The effectiveness of a home-based, patient-specific, functional exercise program on patients with inclusion body myositis (IBM)

Previous research has shown exercise to be beneficial in the treatment of myositis-affected patients. However, the potential of functional exercises to improve muscle strength and function in the absence of disease progression markers in patient\u27s with Inclusion Body Myositis (IBM) is not well understood. It is believed that the initial exercise dose and patient specificity is of paramount importance in the successful use of this modality in the routine management and long term treatment of such patients. The objective of this study was to investigate the effects of a home-based, patient-specific functional exercise programme, including aerobic exercise and resistance training, on muscle strength, endurance and function, and the aerobic capacity of the patient. Pre muscle strength and functional assessments, and a maximal aerobic exercise test were conducted on seven IBM patients\u27 prior to a 12-week training period. As part of the patient\u27s routine management, the patients maintained their scheduled visits to the neuromuscular clinic whereby their serum creatine kinase (CK) levels were assessed pre- and post-training intervention. The patients\u27 were gently and selectively overloaded in the early stages of their 12-week exercise program to encourage compliance and gradual adaptation, and to prevent \u27overtraining\u27 early in the program. The exercise program combined upper and lower body resistance training exercises with an aerobic component. It was anticipated that the patients would exercise frequently at low intensities and at volumes that would optimally induce muscular strength and endurance improvements. Integral to the prescription of exercise for this patient group was the patient-specificity of the exercise dose being prescribed and the method of exercise overload. The patient\u27s progress was monitored by fortnightly phone calls; maintenance of the patients scheduled visits to their specialist at the neuromuscular clinic, and a \u27training diary\u27 was given to the patient to fill out daily. At the conclusion of the training intervention period, all parameters of muscle strength and function were reassessed, and the patients undertook follow-up testing of their maximal aerobic capacity. The results show that, a diseased muscle, having undergone exercise training, maintained its strength (knee extension [100.9±10%]) (mean±standard error [SE]), whilst significant improvements (p \u3c 0.05) were observed in otherwise healthy, trained muscles, with hip abduction strength improving by 59.1±31 %, shoulder abduction strength increasing by 66.1±12% and hip flexion strength increasing by 83.7±35%. Functional assessments showed that there was not a statistically significant improvement in the time taken to perform a stair climb and walk 30 metres, and also the amount of paces used during the walk. However, the patient group improved in all functional tasks. Research suggests that muscle strength and function can be improved by resistance training and an aerobic exercise program. However, further research is required to evaluate the effects of a mild, daily, exercise program performed in the patient\u27s home. Exercise guidelines for this clinical population are substantially lacking. However, this study has added to the current depth of knowledge regarding exercise and Inclusion Body Myositis patients\u27. Program adherence, exercise prescription and progression and program monitoring are areas which require further examination in long-term, multi-centre exercise intervention trials. It would appear that an exercise program tailored to the individual is important for the clinical management of the disease

New Teacher Excellence: The Impact of State Policy on Induction Program Implementation

Focusing specifically on state policies on supporting new teachers, it dispels the notion that policy itself is a cure-all. It takes a more expansive view of policy -- including not just legislation and regulations, but also funding, evaluation and program infrastructure -- and concludes that, in the case of teacher induction, while comprehensive state policies may increase the likelihood that intensive induction programs will take root in schools and districts, it is also dependent upon a range of contextual factors, including leadership support, stakeholder commitment and a collective vision. This report has implications for public policies beyond simply those focused on new teachers

Innovative STRoke Interactive Virtual thErapy (STRIVE) online platform for community-dwelling stroke survivors: a randomised controlled trial protocol

Introduction: The STRoke Interactive Virtual thErapy (STRIVE) intervention provides community-dwelling stroke survivors access to individualised, remotely supervised progressive exercise training via an online platform. This trial aims to determine the clinical efficacy of the STRIVE intervention and its effect on brain activity in community-dwelling stroke survivors.Methods and analysis: In a multisite, assessor-blinded randomised controlled trial, 60 stroke survivors >3 months poststroke with mild-to-moderate upper extremity impairment will be recruited and equally randomised by location (Melbourne, Victoria or Launceston, Tasmania) to receive 8 weeks of virtual therapy (VT) at a local exercise training facility or usual care. Participants allocated to VT will perform 3–5 upper limb exercises individualised to their impairment severity and preference, while participants allocated to usual care will be asked to maintain their usual daily activities. The primary outcome measures will be upper limb motor function and impairment, which will be assessed using the Action Research Arm Test and Upper Extremity Fugl-Meyer, respectively. Secondary outcome measures include upper extremity function and spasticity, as measured by the box and block test and Modified AshworthScale, respectively, and task-related changes in bilateral sensorimotor cortex haemodynamics during hand reaching and wrist extension movements as measured by functional near-infrared spectroscopy. Quality of life will be measured using the Euro-Quality of Life-5 Dimension-5 Level Scale, and the Motor Activity Log-28 will be used to measure use of the hemiparetic arm. All measures will be assessed at baseline and immediately postintervention

Energy Expenditure and Cost during Walking after Stroke: A Systematic Review

OBJECTIVES: To systematically review the evidence to determine energy expenditure (EE) in volume of oxygen uptake (V̇O2) (mL/kg/min) and energy cost in oxygen uptake per meter walked (V̇O2/walking speed; mL/kg/m) during walking poststroke and how it compares with healthy controls; and to determine how applicable current exercise prescription guidelines are to stroke survivors. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and CINAHL were searched on October 9, 2014, using search terms related to stroke and EE. Additionally, we screened reference lists of eligible studies. STUDY SELECTION: Two independent reviewers screened titles and abstracts of 2115 identified references. After screening the full text of 144 potentially eligible studies, we included 29 studies (stroke survivors: n=501, healthy controls: n=123), including participants with confirmed stroke and a measure of V̇O2 during walking using breath-by-breath analysis. Studies with (9 studies) and without (20 studies) a healthy control group were included. DATA EXTRACTION: Two reviewers independently extracted data using a standard template, including patient characteristics, outcome data, and study methods. DATA SYNTHESIS: Mean age of stroke survivors was 57 years (range, 40-67y). Poststroke EE was highly variable across studies and could not be pooled because of high heterogeneity. EE during steady-state overground walking at matched speeds was significantly higher in stroke survivors than healthy controls (mean difference in V̇O2, 4.06 mL/kg/min; 95% confidence interval [CI], 2.21-5.91; 1 study; n=26); there was no significant group difference at self-selected speeds. Energy cost during steady-state overground walking was higher in stroke survivors at both self-selected (mean difference, .47 mL/kg/m; 95% CI, .29-.66; 2 studies; n=38) and matched speeds compared with healthy controls (mean difference, .27 mL/kg/m; 95% CI, .03-.51; 1 study; n=26). CONCLUSIONS: Stroke survivors expend more energy during walking than healthy controls. Low-intensity exercise as described in guidelines might be at a moderate intensity level for stroke survivors; there is a need for stroke-specific exercise guidelines

The safety and feasibility of early cardiorespiratory fitness testing after stroke

Background Cardiorespiratory fitness testing is recommended as part of a pre-exercise evaluation to aid the programming of safe, tailored cardiorespiratory fitness training after stroke. But there is limited evidence for its safety and feasibility in people with stroke with varying impairment levels in the early subacute phase of stroke recovery. Objective To assess the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase after stroke. Design A sub-study of a larger single service, multi-site, prospective cohort feasibility study (Cardiac Rehabilitation in Stroke Survivors to Improve Survivorship [CRiSSIS]). Setting Private subacute inpatient rehabilitation facilities. Participants Consecutive admissions of people with ischemic stroke admitted to subacute rehabilitation facilities. Intervention Not applicable. Main Outcome(s) Safety was determined by the occurrence of adverse or serious adverse events. Feasibility was determined by assessing the (1) number of participants recruited and (2) number of participants able to complete the fitness test. Results Between April 2018 and December 2019, a total of 165 people with stroke were screened to participate; 109 were eligible and 65 were recruited. Of the 62 who completed testing, 41 participants were able to complete a submaximal fitness test at a median of 12 days post-stroke. One minor adverse event was recorded. Of the 21 participants unable to complete the fitness test; 4 declined to complete the test, 9 were unable to commence the test, and 8 were unable to complete the first stage of the protocol due to stroke-related impairments. Participants with mild stroke, greater motor and cognitive function, and fewer depressive symptoms were more likely to be able to complete the cardiorespiratory fitness test. Conclusion Cardiorespiratory fitness testing was safe for most people with mild-to-moderately severe ischemic stroke and transient ischemic attack in the early subacute phase, but only two-thirds of the participants could complete the test

Inequality and the American classroom:: Experiential strategies for teaching social justice

Purpose: The purpose of this study is to examine the impact of a mixed format, experiential course on changes in Honors students’ attitudes about various issues of inequality.  Methodology: Students enrolled in the course (N = 75), taught during the 2016 Presidential election, were asked about their opinions on a variety of inequality topics using a pre-test and post-test survey, with the post-test survey including questions on how perceptions of inequality had changed over the course of the semester.  Findings and implications: Results indicate that some students became more self-aware of their position in society and were less sure that people in general, and they themselves in particular, would be responsible for their own hard work. Importantly, students were less likely to believe that people faced fair and equal opportunities in the labor market and their overall level of support for unions increased during the semester. Most students agreed that the outside speakers, a key component of the course, provided new information on various aspects of inequality and impacted their overall perceptions of inequality. However, students were much less agreed on how they felt both about the future of the country and the future of inequality

Toric Ideals of Characteristic Imsets via Quasi-Independence Gluing

Characteristic imsets are 0-1 vectors which correspond to Markov equivalence classes of directed acyclic graphs. The study of their convex hull, named the characteristic imset polytope, has led to new and interesting geometric perspectives on the important problem of causal discovery. In this paper we begin the study of the associated toric ideal. We develop a new generalization of the toric fiber product, which we call a quasi-independence gluing, and show that under certain combinatorial homogeneity conditions, one can iteratively compute a Gr\"obner basis via lifting. For faces of the characteristic imset polytope associated to trees, we apply this technique to compute a Gr\"obner basis for the associated toric ideal. We end with a study of the characteristic ideal of the cycle and propose directions for future work.Comment: 19 pages, 7 figure

Australian Physical Activity Clinical Practice Guideline for people with moderate to severe traumatic brain injury: Technical Report

Background In 2020, the World Health Organization (WHO) released updated physical activity and sedentary behaviour guidelines, which for the first-time included a guideline for people living with disability. The disability guideline is based on evidence from the general population and eight common health conditions causing disability, but did not include people with traumatic brain injury (TBI), nor did it consider the rehabilitation phase of recovery from injury. In 2019, the Australian federal government launched the Traumatic Brain Injury Mission. The Mission was tasked with providing $50 million over 10 years under the Medical Research Future Fund (MRFF) to support research. The goal of the Mission is to better predict recovery outcomes after a TBI, identify the most effective care and treatments, and reduce barriers to support people to live their best possible life after TBI. In 2021, our team was funded through the MRFF TBI Mission to develop an Australian Physical Activity Clinical Practice Guideline for people living with moderate to severe TBI (msTBI). The overarching project to guide the development of the guideline was called BRIDGES (BRain Injury: Developing GuidElineS for physical activities). Objective To develop an Australian clinical practice guideline to support the clinical decision-making of health professionals working with people with msTBI and increase uptake of safe and beneficial physical activity by people living with msTBI. Methods The overarching BRIDGES project was guided by the Exploration Preparation Implementation Sustainment (EPIS) framework. We used a Grading of Recommendations Assessment, Development and Evaluation (GRADE) ADOLOPMENT approach to determine whether to ‘adapt’ or ‘adopt’ the WHO guideline or develop de novo recommendations. We established guideline leadership and development groups, conducted a rapid systematic review to identify direct evidence in TBI, and reviewed guidelines in other relevant health conditions (i.e., stroke, cerebral palsy) to identify indirect evidence. To further inform guideline development and implementation considerations, we conducted an audit of brain injury services in Australia and qualitative consultations with key stakeholders, including people with msTBI. Results Direct evidence for the prescription of physical activity for people with msTBI is limited. The clinical practice guideline developed incorporates 10 de novo evidence-based recommendations with additional good practice points and precautionary practice points to guide clinical decision-making. The physical activity recommended is aerobic exercise, strength training, mobility training, sport and physical recreation, and promotion of physical activity. The physical activity is recommended for children, adolescents, adults, and older adults across the continuum of rehabilitation. Conclusion While there remain evidence gaps that require further research, and further work on how the guideline can be implemented into clinical practice is needed, physical activity interventions tailored to the individual’s goals and needs should be standard clinical practice for health professionals working with people with msTBI in Australian rehabilitation, community, home, and school (for children and adolescents) settings

Exergaming as a viable therapeutic tool to improve static and dynamic balance among older adults and people with idiopathic Parkinson\u27s disease: a systematic review and meta-analysis

The use of virtual reality games (known as "exergaming") as a neurorehabilitation tool is gaining interest. Therefore, we aim to collate evidence for the effects of exergaming on the balance and postural control of older adults and people with idiopathic Parkinson\u27s disease (IPD). Six electronic databases were searched, from inception to April 2015, to identify relevant studies. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were used to calculate effect sizes between experimental and control groups. I (2) statistics were used to determine levels of heterogeneity. 325 older adults and 56 people with IPD who were assessed across 11 -studies. The results showed that exergaming improved static balance (SMD 1.069, 95% CI 0.563-1.576), postural control (SMD 0.826, 95% CI 0.481-1.170), and dynamic balance (SMD -0.808, 95% CI -1.192 to -0.424) in healthy older adults. Two IPD studies showed an improvement in static balance (SMD 0.124, 95% CI -0.581 to 0.828) and postural control (SMD 2.576, 95% CI 1.534-3.599). Our findings suggest that exergaming might be an appropriate therapeutic tool for improving balance and postural control in older adults, but more -large-scale trials are needed to determine if the same is true for people with IPD

Accelerometer use in young people with Down syndrome: A preliminary cross-validation and reliability study

Background Inadequate physical activity is a problem for people with Down syndrome and objective monitoring using accelerometers may be inaccurate in this population. Method This was a cross-validation and reliability study comparing two triaxial accelerometers (the SenseWear and RT3) to a criterion measure (the OxyCon Mobile) in 10 young people (M age = 20 ± 2) with Down syndrome. A ROC curve analysis was conducted to determine intensity thresholds from RT3 activity counts. Results During self-selected pace walking, the accelerometers overestimated energy expenditure and had large limits of agreement (SenseWear: −0.5–3.6 METs; RT3: −0.2–2.7 METs). At this pace, SenseWear armband step counts were highly correlated with observed steps (r = .98) but underestimated steps by up to 12%. We developed RT3 thresholds that demonstrated good to excellent sensitivity and specificity in classifying physical activity intensity. Conclusions SenseWear steps and RT3 activity count thresholds can be used to monitor physical activity in young people with Down syndrome, although energy expenditure estimates should be used with caution in this population