Assessing control of postural stability in community-living older adults using performance-based limits of stability

<p>Abstract</p> <p>Background</p> <p>Balance disability measurements routinely used to identify fall risks in frail populations have limited value in the early detection of postural stability deficits in community-living older adults. The objectives of the study were to 1) measure performance-based limits of stability (LOS) in community-living older adults and compare them to theoretical LOS computed from data proposed by the Balance Master^®system, 2) explore the feasibility of a new measurement approach based on the assessment of postural stability during weight-shifting tasks at performance-based LOS, 3) quantify intra-session performance variability during multiple trials using the performance-based LOS paradigm.</p> <p>Methods</p> <p>Twenty-four healthy community-living older adults (10 men, 14 women) aged between 62 to 85 (mean age ± sd, 71.5 ± 6 yrs) participated in the study. Subjects' performance-based LOS were established by asking them to transfer their body weight as far as possible in three directions (forward, right and left) without changing their base of support. LOS were computed as the maximal excursion of the COP in each direction among three trials. Participants then performed two experimental tasks that consisted in controlling, with the assistance of visual feedback, their centre of pressure (COP) within two predefined targets set at 100% of their performance-based LOS. For each tasks 8 trials were performed. Ground reaction forces and torques during performance-based LOS evaluation and experimental tasks were recorded with a force plate. Sway area and medio-lateral mean COP displacement speed variables were extracted from force plate recordings.</p> <p>Results</p> <p>Significant differences between theoretical LOS computed from maximum leaning angles derived from anthropometric characteristics and performance-based LOS were observed. Results showed that a motor learning effect was present as the participants optimized their weight-shifting strategy through the first three trials of each task using the visual biofeedback provided on their COP. Reliable measures of control of postural stability at performance-based LOS can be obtained after two additional trials after the learning phase (0.69 > ICC > 1.0).</p> <p>Conclusion</p> <p>Establishing performance-based LOS instead of relying on estimations of theoretical LOS offers a more individualized and realistic insight on the true LOS of an individual. Performance-based LOS can be used as targets during weight-shifting postural tasks with real time visual feedback of the COP displacement to assess postural stability of community-living older adults. In order to obtain reliable results, a learning phase allowing subjects to learn how to control their COP displacement is needed.</p

Recommendations for a core outcome set for measuring standing balance in adult populations: a consensus-based approach

Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice.To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults.A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria.The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS.Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations.Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate.The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally

Arabidopsis leucine-rich repeat receptor–like kinase NILR1 is required for induction of innate immunity to parasitic nematodes

Plant-parasitic nematodes are destructive pests causing losses of billions of dollars annually. An effective plant defence against pathogens relies on the recognition of pathogen-associated molecular patterns (PAMPs) by surface-localised receptors leading to the activation of PAMP-triggered immunity (PTI). Extensive studies have been conducted to characterise the role of PTI in various models of plant-pathogen interactions. However, far less is known about the role of PTI in roots in general and in plant-nematode interactions in particular. Here we show that nematode-derived proteinaceous elicitor/s is/are capable of inducing PTI in Arabidopsis in a manner dependent on the common immune co-receptor BAK1. Consistent with the role played by BAK1, we identified a leucine-rich repeat receptor-like kinase, termed NILR1 that is specifically regulated upon infection by nematodes. We show that NILR1 is essential for PTI responses initiated by nematodes and nilr1 loss-of-function mutants are hypersusceptible to a broad category of nematodes. To our knowledge, NILR1 is the first example of an immune receptor that is involved in induction of basal immunity (PTI) in plants or in animals in response to nematodes. Manipulation of NILR1 will provide new options for nematode control in crop plants in future

Sensing of molecular patterns through cell surface immune receptors

In plants, sensing of Pathogen/Microbe-Associated Molecular Patterns (PAMPs/MAMPs) and host-derived Damage-Associated Molecular Patterns (DAMPs) by host cell surface Pattern Recognition Receptors (PRRs) activates Pattern-Triggered Immunity (PTI). The identification of an increasing number of immunogenic patterns and PRRs illustrates that PTI is a universal defence mechanism against pathogens, pests, and parasitic plants, and that evolutionary selective pressure drives diversification of molecular patterns and diversity of PRRs. Further advances unravelled how some prototypical PRRs get activated to initiate metabolic adaptation and defence responses that stop invaders. Deeper insights into the repertoire of PRRs will reveal how plants manage to mount appropriate defence against diverse kinds of invaders and how we can biotechnologically exploit nature's design for sustainable agriculture

The effects of different carrying methods on locomotion stability, gait spatio-temporal parameters and spinal stresses

Manual material handling (MMH) contributes to a large percentage of musculoskeletal disorders. One of its fundamental activities is load carrying that can be accomplished in several strategies, with each one imposing different types of stresses on the musculoskeletal system. Therefore, the first goal of this study was to determine the effect of different carrying methods on walking stability using motion capture analysis. Second, to analyze gait adaptations to stresses associated with load carrying in order to prevent falling. Third, to investigate the effect of these stresses coupled with human body adjustment on the forces at the L5/S1 disc. Thirty participants carried 10 and 30 lbs loads via frontal, lateral, bilateral, and posterior carriages. Frontal and lateral methods generated the most unstable conditions compared to the others. The unstable locomotion forced the gait parameters to be significantly altered in order to maintain stability. Additionally, the postures maintained in these conditions resulted in significantly high compression and shear forces acting at the L5/S1 disc when compared to the other carrying methods. Moreover, heavier weights exacerbated the effect on the dependent variables. Notably, bilateral and posterior carrying methods provided results comparable to the unloaded walking baseline. In conclusion, to reduce the potential risks associated with load carrying, the recommendation to split the load between both hands using bilateral carrying method or carrying it posteriorly should be taken into account while designing MMH activities. •Frontal and lateral carrying method generated the most unstable conditions compared to the others.•The unstable locomotion forced the gait parameters to be significantly altered in order to maintain stability.•Trunk adjustments resulted in significantly high compression and shear forces acting at the L5/S1 disc.•Bilateral and posterior carriages resulted in stable locomotion, and normal gait parameters

Monitoring in the neurocritical care unit

Neuromonitoring is the hallmark of intensive care units in critically ill brain-injured patients. Neurologic examination is fundamental, still, however, not always applicable in patients with altered mental status, language disorders or those who are sedated and/or mechanically ventilated. Therefore, other methods of monitoring are suitable. Older neurologic monitoring techniques including monitoring intracranial pressure, cerebral perfusion pressure, jugular venous oxygenation, transcranial Doppler sonography and continuous electroencephalogram together with newer techniques such as cerebral microdialysis, brain tissue oxygenation and cerebral near-infrared spectroscopy are now more often used in neurointensive care. These methods have important limitations when used as standalone parameters. Multimodal monitoring, a combination of these techniques, may be able to provide more detailed, accurate and timely information regarding a patient’s status. However, few data exist on the many possible combinations of parameters, and some of the newer techniques remain unproven in benefit