Fall risk in people with MS: A Physiological Profile Assessment study.

INTRODUCTION: The Physiological Profile Assessment (PPA) is used in research and clinical practice for assessing fall risk. We compared PPA test performance between people with multiple sclerosis (MS) and healthy controls, determined the fall-risk profile for people with MS and developed a reference database for people with MS. METHODS: For this study, 416 ambulant people with MS (51.5 ± 12.0 years) and 352 controls (52.8 ± 12.2 years) underwent the PPA (tests of contrast sensitivity, proprioception, quadriceps strength, reaction time and sway) with composite fall-risk scores computed from these measures. MS participants were followed prospectively for falls for 3 months. RESULTS: The MS participants performed significantly worse than controls in each PPA test. The average composite fall-risk score was also significantly elevated, indicating a "marked" fall risk when compared with controls. In total, 155 MS participants (37.3%) reported 2 + falls in the follow-up period. Frequent fallers performed significantly worse than non-frequent fallers in the contrast sensitivity, reaction time and sway tests and had higher PPA composite scores. CONCLUSIONS: In line with poor PPA test performances, falls incidence in people with MS was high. This study provides comprehensive reference data for the PPA measures for people with MS that could be used to inform future research and clinical practice

Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial

Vaughan P Nicholson,1 Justin WL Keogh,2–4 Nancy L Low Choy1 1School of Physiotherapy, Australian Catholic University, Brisbane, QLD, Australia; 2Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia; 3Human Potential Centre, AUT University, Auckland, New Zealand; 4Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, QLD, Australia Purpose: To investigate the influence of a single session of locomotor-based motor imagery training on motor learning and physical performance. Patients and methods: Thirty independent adults aged >65 years took part in the randomized controlled trial. The study was conducted within an exercise science laboratory. Participants were randomly divided into three groups following baseline locomotor testing: motor imagery training, physical training, and control groups. The motor imagery training group completed 20 imagined repetitions of a locomotor task, the physical training group completed 20 physical repetitions of a locomotor task, and the control group spent 25 minutes playing mentally stimulating games on an iPad. Imagined and physical performance times were measured for each training repetition. Gait speed (preferred and fast), timed-up-and-go, gait variability and the time to complete an obstacle course were completed before and after the single training session. Results: Motor learning occurred in both the motor imagery training and physical training groups. Motor imagery training led to refinements in motor planning resulting in imagined movements better matching the physically performed movement at the end of training. Motor imagery and physical training also promoted improvements in some locomotion outcomes as demonstrated by medium to large effect size improvements after training for fast gait speed and timed-up-and-go. There were no training effects on gait variability. Conclusion: A single session of motor imagery training promoted motor learning of locomotion in independent older adults. Motor imagery training of a specific locomotor task also had a positive transfer effect on related physical locomotor performance outcomes. Keywords: mental practice, gait, elderly, rehabilitation, mobility, motor imagery, motor contro

Timed stance performances reflect differences in age, prevalence of comorbidities, medication use, fall history and activity level: Early screening for balance loss is indicated

To determine if 10-second trials of bilateral and one-legged stance measures detected balance loss and influence of known risk factors for falls in women aged 20-80 years. 456 healthy adult women attempted 10-second trials of bilateral stance (firm and foam surfaces) and one-legged stance, with eyes open (EO) and eyes closed (EC). Data for age, co-morbidities, medication use, fall history and activity level were compared for three categories of stability: (i) stable: all trials completed; (ii) unsteady: completed/failed one to two trials; and (iii) failed all trials. Bilateral stance on foam (EC) and one-legged stance (EO) yielded low failure rates for women older than 50 years (up to 15% categorised as unsteady and 6% as unstable). Compared to stable women, the unsteady and unstable women were older (P < 0.001) reported more co-morbidities, using more medications (P < 0.001), more falls (P < 0.05) and less activity (P < 0.05). Women older than 50 years who fail 10-second trials of bilateral stance (foam EC) and one-legged stance (EO) should be referred for education and fall prevention intervention

Positive effects of exercise on falls and fracture risk in osteopenic women

Exercise may affect osteopenic women at risk of falls and fractures. A workstation approach to exercise was evaluated in a randomised study of 98 women. The intervention group improved in measures of balance, strength and bone density. This study supports a preventative exercise approach that aims to reduce risk factors for fractures and falls, in women already at risk, through balance training and weight-bearing activity

Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma

Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10-15), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10-16), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10-14), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10-11), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10-12). We also confirmed significant association at three previously described loci (P < 5 × 10-8 for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG