are measured for the pulp of the big toe, medial heel, and the dorsum of the foot. Loss of 2- or 1-point sensation was recorded as sensibility score and compared with controls. Statistical analysis of data and their comparisons for the 2 groups was completed. There were 55% females in control and 64% in neuropathy patients, whereas average age was 50 and 62 years, respectively. Neuropathy was the result of diabetes in 64.5%, hypothyroidism in 19.3%, their combination in 13%, and of unknown etiology in the remaining 19% of patients. Controls had significantly lower mean sway than neuropathy patients (22.9 +/- 9% vs. 189.5 +/- 180%, P = 0.006). Likewise, sensibility score for normal and neuropathy patients was also significantly different (31.4 +/- 9% vs. 232.8 +/- 59%, P <0.0001). When compared with the controls, 99% upper limit of confidence, sensibility in the neuropathy group at the hallux pulp was abnormal at a level consistent with axonal loss in 52% and was completely absent in the remaining 48%. Similarly, at the heel, sensibility was normal in 6.5%, abnormal at a level consistent with axonal loss in 71%, and absent in the remaining 22.5%. The correlation coefficient between sway and sensibility score was 0.36. The results of this investigation for the first time document the intuitive relationship between increasing loss of foot sensibility and increasing loss of balance. These measurements can now be used prospectively to evaluate whether restoration of sensation to patients with neuropathy, through peripheral nerve decompression, can improve balance and reduce falls/fractures in this patient population.

Accidental Falls↗

PubMedDate not supplied

Walking ability in spina bifida patients: a model for predicting future ambulatory status based on sitting balance and motor level.

Two-hundred six patients with spina bifida were followed from birth to an average age of 115 months. We characterized the population in terms of factors which we expected to affect walking ability. Two independent predictors of community ambulation were identified through regression analysis: sitting balance and motor level. We used these variables to develop a mathematical method to predict which groups were likely to be independent walkers into adolescence. When we tested this equation against our actual population, we correctly characterized walkers as such in 92% of the cases. Furthermore, when we applied this equation to another random population taken from our clinic, we successfully characterized walkers in 92% of the cases. The strength of these observations allows us to provide guidelines to parents about the likelihood of their children being able to walk independently as adolescents on the basis of motor level and sitting balance, which can be assessed at an early age.

Adolescent↗

PubMed2005

Differential freshwater adaptation in juvenile sea-bass Dicentrarchus labrax: involvement of gills and urinary system.

The effects of long-term freshwater acclimatization were investigated in juvenile sea-bass Dicentrarchus labrax to determine whether all sea-bass juveniles are able to live in freshwater and to investigate the physiological basis of a successful adaptation to freshwater. This study particularly focused on the ability of sea-bass to maintain their hydromineral balance in freshwater and on their ion (re)absorbing abilities through the gills and kidneys. Two different responses were recorded after a long-term freshwater acclimatization. (1) Successfully adapted sea-bass displayed standard behavior; their blood osmolality was maintained almost constant after the freshwater challenge, attesting to their efficient hyperosmoregulation. Their branchial and renal Na+/K+-ATPase abundance and activity were high compared to seawater fish due to a high number of branchial ionocytes and to the involvement of the urinary system in active ion reabsorption, producing hypotonic urine. (2) Sea-bass that had not successfully adapted to freshwater were recognized by abnormal schooling behavior. Their blood osmolality was low (30% lower than in the successfully adapted sea-bass), which is a sign of acute osmoregulatory failure. High branchial Na+/K+-ATPase abundance and activity compared to successfully adapted fish were coupled to a proliferation of gill chloride cells, whose ultrastructure did not display pathological signs. The large surface used by the gill chloride cells might negatively interfere with respiratory gas exchanges. In their urinary system, enzyme abundance and activity were low, in accordance with the observed lower density of the kidney tubules. Urine was isotonic to blood in unsuccessfully adapted fish, ruling out any participation of the kidney in hyperosmoregulation. The kidney failure seems to generate a compensatory ion absorption through increased gill activity, but net ion loss through urine seems higher than ion absorption by the gills, leading to lower hyper-osmoregulatory performance and to death.

Adaptation, Physiological↗

PubMed1985

Effect of different growth hormone-releasing factors on the concentrations of growth hormone, insulin and metabolites in the plasma of sheep maintained in positive and negative energy balance.

Three experiments were conducted to compare the ability of different preparations of growth hormone-releasing factor (GRF) to stimulate GH secretion in sheep maintained in positive and negative energy balance. In experiment 1 five sheep were injected (i.v.) with three preparations of human pancreatic GRF (hpGRF-44, hpGRF-40, hpGRF-29-NH2) and one preparation of rat hypothalamic GRF (rhGRF-29-NH2) all at 98.0 pmol/kg, or control vehicle, in a Latin square design when the animals either had free access to food or were fed half their maintenance requirements. Analysis of plasma samples, obtained before and for 150 min after injection, revealed that the reduced food intake resulted in the expected changes in body weight and circulating GH, insulin, glucose, urea and non-esterified fatty acids. The maximum post-injection concentrations of GH did not differ between either the two levels of feeding or the four GRF preparations but the mean post-injection concentration of GH was significantly higher for all GRF treatments on the restricted ration (P less than 0.001). The mean post-injection response to rhGRF-29-NH2 was less than that obtained with hpGRF-44 for sheep with food available ad libitum (P less than 0.05) and was clearly more persistent for all GRF treatments in animals fed the reduced diet (P less than 0.001). In experiment 2 the same five sheep were injected i.v. with rhGRF-29-NH2 (98.0 pmol/kg) when they had free access to food and after food had been withdrawn for 3 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1999

Coimpairments: strength and balance as predictors of severe walking disability.

BACKGROUND: Little information is available on the joint effects of multiple impairments (coimpairments) on the risk of disability. Our aim was to study the joint effects of strength and balance impairments on severe walking disability. METHODS: The data are from the baseline of the Women's Health and Aging Study (WHAS), a study of moderately to severely disabled women. A total of 1,002 women aged 65 and older participated in the tests, which took place in their homes. Severe walking disability was defined as self-reported inability to walk one-quarter mile and customary walking speed in a 4-meter test of < or =0.4 m/s. Balance was measured as an ability to hold progressively more difficult stands (feet side-by-side, semitandem and tandem stands). Maximal knee extension strength was measured using a hand-held dynamometer. RESULTS: There were 129 women who were severely walking disabled but able to walk at least minimally. In logistic regression analysis, balance and knee extension strength were independent predictors of severe walking disability. To study the combined effects, nine groups were formed on the basis of strength tertiles by balance categories in the entire population. In the best balance category, the crude prevalences of severe walking disability were 1.2%, 4.9%, and 14.3% in the highest to lowest strength tertiles. In the middle balance category, the rates were 2.9%, 10.0%, and 45.4.1%, and in the poorest balance category 4.9%, 22.1%, and 42.6%, correspondingly. The age, body weight, and height-adjusted odds ratios (OR) showed that the risk of severe walking disability in the subgroup with best balance and strength was less than 5% of the risk in the subgroup with poorest balance and strength (OR .034, 95% confidence interval [CI] .007-.166). Correspondingly, in the subgroups with poorest strength and best balance (OR .097, 95% CI .025-.38) or poorest balance and best strength (OR .102, 95% CI .012-.866) the risk was about 10%. The age-specific estimates of prevalence of severe walking disability in women were: 2.0% for ages 65-74 years, 3.4% for ages 75-84 years, and 9.1% for ages 85 years and older. CONCLUSIONS: The burden of coimpairments seems to be greater than the sum of single impairments involved. An effective way to reduce severe disabilities could be prevention of coimpairments.

Age Factors↗

PubMed1985

The effects of dietary minerals and electrolytes on the growth and physiology of the young chick.

The effects of the mineral elements, calcium and available phosphorus (aP), and the electrolytes, sodium, potassium and chloride in the diet on the growth and physiology of male broiler-type chickens were investigated. The concepts of total dietary cation-anion and electrolyte (Na + K - Cl, meq/kg) balance were compared for their ability to describe observed growth and various parameters to 42 d of age. There were 12 dietary treatments; each was given to four replicates of 32 birds housed in a deep-litter, environmentally controlled shed. Diets were nutritionally adequate and were based on practical ingredients. Total cation-anion balance was varied from 327 to 700 meq/kg and electrolyte balance, from -29 to 553 meq/kg. Results showed that total dietary cation-anion balance did not describe the growth of chickens as well as electrolyte balance. Low (less than 180 meq/kg) or high (greater than 300 meq/kg) electrolyte balance in a diet led to depressed liveweight at 42 d of age. There was an optimum electrolyte balance from 250 to 300 meq/kg. The extent of liveweight depression from feeding diets with an electrolyte balance greater than 300 meq/kg depended on the type of cation added to the diet (Na or K): the range of the Na:K ratio for optimum growth was 0.5-1.8. Acid-base balance was influenced mainly by a diet with a low electrolyte balance (-29 meq/kg). Plasma ion levels (Ca, inorganic P, Mg, Na, K, Cl) were unaffected by dietary treatment, except that high dietary calcium reduced plasma inorganic P levels. Increasing calcium from 1.30 to 1.74% reduced liveweight at 42 d of age by 5%, but subsequent increases up to 2.30% Ca had relatively minor effects. Liveweight tended to be lower for birds fed a diet containing 1.30% Ca and 0.81% aP compared to 0.45% aP with 1.30% Ca. Total cation-anion balance cannot be used in preference to dietary electrolyte balance to describe growth of broiler chickens. However, even though there was a good relationship between growth and dietary electrolyte balance, there were specific cation effects (Na and K) independent of electrolyte balance.

Acid-Base Equilibrium↗

PubMedDate not supplied

Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities.

BACKGROUND: While the fear of falling is a common psychological consequence of falling, older adults who have not fallen also frequently report this fear. Fear of falling can lead to activity restriction that is self-imposed rather than due to actual physical impairments. Evidence suggests that exercise can significantly improve balance confidence, as measured by falls-related self-efficacy scales. However, there are no prospective reports that correlate change in balance confidence with changes in fall risk and physical abilities as induced by participating in a group-based exercise program. OBJECTIVE: The primary purpose of this prospective study was to examine the relationship between the change in balance confidence and the changes in fall risk and physical abilities in older women with confirmed low bone mass after 13 weeks of exercise participation. The secondary purpose of this study was to examine the relationship between the change in balance confidence and the change in physical activity level. METHODS: The sample comprised 98 women aged 75-85 years with low bone mass. Participants were randomly assigned to one of three groups: resistance training (n = 32), agility training (n = 34), and stretching (sham) exercises (n = 32). The 50-min exercise classes for each study arm were held twice weekly at a local YMCA community centre. RESULTS: Both resistance training and agility training significantly improved balance confidence by 6% from baseline after 13 weeks. However, the change in balance confidence was only weakly correlated with improved general physical function and not significantly correlated with the changes in fall risk score, postural stability, gait speed, or physical activity level. As well, we observed balance confidence enhancement in the presence of increased fall risk or deterioration in physical abilities. CONCLUSIONS: Two different types of exercise training improved balance confidence in older women with low bone mass. This change in balance confidence was significantly correlated with change in general physical function. Because of the observation of discordance between balance confidence change and changes in fall risk and physical abilities, those who design group-based exercise programs for community-dwelling older adults may wish to consider including an education component on factors that influence fear of falling. Objective changes in fall risk factors cannot be assumed to mirror change in fear of falling and physical abilities in older adults in the short-term.

Accidental Falls↗

PubMed2001

Lower extremity prosthetic mobility: a comparison of 3 self-report scales.

OBJECTIVE: To assess and compare the reliability and validity of the Houghton Scale, the Prosthetic Profile of the Amputee Locomotor Capabilities Index (PPA-LCI), and the Prosthetic Evaluation Questionnaire (PEQ) mobility subscale, 3 disease-specific self-report measures of functional mobility for lower extremity prosthetic mobility. DESIGN: Four-week test-retest: 1 sample for reliability analyses, 1 sample for validity analyses. SETTING: University-affiliated outpatient amputee clinic, in Ontario, Canada. PARTICIPANTS: Two outpatient amputee samples (sample 1 [n = 55], for reliability analysis; sample 2 [n = 329], for validity analysis). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Test-retest of reliability and convergent validity of the 3 scales. Convergent validity and discriminative ability were also assessed after setting a priori hypotheses for 2 scales of walking performance, balance confidence, and other indicators of ambulatory ability. RESULTS: The reliability of the PPA-LCI (intraclass correlation coefficient [ICC] = .88) was slightly higher than the Houghton Scale (ICC = .85) and the PEQ mobility subscale (ICC = .77). The PPA-LCI was prone to high ceiling effects (40%) that would limit its ability to detect improvement. Evidence for convergent validity, when compared with the 2-Minute Walk Test, Timed Up and Go, and the Activity-Specific Balance Confidence Scale, was supported as hypothesized in all the scales. Each of the scales was able to discriminate between different groups for amputation cause, walking distance, mobility device use, and automatism, with each having varying strength related to relative precision. The Houghton Scale was the only scale able to distinguish between amputation levels. CONCLUSIONS: Reliability and validity of all the scales are acceptable for group level comparison. None of the scales had clearly superior psychometric properties compared with the others. Further research is required to assess responsiveness.

Artificial Limbs↗