Relationship between the Romberg Test and the Wii Basic Balance Test and Cognition in Athletes with Concussion

Background: Approximately 30% of individuals with a sport-related concussion present with postural instability. Multiple clinical balance tests exist to diagnose postural instability; yet little is known about the potential relationship between these type of postural assessments and cognition post-concussion. Aim: The purpose of the current study was to assess the relationship between the Romberg test, the Wii Fit basic balance test (WBBT), and the composite scores on the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test in a sample of athletes with concussions. Methods: 55 post-concussed athletes (40 male) completed the Romberg Test (RT) (−/+), the WBBT, and ImPACT test. Wii Fit basic balance test performance was operationalized as the number of successfully completed trials (of 5 trials of increasing difficulty) within 30 seconds. Pearson’s and point-biserial correlations examined univariate associations among the variables. Results: The RT and WBBT were not significantly related (r = −0.029, p = 0.832). The RT weakly correlated with ImPACT impairment scores (r= 0.26, p= 0.041), whereas WBBT the number of trials did not (r = − 0.20, p = 0.155). Romberg Test scores were significantly correlated with ImPACT Visual Processing Speed Score (r = 0.27, p = 0.036) and Reaction Time score (r = 0.34, p = 0.006). In contrast, WBBT trials were significantly correlated with the ImPACT Visual Memory Score (r = − 0.41, p = 0.003). Conclusions: These results suggest that the WBBT and RT assess unique aspects of postural control. The RT may relate directly to single sensory cognitive and motor processing, while the WBBT may relate to multi-sensory visually driven cognitive and motor processing. Relevance for patients: Clinical balance tests could point to different cognitive impairments post-concussion

Validating the Adidas miCoach for estimating pace, distance, and energy expenditure during outdoor over-ground exercise accelerometer

The Adidas miCoach was developed as a personal training system to estimate pace, distance and energy expenditure (EE) but has yet to be validated. PURPOSE: To validate the Adidas miCoach for estimating pace (min/km), distance (km) and EE (kcal/min) during outdoor over-ground walking and running for two different sensor configurations. METHODS: Six male and 8 female moderately endurance trained participants (mean ± SD age: 28.2 ± 8.5 y; height: 167.4 ± 7.8 cm; mass: 60.9 ± 11.1 kg; VO2max: 54.4 ± 5.5 mL/kg/min) completed this validation study. The protocol consisted of walking at 53.6, 80.4, and 107.2 m/min and running at 134.0, 160.8, 187.6, and 214.0 m/min on an outdoor track while wearing a portable metabolic measurement unit (Cosmed K4b2). A miCoach sensor was attached to the right shoelaces (Laces) and a second miCoach sensor was inserted in the right insole of the shoe (Midsole). Estimated pace, distance and EE were compared to values determined by criterion methods (Actual). Data were analyzed using a repeated-measure ANOVA (pace, distance) or ANCOVA (EE) to evaluate significant differences. RESULTS: A significant main effect (P \u3c 0.035) was observed for speed indicating an increase in measured values at each subsequent speed for pace, distance, and EE. For pace at all speeds, the laces and midsole miCoach estimated pace were significantly different from each other (P \u3c 0.01), and from actual pace (P \u3c 0.02). For distance, the laces and midsole miCoach estimates were similar for all speeds; however, significant differences were observed for the midsole at 53.6 m/min (P = 0.003) and for both laces and midsole at 80.4 and 107.2 m/min (P ≤ 0.05) compared to actual distance. For walking speeds, miCoach estimated EE was significantly different between laces and midsole (P \u3c 0.04), and compared to actual EE (P \u3c 0.001); however, midsole at 160.8 m/min (P = 0.035) and both laces and midsole at 187.6 and 214.4 m/min (P \u3c 0.01) were significantly different from actual EE. CONCLUSION: These data indicate that the Adidas miCoach is accurate for estimating distance. However, it lacks the ability to accurately estimate pace and EE across a range of walking and running speeds. Additionally, it appears that the laces configuration produced more accurate estimates than the midsole

Examining the antecedents of challenge and threat states: The influence of perceived required effort and support availability

To date, limited research has explicitly examined the antecedents of challenge and threat states proposed by the biopsychosocial model. Thus, the aim of the present study was to examine the influence of perceived required effort and support availability on demand/resource evaluations, challenge and threat states, and motor performance. A 2 (required effort; high, low) � 2 (support availability; available, not available) between-subjects design was used with one hundred and twenty participants randomly assigned to one of four experimental conditions. Participants received instructions designed to manipulate perceptions of required effort and support availability before demand/resource evaluations and cardiovascular responses were assessed. Participants then performed the novel motor task (laparoscopic surgery) while performance was recorded. Participants in the low perceived required effort condition evaluated the task as more of a challenge (i.e., resources outweighed demands), exhibited a cardiovascular response more indicative of a challenge state (i.e., higher cardiac output and lower total peripheral resistance), and performed the task better (i.e., quicker completion time) than those in the high perceived required effort condition. However, perceptions of support availability had no significant impact on participants' demand/resource evaluations, cardiovascular responses, or performance. Furthermore, there was no significant interaction effect between perceptions of required effort and support availability. The findings suggest that interventions aimed at promoting a challenge state should include instructions that help individuals perceive that the task is not difficult and requires little physical and mental effort to perform effectively

Access to primary care for socio-economically disadvantaged older people in rural areas: exploring realist theory using structural equation modelling in a linked dataset

Background: Realist approaches seek to answer questions such as ‘how?’, ‘why?’, ‘for whom?’, ‘in what circumstances?’ and ‘to what extent?’ interventions ‘work’ using context-mechanism-outcome (CMO) configurations. Quantitative methods are not well-established in realist approaches, but structural equation modelling (SEM) may be useful to explore CMO configurations. Our aim was to assess the feasibility and appropriateness of SEM to explore CMO configurations and, if appropriate, make recommendations based on our access to primary care research. Our specific objectives were to map variables from two large population datasets to CMO configurations from our realist review looking at access to primary care, generate latent variables where needed, and use SEM to quantitatively test the CMO configurations. Methods: A linked dataset was created by merging individual patient data from the English Longitudinal Study of Ageing and practice data from the GP Patient Survey. Patients registered in rural practices and who were in the highest deprivation tertile were included. Three latent variables were defined using confirmatory factor analysis. SEM was used to explore the nine full CMOs. All models were estimated using robust maximum likelihoods and accounted for clustering at practice level. Ordinal variables were treated as continuous to ensure convergence. Results: We successfully explored our CMO configurations, but analysis was limited because of data availability. Two hundred seventy-six participants were included. We found a statistically significant direct (context to outcome) or indirect effect (context to outcome via mechanism) for two of nine CMOs. The strongest association was between ‘ease of getting through to the surgery’ and ‘being able to get an appointment’ with an indirect mediated effect through convenience (proportion of the indirect effect of the total was 21%). Healthcare experience was not directly associated with getting an appointment, but there was a statistically significant indirect effect through convenience (53% mediated effect). Model fit indices showed adequate fit. Conclusions: SEM allowed quantification of CMO configurations and could complement other qualitative and quantitative techniques in realist evaluations to support inferences about strengths of relationships. Future research exploring CMO configurations with SEM should aim to collect, preferably continuous, primary data

Patient complexity in quality comparisons for glycemic control: An observational study

<p>Abstract</p> <p>Background</p> <p>Patient complexity is not incorporated into quality of care comparisons for glycemic control. We developed a method to adjust hemoglobin A1c levels for patient characteristics that reflect complexity, and examined the effect of using adjusted A1c values on quality comparisons.</p> <p>Methods</p> <p>This cross-sectional observational study used 1999 national VA (US Department of Veterans Affairs) pharmacy, inpatient and outpatient utilization, and laboratory data on diabetic veterans. We adjusted individual A1c levels for available domains of complexity: age, social support (marital status), comorbid illnesses, and severity of disease (insulin use). We used adjusted A1c values to generate VA medical center level performance measures, and compared medical center ranks using adjusted versus unadjusted A1c levels across several thresholds of A1c (8.0%, 8.5%, 9.0%, and 9.5%).</p> <p>Results</p> <p>The adjustment model had R²= 8.3% with stable parameter estimates on thirty random 50% resamples. Adjustment for patient complexity resulted in the greatest rank differences in the best and worst performing deciles, with similar patterns across all tested thresholds.</p> <p>Conclusion</p> <p>Adjustment for complexity resulted in large differences in identified best and worst performers at all tested thresholds. Current performance measures of glycemic control may not be reliably identifying quality problems, and tying reimbursements to such measures may compromise the care of complex patients.</p

The Cortisol Response to Anticipated Intergroup Interactions Predicts Self-Reported Prejudice

Objectives: While prejudice has often been shown to be rooted in experiences of threat, the biological underpinnings of this threat–prejudice association have received less research attention. The present experiment aims to test whether activations of the hypothalamus-pituitary-adrenal (HPA) axis, due to anticipated interactions with out-group members, predict self-reported prejudice. Moreover, we explore potential moderators of this relationship (i.e., interpersonal similarity; subtle vs. blatant prejudice). Methodology/Principal findings: Participants anticipated an interaction with an out-group member who was similar or dissimilar to the self. To index HPA activation, cortisol responses to this event were measured. Then, subtle and blatant prejudices were measured via questionnaires. Findings indicated that only when people anticipated an interaction with an out-group member who was dissimilar to the self, their cortisol response to this event significantly predicted subtle (r =.50) and blatant (r =.53) prejudice. Conclusions: These findings indicate that prejudicial attitudes are linked to HPA-axis activity. Furthermore, when intergroup interactions are interpreted to be about individuals (and not so much about groups), experienced threat (or its biological substrate) is less likely to relate to prejudice. This conclusion is discussed in terms of recent insights from social neuroscience

Manipulating cardiovascular indices of challenge and threat using resource appraisals

Challenge and threat reflect two distinct psychophysiological approaches to motivated performance situations. Challenge is related to superior performance in a range of tasks compared to threat, thus methods to promote challenge are valuable. In this paper we manipulate challenge and threat cardiovascular reactivity using only resource appraisals, without altering perceived task demands between challenge and threat conditions. Study 1 used a competitive throwing task and Study 2 used a physically demanding climbing task. In both studies challenge task instructions led to challenge cardiovascular reactivity and threat task instructions led to threat cardiovascular reactivity. In Study 1, participants who received challenge instructions performed better than participants who received threat instructions. In Study 2, attendance at the climbing task did not differ across groups. The findings have implications for stress management in terms of focusing on manipulating appraisals of upcoming tasks by promoting self-efficacy and perceived control and focusing on approach goals. Future research could more reliably assess the influence of similar task instructions on performance. © 2014 Elsevier B.V