Functional gait rehabilitation in elderly people following a fall-related hip fracture using a treadmill with visual context: design of a randomized controlled trial

Background: Walking requires gait adjustments in order to walk safely in continually changing environments. Gait adaptability is reduced in older adults, and (near) falls, fall-related hip fractures and fear of falling are common in this population. Most falls occur due to inaccurate foot placement relative to environmental hazards, such as obstacles. The C-Mill is an innovative, instrumented treadmill on which visual context (e. g., obstacles) is projected. The C-Mill is well suited to train foot positioning relative to environmental properties while concurrently utilizing the high-intensity practice benefits associated with conventional treadmill training. The present protocol was designed to examine the efficacy of C-Mill gait adaptability treadmill training for improving walking ability and reducing fall incidence and fear of falling relative to conventional treadmill training and usual care. We hypothesize that C-Mill gait adaptability treadmill training and conventional treadmill training result in better walking ability than usual care due to the enhanced training intensity, with superior effects for C-Mill gait adaptability treadmill training on gait adaptability aspects of walking given the concurrent focus on practicing step adjustments. Methods/design: The protocol describes a parallel group, single-blind, superiority randomized controlled trial with pre-tests, post-tests, retention-tests and follow-up. Hundred-twenty-six older adults with a recent fall-related hip fracture will be recruited from inpatient rehabilitation care and allocated to six weeks of C-Mill gait adaptability treadmill training (high-intensity, adaptive stepping), conventional treadmill training (high-intensity, repetitive stepping) or usual care physical therapy using block randomization, with allocation concealment by opaque sequentially numbered envelopes. Only data collectors are blind to group allocation. Study parameters related to walking ability will be assessed as primary outcome pre-training, post-training, after 4 weeks retention and 12 months follow-up. Secondary study parameters are measures related to fall incidence, fear of falling and general health. Discussion: The study will shed light on the relative importance of adaptive versus repetitive stepping and practice intensity for effective intervention programs directed at improving walking ability and reducing fall risk and fear of falling in older adults with a recent fall-related hip fracture, which may help reduce future fall-related health-care costs

An allometric study of lung morphology during development in the Australian pelican, Pelicanus conspicillatus, from embryo to adult

Pelicans produce altricial chicks that develop into some of the largest birds capable of sustained flight. We traced pulmonary morphological development in the Australian pelican, Pelicanus conspicillatus, from third trimester embryos to adults. We described growth and development with allometric relationships between lung components and body mass or lung volume, according to the equation y = ax(b). Pelican lung volume increased faster than body mass (b = 1.07). Relative to lung volume, the airways and vascular spaces increased allometrically (b > 1) in embryos, but isometrically (b ≈ 1) after hatching. Parabronchial mantle volume decreased (b < 1) prior to hatching and increased isometrically thereafter. Surface area of air capillaries, blood capillaries and the blood–gas barrier increased relative to lung volume (b > 0.67) before and after hatching. Barrier thickness decreased before hatching, remained constant in juveniles and decreased by adulthood. The anatomical diffusing capacity significantly increased before hatching (b = 4.44) and after hatching (b = 1.26). Although altricial pelicans developed pulmonary complexity later than precocial turkeys, the volume-specific characteristics were similar. However, lungs of volant adult pelicans became significantly larger, with a greater capacity for gas exchange, than lungs of terrestrial turkeys. Exchange characteristics of growing pelican lungs were inferior to those of adult birds of 26 other species, but converged with them at maturity

MS and me:exploring the impact of multiple sclerosis on perceptions of self

Purpose: The aim of this qualitative study was to explore the impact of multiple sclerosis (MS) on perceptions of self as well as the emotional, social and practical implications of any self-reported changes. Method: Twelve participants were interviewed and interpretative phenomenological analysis used to analyse the data. Participants were recruited from a MS hospital clinic in the north-west of England. Results: Four themes were identified although for reasons of space and novelty three were discussed, (i) ‘my body didn’t belong to me’: the changing relationship to body, (ii) ‘I miss the way I feel about myself’: the changing relationship to self and (iii) ‘let’s just try and live with it’: incorporating yet separating MS from self. Conclusions: The onset of MS was seen to impact upon self yet impact did not necessarily equate with a loss of self but rather a changed self. Self-related changes did, however, carry the potential to impact negatively upon a person’s mood and psychological functioning and consequently, clinicians are encouraged to consider issues relating to self as standard. Implications for Rehabilitation The onset of MS does not automatically bring into question a person’s sense of self. Rather, it is the degree to which symptoms impact upon a person’s ability to fulfil roles integral to their pre-MS self, that appear to have the greatest re-defining impact. Symptoms that threaten perceptions of self are more likely to contribute to emotional problems such as depression and anxiety. Clinicians can support people to maintain a positive sense of self by assessing which symptoms affect them most and, where possible, helping them reconnect with valued interests, roles and activities, albeit in an adapted fashion

Health-related quality of life in clinically isolated syndrome and risk of conversion to multiple sclerosis

BACKGROUND AND OBJECTIVES: A few studies have found that low scores on self-rated health and quality of life measures are associated with following worsening disability in multiple sclerosis (MS). We wanted to estimate the association between self-rated quality of life scores among patients with clinically isolated syndrome (CIS) and the risk of subsequent conversion to definite MS. METHODS: One hundred sixty-two patients from the GERONIMUS cohort with a symptom or sign suggestive of MS and without a definite diagnosis of MS at the time of inclusion were asked to evaluate their health-related quality of life according to MSQoL-54 scale. They were clinically assessed and mood and depression scales were applied. The association between the scores of these scales and the risk of converting to definite MS during a 5-year follow-up was estimated using the Cox- proportional hazard regression model. RESULTS: Quality of life at examination was significantly lower compared to those of an age- and sex-adjusted general Italian population. During the follow-up, 116 patients (72%) converted to definite MS. No significant predictive effects were found for the summary scales of MSQol-54 or other scales. The estimates did not change after adjusting for age, sex, BMI, education, MRI findings, Expanded Disability Status Scale (EDSS) score, and treatment at time of examination. CONCLUSION: Persons with CIS in this cohort reported reduced self-rated quality of life compared to the general population, but variation in these scores was not associated with subsequent conversion from CIS to clinical definite MS