Feasibility of trial procedures for a randomised controlled trial of a community based group exercise intervention for falls prevention for visually impaired older people: the VIOLET study

Background Visually impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. The aim was to adapt the existing Falls Management Exercise (FaME) programme for VIOP, delivered in the community, and to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of this adapted intervention. Methods Two-centre randomised mixed methods pilot trial and economic evaluation of the adapted group-based FaME programme for VIOP versus usual care. A one hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle and Glasgow), delivered by third sector (voluntary and community) organisations. Participants were advised to exercise at home for an additional two hours over the week. Those randomised to the usual activities group received no intervention. Outcome measures were completed at baseline, 12 and 24 weeks. The potential primary outcome was the Short Form Falls Efficacy Scale – International (SFES-I). Participants’ adherence was assessed by reviewing attendance records and self-reported compliance to the home exercises. Adherence with the course content (fidelity) by instructors was assessed by a researcher. Adverse events were collected in a weekly phone call. Results Eighteen participants, drawn from community-living VIOP were screened; 68 met the inclusion criteria; 64 participants were randomised with 33 allocated to the intervention and 31 to the usual activities arm. 94% of participants provided data at the 12 week visit and 92% at 24 weeks. Adherence was high. The intervention was found to be safe with 76% attending nine or more classes. Median time for home exercise was 50 min per week. There was little or no evidence that fear of falling, balance and falls risk, physical activity, emotional, attitudinal or quality of life outcomes differed between trial arms at follow-up. Conclusions The intervention, FaME, was implemented successfully for VIOP and all progression criteria for a main trial were met. The lack of difference between groups on fear of falling was unsurprising given it was a pilot study but there may have been other contributory factors including suboptimal exercise dose and apparent low risk of falls in participants. These issues need addressing for a future trial

An investigation of the effects of walking frame height and width on walking stability

Background Walking aids are designed for structural support during walking, however, surprisingly self-reported use of a walking aid (“Yes, I use one.”) has been identified as a risk factor for falling. Adjustment and design of walking aids may affect their usefulness in facilitating a stable walking pattern. We previously identified that increased body weight transfer onto a walking frame (‘device loading’) is associated with increased user stability. Research Question We asked: “Could adjustment of walking frame height to a lower height than clinically recommended serve as a mechanism to facilitate device loading and thereby increase stability? And: “Do ultra-narrow frames have an adverse effect on stability as compared to standard-width frames? Methods Ten older adults that were users of front-wheeled walking frames walked with walking frames of 1)‘standard width, standard height’, 2)‘standard width, low height’, 3)‘narrow width, standard height’. Smart Walker technology was used to record forces acting on the walking frame and inside the user’s shoes, and cameras recorded relative position of the user’s feet in relation to the frame’s feet. Stability of the user-frame system and device loading (percent body weight transferred onto the frame) were calculated. A general linear mixed effects model was used for statistical analysis. Results A lower height setting did not increase device loading and stability, therefore adjusting the height to a lower setting proved to be an unsuccessful mechanism to increase stability. However, device loading was positively correlated with stability for all frame conditions (p<0.05). Finally, stability was reduced when walking with the ultra-narrow, as compared to standard-width, frame (p=0.002). Significance To increase stability in fall-prone users, active encouragement to transfer body weight onto the walking frame is needed. Considering the adverse effects of ultra-narrow frames on stability, such frames should be prescribed and used with caution

Complex communication signals: the case of the Blue-black Grassquit Volatinia jacarina (Aves, Emberizidae) song. Part I - A structural analysis

The song of the Blue-black Grassquit Volatinia jacarina is different for every individual and the structural differences between individuals are quite complex. Samples of songs from different Brazilian localities, as well as from Venezuela and Mexico, were studied through a comparative analysis of their sonograms. From the structural point of view, the results show a song composed of a single note that is compacted in a ''window'' between 2 and 13 kHz and rarely occupying more than half of a second. The note is essentially pure and is repeatedly uttered with a high level of fidelity. A global frequency modulation decreases from the beginning to the end of the song. The main song components are referred to as ''Blocks'' and are of three types: ''Vibrations'' (Buzzes or Vibratos), ''Arabesques'' (complex notes) and ''Isolated Modulations'' (simple syllables). Among other characteristics are double voices, which are quite diverse and probably function as codes for individual recognition. This song is considered a special case where a signature system has been developed to a high level of inter-individual variability.<br>O canto do Tiziu Volatinia jacarina é único para cada indivíduo e as diferenças estruturais entre um e outro indivíduo são muito complexas. Cantos gravados em diversos lugares do Brasil e alguns da Venezuela e do México foram estudados através de uma análise comparativa dos seus sonogramas. Do ponto de vista estrutural, os resultados mostram que o canto é constituído por uma nota única que se encontra compactada numa ''janela'' entre 2 e 13 kHz e raramente ultrapassa meio segundo de duração. A nota, essencialmente pura, é repetida com alto grau de fidelidade entre uma emissão e outra. Constata-se uma modulação de freqüência global descendente do início ao fim do canto. Os principais componentes do canto do Tiziu foram denominados ''Blocos'' e são basicamente de três tipos: as ''Vibrações'' (Buzzes ou Vibratos), os ''Arabescos'' (notas complexas) e as ''Modulações Isoladas'' (sílabas simples). Entre outras características estão as ''duplas vozes'' que mostram ampla diversificação e têm por função servir de códigos para o reconhecimento individual. Consideramos o canto do Tiziu como um caso especial em que um ''sistema de assinatura'' foi desenvolvido a um elevado nível de variabilidade interindividual

Aggressive Signaling in Song Sparrows and Other Songbirds

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