Balance In Daily Life Research Articles

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol

BackgroundFalling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.MethodsFor this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant’s progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA’s are used to analyze the trial outcomes.DiscussionThe results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.Trial registrationThe trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).

Development and psychometric properties of the Balance in Daily Life (BDL) scale in a population of frail older people

BackgroundBalance disorders in older people cause falls, which can have serious functional and economic consequences. No existing scale relates fall risk to daily life situations. This study describes the development, psychometric properties and construct validity of the Balance in Daily Life (BDL) scale, comprising seven routine tasks including answering a phone, carrying a heavy bag, and sitting down and getting up from a chair. MethodsFrail patients aged 65 years or more were prospectively recruited from the geriatric rehabilitation department of a French university hospital. Inclusion criteria included autonomous walking over 20 m and modified Short Emergency Geriatric Assessment score 8–11. Patients with motor skills disorders and comprehension or major memory difficulties were excluded. Patients were assessed on Day 3 and Day 30 with the Balance in Daily Life scale, Timed Up and Go, one-leg stance time, sternal nudge and walking-while-talking tests. The scale was assessed for acceptability, quality, unidimensionality, internal consistency, reliability, temporal stability, responsiveness and construct validity. Results140 patients (83 ± 6 years) were recruited, of whom 139 were assessed at Day 0 and 133 at Day 30. Acceptability was satisfactory (134/139 patients completed the test), quality assessment showed a slight floor effect (6 % of patients with minimal score) and evaluation of item redundancy found no strong correlation (Spearman <0.7). Unidimensionality was verified (Loevinger H coefficient > 0.5 for all items except item 6 = 0.4728). Internal consistency was good (Cronbach alpha = 0.86). Reliability and temporal stability were excellent (ICC = 0.97 and ICC = 0.92). Responsiveness was verified by significant score change p < 0.0001 between Day 0 and Day 30 (decreased by 1 [0; 2] point), in line with other score changes. Construct validity revealed that the Balance in Daily Life scale was convergent with results of the timed up-and-go and one-leg stance time (p < 0.0001 for both) and tended to be higher for participants who had not fallen in the previous 6 months (p = 0.0528). The new questionnaire was divergent to sternal nudge tests (p = 0.0002) and not related to the walking-while-talking test (p = 0.5969). ConclusionThe Balance in Daily Life scale has good psychometric properties for this population. Its simplicity and innovative nature mean that it can be applied in institutions while being easily modifiable to domestic settings.Study registration on clinicaltrials.gov: NCT0334382.

A wearable sensor and framework for accurate remote monitoring of human motion

Remote monitoring and evaluation of human motion during daily life require accurate extraction of kinematic quantities of body segments. Current approaches use inertial sensors that require numerical time differentiation to access the angular acceleration vector, a mathematical operation that greatly increases noise in the acceleration value. Here we introduce a wearable sensor that utilises a spatially defined cluster of inertial measurement units on a rigid base for directly measuring the angular acceleration vector. For this reason, we used computational modelling and experimental data to demonstrate that our new sensor configuration improves the accuracy of tracking angular acceleration vectors. We confirmed the feasibility of tracking human movement by automatic assessment of experimental fall initiation and balance recovery responses. The sensor therefore presents an opportunity to pioneer reliable assessment of human movement and balance in daily life.

Experiences of transition to adulthood and transfer to adult care in young adults with type 1 diabetes: A qualitative study.

To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care. A qualitative approach was used. Ten young adults, six women and four men, aged 19-29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi-structured interviews were transcribed and analysed using qualitative content analysis. Dreaming of being nurtured towards self-reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare. In healthcare, it is important to emphasize not only diabetes-related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self-reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership. These findings can guide nurse specialists in support for emerging adults to achieve self-reliance and indicate the importance of person-centred care when experiencing transition and transfer. The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method.

Occupational balance as a component in weight loss interventions

Background Obesity can limit occupational participation because of physical and mental barriers. Weight loss programmes emphasizing dietary and physical activity may lower body weight; however, mental barriers and sustainable weight loss seemed to be challenged. Weight loss influences daily patterns and structure of occupations and finding a balance in daily life during the weight loss process might improve sustainable weight loss. Aim To explore if and how health professionals conducting weight loss programmes in Danish municipalities address elements related to occupational balance in the daily life of citizens with obesity. Material and methods Twenty individual interviews with health professionals from Danish municipalities were conducted and analysed. Results (1) Helping participants find the time and energy to lose weight, (2) Emphasizing small steps for sustainable changes and (3) Utilizing the citizen’s life experience for direction. Conclusion Elements of occupational balance might be addressed by the participants, however values and meaningfulness regarding occupations seem to be missing. Integrating occupational balance in weight loss programmes could enable health professionals to understand and address sustainable weight loss. Significance Occupational therapists may be ideally suited to support citizens with obesity to sustain weight loss by supporting a balanced life focussing on meaningfulness and values in occupations.

The Utility of Social Media Recruitment to Achieve a More Diverse Participant Sample

Research suggests that the effects of fear of falling on falls may differ by race/ethnicity. We investigated whether race/ethnicity (White, Black, and Hispanic) moderated the longitudinal effects of fear of falling on the incidence of falling and having a repeated fall among community-dwelling older adults. We used data from 2011-2018 of the National Health and Aging Trends Study (NHATS). These included a total of 19,516 person-intervals from 5,113 respondents. Self-reported any fall in the past year was the outcome variable with baseline fear of falling as the predictor and race/ethnicity as the moderator. Known risk factors for falls were included as covariates. Results showed that among respondents without the experience of falling at baseline, baseline fear of falling significantly increased the odds of a new-onset of fall at 1-year follow-up among Blacks, compared to Whites. Among respondents who already fell at baseline, baseline fear of falling significantly increased the odds of having a repeated fall later on among Hispanics, compared to Whites. Clear evidence of racial/ethnic differences was found in the relationship between fear of falling and falls among community-dwelling older adults in the U.S. Special attention should be paid to Black older adults with a fear of falling but have not fallen down recently and Hispanics with fear of falling and have fallen in the past year. Readily available educational programs should be actively advertised to older adults to reduce the fear of falling and culturally tailored educational programs should be developed for older adults from racial/ethnic minority backgrounds.

The Utility of Social Media Recruitment to Achieve a More Diverse Participant Sample

The COVID-19 pandemic created an immediate, lasting impact on recruitment methods in academic research, most notably in the field of gerontology. To protect older adult participants' health during the COVID-19 crisis, the Daily Balance Project, a 30-day micro-longitudinal study of older adults' awareness of balance in daily life, shifted to complete remote administration. Our new remote protocol included developing new methodologies to recruit participants with varying degrees of fall risk and educational attainment. In this study, we present our approach to remote online recruitment and compare educational attainment, objective and subjective fall risk, and alignment of objective/subjective fall risk across three samples recruited via a) Fall Clinic registry (16 participants); b) University e-newsletter to faculty and staff (5 participants); c) social media recruitment (7 participants). Eligibility included being 65+ and wireless internet at home. For samples a and b, screening assessments were conducted via phone while baseline assessments were conducted in-person. For sample c, screener and baseline assessment were virtual. Analysis of recruitment methods aims to determine whether recruitment via social media platforms may provide a sample of participants with more variation in fall risk or alignment of subjective versus objective balance. Results demonstrate no significant differences in educational attainment (p=0.7949) or balance confidence (p=0.213), despite significant differences in the alignment of objective and subjective fall risk (p=0.031). Participants from samples a and b proved more able to accurately assess fall risk, while sample c had the most misalignment between subjective and objective fall risk assessments.

The complexity of having a child with a congenital heart defect in a developing country: A qualitative study of parental needs

PurposeTo explore parental needs related to their experiences of living with a child with congenital heart defect (CHD) since the diagnosis. Design and methodsAn interpretative qualitative study developed with nine parents of children between the ages of five months and 11 years diagnosed with CHD. Interviews were conducted at an ambulatory pediatric cardiology centre. Data were analyzed using inductive thematic analysis. The consolidated criteria for reporting qualitative research (COREQ) was followed for quality reporting. This research was approved by a research committee. ResultsOne central theme emerged, namely ‘A desire to feel safe in dealing with the demands of CHD,’ along with two main themes. The first is ‘Looking for effective relations with healthcare professionals and health care systems’ which encompasses three types of need: (1) need for continuous, clear and accurate information; (2) need for resolution and the support of services such as the public health care system and social services; (3) need for trust in health care professionals. The second theme is ‘Looking for balance in daily life’ with two main needs: (1) maintain family functioning and (2) learn to deal with the child and CHD. ConclusionThe main parental needs are related to their interactions with healthcare professionals and healthcare systems, highlighted by a need for information and trust relationships to feel safe in their daily lives. Practice implicationsOur results imply rethinking the nurse presence in ambulatory care, implementation of a family-centered care approach and addressing the diverse and multifaceted experiences and needs of parents and children with CHD in different health care contexts.

Exploring risk factors for developing occupational ill health – departing from an occupational perspective

Background Sick leave due to stress-related mental ill health increases in society. In occupational therapy, occupational balance is considered important for experiencing health and well-being. Thus, knowledge regarding occupational balance and occupational value constitute essential parts of occupational therapists’ work with people suffering from occupational ill health. Objective The aim of this study is to analyse the relationships between sociodemographic factors, occupational value, occupational balance and perceived health in people suffering from occupational ill health. Methods In a quantitative cross-sectional study data from a total of 218 individuals were included, 192 women, 22 men and 4 individuals who did not specify their gender. Data were collected by means of surveys prior to an occupational therapy intervention. The instruments used included OVal-pd, OBQ, EQ5D and a sociodemographic questionnaire. Data were analysed using regression and decision tree analysis. Results The results show that individuals who experience an imbalance in their everyday life and who have few or no experiences of daily occupations imprinted by socio-symbolic occupational value experienced lower perceived health. Conclusions Low level of experiences of balance in daily life and occupational value seems to be the main risk factors for the development of occupational ill health, rather than sociodemographic factors.

Stability Limits for Vertical Vibrations of Paraplegic Subjects while Using Passive Orthosis

Spinal cord injury (SCI) subjects use passive orthosis to assist them with the postural balance in daily life. Vertical vibrations are used to improve the postural balance of theses patients, mainly in terms of whole-body-vibrations, as in therapies. It is noteworthy to understand in what situation these patients are able to tolerate vertical vibrations while wearing orthosis. The main focus of this paper is to model vertical vibrations in the postural balance of arm free standing of the paraplegic subjects who use passive orthosis, and, mathematically understand the stability limits for these vibrations. To find the stable amplitudes and frequencies, equations of motions of the system are translated into non-homogeneous Mathieu equations, which are then analytically solved and the results are numerically plotted. In addition, the effect of shoe stiffness on the amplitude and frequency of the vibrations which violate stability are studied. The results show to be sure of the stability of the paraplegics in vertical vibrations, the shoe sole of the orthosis should have high values of stiffness, and this will guarauntee bigger ranges of stable vibrations and safer stance for the patients. Using the results, one can interpret how a paraplegic subject with passive orthosis may react to vertical perturbations, meaning, what ranges of frequencies and amplitudes of perturbations is tolerable without losing stability. This study is one of the necessities in designing new passive orthosis with more stability when exposed to perturbations.

Review of balance recovery in response to external perturbations during daily activities

Balance is an essential capability to ensure upright standing and locomotion. Various external perturbations challenge our balance in daily life and increase the risk for falling and associated injury. Researchers try to identify the human mechanisms to maintain balance by intentional perturbations. The objectives of this work were to point out which areas of perturbation based research are well covered and not well covered and to extract which coping mechanisms humans use to respond to external perturbations. A literature review was performed to analyze mechanisms in response to external perturbations such as pushes to the body or ground level changes during standing, walking, running and hopping. To get a well-structured overview on the two dimensions, the perturbation type and the task, the Perturbation Matrix (PMA) was designed. We found that multiple studies exist for the tasks walking and standing, while hopping and running are covered less. However, all tasks still offer opportunities for both in-depth and fundamental research. Regarding the recovery mechanisms we found that humans can recover from various types of perturbations with versatile mechanisms using combinations of trunk, as well as upper and lower limb movements. The recovery movements will adapt depending on the perturbation intensity, direction and timing. Changes in joint kinetics, joint kinematics and muscle activity were identified on the joint level and leg stiffness and leg length on the global leg level. We believe that the insights from the extracted mechanisms may be applied to the hardware and control of robotic limbs or lower limb exoskeletons to improve the balance and robustness during standing or locomotion.

Determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation: perspectives of rehabilitation professionals and wheelchair users

Purpose: To gain insight into determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation, from the perspective of both wheelchair users and rehabilitation professionals.Methods: Seven focus groups were conducted: five with wheelchair users (n = 25) and two with rehabilitation professionals (n = 11). The transcripts were analysed using a sequential coding strategy, in which the reported determinants of physical activity were categorized using the Physical Activity for people with a Disability (PAD) model.Results: Reported personal determinants of physical activity were age, general health status, stage of life, demotivation due to difficulty burning calories, available time and energy, balance in daily life, attitude, and history of a physically active lifestyle. Reported environmental determinants were professional guidance, inconvenient exercise times, accessibility of facilities, costs, transportation difficulties, equipment difficulties, and social support.Conclusions: Important, changeable determinants of physical activity that might be influenced in future lifestyle interventions for wheelchair users are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities (providing information on how and where to find accessible facilities), and social support (learning how to get this).Implications for rehabilitationA physically active lifestyle improves everyday functioning, and decreases disability and the risk of secondary health problems in wheelchair users with spinal cord injury or lower limb amputation.After inpatient rehabilitation, it is difficult for wheelchair users to maintain or further enhance their physical activity, a lifestyle intervention can help them in this.To be effective, lifestyle interventions should address important, changeable determinants of physical activity.Important, changeable determinants of physical activity reported by wheelchair users and rehabilitation professionals are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities, and social support.

“Better safe than sorry”: a qualitative content analysis of participant's perspectives of fall-related concerns and balance in older women with osteoporosis after balance training

Purpose: To explore how older women with osteoporosis perceive fall-related concerns and balance in daily life after having participated in balance training. Methods: Explorative study. Semi-structured interviews were conducted with 19 women (66–84 years), with osteoporosis recruited from an ongoing RCT; participants were asked about their perceived fall-related concerns and balance. Interviews were taped and transcribed verbatim. Data were analyzed using inductive qualitative content analysis. Results: One underlying theme emerged: “Internalized risk perception related to experience of bodily fragility”, and three manifest categories: empowerment, safety and menace. A dynamic process between the categories was found, in which contextual and personal factors influenced perceptions of fall-related concerns and balance, i.e. winter season may lead a person who is highly empowered and/or uses active strategies into a situation of perception of menace and avoidance of activity. Conclusion: To cope with the fragility caused by osteoporosis informants had an internalized risk perception that protected them against possible threats and harm. Informants perceived improved empowerment and self-efficacy after participation in balance training. They resumed activities and became more active and independent in daily life using safety precautions and fall-prevention strategies. Depending on contextual factors, some situations still invoked fear and led to avoidance.Implication for RehabilitationRisk awareness protecting against possible threats and harms seems to be internalized in older women living with osteoporosis.When designing fall prevention programs, it is important to recognize that contextual and personal factors have a major influence on how older women with osteoporosis perceive fall-related concerns and balance.Perception of fragility and risk seems to be a significant problem for older women with osteoporosis and health-care providers should encourage their patients to participate in tailored balance training programs to overcome these concerns.

Continuity means “preserving a consistent whole”—A grounded theory study

Living with a chronic disease like chronic heart failure (CHF) results in disruptions, losses, and setbacks in the participants’ daily lives that affect health and well-being. By using grounded theory method, we illuminate whether persons with CHF experience discontinuity in life and, if so, what helps them to preserve and strengthen continuity in their daily lives. Thirteen individual interviews and one group interview with five participants, aged 62 to 88 years, were carried out. Through data collection and data analysis, we constructed three concepts that make up a model illustrating the participants’ experiences in daily life in relation to corporeality, temporality, and identity: experiences of discontinuity, recapturing approaches, and reconciliation. The first concept, experiences of discontinuity, was constructed from the following categories: the alienated body, the disrupted time, and the threatened self. The second concept, recapturing approaches, consists of categories with continuity creative constructions: repossessing the body, maintaining a façade, seizing the day, restoring the balance of time, and preserving self. These actions are intended to overcome problems and master changes in order to maintain balance in daily life through constructions that recreate normality and predictability. The third concept, reconciliation, was constructed from three categories: feel normal, set to adjust, and be positioned. These categories describe how the participants minimize their experiences of discontinuity by recapturing approaches in order to reconcile with various changes and maintain continuity in daily life. Our findings provide a fresh perspective on continuity that may contribute to the development of significant interventions in continuity of care for persons with CHF. However, continuity requires that healthcare systems support each patient's ability to manage change, reorientation, and adjustment to the new situation in order to make it easier for the patient to create and continue living their daily lives as they desire.

Minimizing the dysfunctional interplay between activity and recovery: A grounded theory on living with fibromyalgia

The aim of this study was to generate a substantive theory, based on interviews with women with fibromyalgia, explaining how they manage their main concerns in daily life. The study has an inductive approach in line with classic grounded theory (Glaser, 1992). Twenty-three women living in the southwest region of Sweden were interviewed in-depth about their daily living with fibromyalgia and problems related to this. Probing and follow-up questions were asked by the interviewers when relevant. The interviews were transcribed verbatim and consecutively analysed in line with guidelines for grounded theory. The results showed that the main concern for women with fibromyalgia was to reach a balance in daily life. This concern was resolved by them using different strategies aimed at minimizing the dysfunctional interplay between activity and recovery (core category). This imbalance includes that the women are forcing themselves to live a fast-paced life and thereby tax or exceed their physical and psychological abilities and limits. Generally, the fibromyalgia symptoms vary and are most often unpredictable to the women. Pain and fatigue are the most prominent symptoms. However, pain-free periods occur, often related to intense engagement in some activity, relaxation or joy, but mainly the “pain gaps” are unpredictable. To reach a balance in daily life and manage the dysfunctional interplay between activity and recovery the women use several strategies. They are avoiding unnecessary stress, utilizing good days, paying the price for allowing oneself too much activity, planning activities in advance, distracting oneself from the pain, engaging in alleviating physical activities, and ignoring pain sensations. Distracting from the pain seems to be an especially helpful strategy as it may lead to “pain gaps”. This strategy, meaning to divert attention from the pain, is possible to learn, or improve, in health promoting courses based on principles of cognitive behavioural therapy (CBT). We suggest that such courses are offered in primary care for patients with fibromyalgia or other types of longstanding pain. The courses should be led by registered nurses or psychologists, who are experienced in CBT and have extensive knowledge about theories on longstanding pain, stress and coping. Such courses would increase well-being and quality of life in women suffering from fibromyalgia.

Balancing extensive ambition and a context overflowing with opportunities and demands: A grounded theory on stress and recovery among highly educated working young women entering male-dominated occupational areas

Several factors underline the issue of stress-related health among young highly educated women. Major societal changes might provide more new challenges with considerably changed and expanded roles than were expected by earlier generations, especially among women. The quantity of young women with higher education has also increased threefold in Sweden in less than two decades and there are a growing number of young women that hereby break with traditional gender positions and enter new occupational areas traditionally dominated by men. The research questions in the present study were: “What is the main concern, regarding stress and recovery, among young highly educated working women breaking with traditional gender positions and entering male-dominated occupational areas?” and “How do they handle this concern?” We conducted open-ended interviews with 20 informants, aged 23–29 years. The results showed that the synergy between highly ambitious individuals and a context overflowing with opportunities and demands ended up in the informants’ constantly striving to find a balance in daily life (main concern). This concern refers to the respondents experiencing a constant overload of ambiguity and that they easily became entangled in a loop of stress and dysfunctional coping behavior, threatening the balance between stress and sufficient recovery. In order to handle this concern, the respondents used different strategies in balancing extensive ambition and a context overflowing with opportunities and demands (core category). This preliminary theoretical model deepens our understanding of how the increasing numbers of highly educated young women face complex living conditions endangering their possibility of maintaining health and work ability.

The moveable handhold: A new paradigm to study visual contributions to the control of balance-recovery reactions

Balance-recovery reactions that involve rapid step or reach-to-grasp movements are prevalent and functionally important responses to instability. Successful use of these reactions to recover balance in daily life requires a capacity to modulate the reaction to deal with the continual variation in environmental constraints that occurs as the person moves, i.e. location of objects that can obstruct limb movements or serve as handholds to grasp. The most direct approach to study this involves applying balance perturbations as subjects move within a visually complex environment; however, this approach does not allow precise control over kinematic variables or visual inputs, and is susceptible to strong learning effects. We have therefore developed an alternate approach, wherein the subject is stationary and the relative motion between subject and constraints that normally occurs as a result of ambulation is instead introduced via movement of the surrounding obstacles or handholds. We previously developed a motor-driven “obstacle-mover” to manipulate constraints on step reactions, and now describe an analogous approach to study reach-to-grasp reactions, using a motor-driven “handhold-mover”. We anticipate that this paradigm will provide new opportunities to probe CNS control of upright stance, by providing a sensitive indicator of limitations in the neuromusculoskeletal systems. It can also be used to test perturbation-evoked reactions in seated subjects, thereby allowing testing or training of persons who are unable to stand and use of techniques (e.g. TMS, EEG) that can be difficult to perform in free-standing subjects.

Commentary on Kristofferzon M‐L, Löfmark R &amp; Carlsson M (2007) Striving for balance in daily life: experiences of Swedish women and men shortly after a myocardial infarction. Journal of Clinical Nursing 16, 391–401

Myocardial infarction (MI) poses a serious threat to individuals and often disrupts the normal functioning of almost every aspect of their daily lives. Information about the experiences of men and women after MI is important to inform the development of needs-led, individualized cardiac care and rehabilitation, yet there is a paucity of qualitative studies investigating this issue. Kristofferzon et al. (2007) attempted to address this deficiency with a phenomenological study of the daily life experiences of Swedish men and women during the time from the onset of the MI to the interview, conducted four to six months later. The analysis generated three themes –‘threatening ordinary life’, ‘struggling for control’ and ‘the ambiguous network’– and a general pattern ‘striving for balance’. It is, however, not clear whether any analysis was undertaken to examine the process of adjustment of the patients after MI. The information presented in the different themes was discrete and even contradictory. For example, in the theme ‘threatening ordinary life’, the hindering factors for lifestyle change for women and men were respectively described as the ingrained habits of family members and low motivation of patients. However, the information in the theme ‘struggling for control’ indicated that women identified family as an important support for lifestyle changes and men tried to take their own initiative to change unhealthy habits. Also, in the theme ‘the ambiguous network’, the authors stated that women had problems in knowing what to ask the formal caregiver, but in another paragraph, women were found to appreciate the dialogues with the cardiac nurse while they were seeking health advice. Such inconsistencies might be because of the fact that the patients were describing their situations at different times during the four to six months after the MI. Perhaps what is needed now is research that explores the way patients’ situations change over the recovery period. Such information would be valuable in offering nurses and other health care professionals insights into the factors that are likely to facilitate or hinder successful adjustment to MI. As previous studies have only examined the adjustment process in female patients (Kerr & Fothergill-Bourbonnais 2002, Sutherland & Jensen 2000, Tobin 2000), information about gender differences in this regard is needed. Kristofferzon et al. (2006) focused on problems, managing problems and social support. Although the study identified gender differences in these areas, most of the findings do not appear unique or particularly different from previous studies of men and women with MI (Tobin 2000, Kristofferzon et al. 2003). However, there were some exceptions. For example, the finding about men's positive illness behaviour in response to chest pain was very different from that of the study by White and Johnson (2000), in which men reacted with denial to maintain their self-concept as ‘healthy’. The high social support of women also contrasted with an earlier review paper by the same authors (Kristofferzon et al. 2003). Comparing and contrasting the different aspects of these studies, in fact, might provide important cues to explain the differences in internal and external coping resources of patients after MI, and it is, perhaps, surprising that the authors did not allude to this in their paper. The process of adjustment to MI is complex and, although previous studies consistently report that patients initially attempt to make sense of a very disruptive situation and try strategies to return to a state of equilibrium, success is likely to be affected by a variety of factors, including gender and social network. Research should start to focus on issues such as: how does this process operate, what are the other possible influencing/mediating factors, how is a patient's coping resources affected, and to what extent should an MI be regarded as an issue in the patient's family and social contexts. The provision of such information would help shape the organization and delivery of cardiac care and rehabilitation services that play such an important role in assisting individuals to return to a normal life (Thompson 2002).

Striving for balance in daily life: experiences of Swedish women and men shortly after a myocardial infarction

The aim is to describe experiences of daily life of women and men during the first four to six months after a myocardial infarction. The focus is on problems, managing problems and support from their network. A cardiac event is traumatic and may influence well-being during a significant period of time. Few qualitative studies have investigated experiences of both women and men after a myocardial infarction and remarkably little research has been conducted on men's experiences. The study design was descriptive, retrospective and qualitative. Semi-structured interviews were conducted with 20 women and 19 men from January 2000 to November 2001. Data were analysed using qualitative content analysis. Three themes were generated from the analysis: 'Threatening ordinary life', 'Struggling for control' and 'The ambiguous network'. Physical symptoms and emotional distress were the most commonly described problems during the first months after a myocardial infarction. The informants manage the problems by negotiating with themselves, relying on their own capabilities, changing attitudes and behaviours and taking their own decisions and actions. The network was generally supportive but rather often the informants also experienced communication problems when they interacted with their network. Women and men strive for balance between problems and resources in daily life after a myocardial infarction. How well they succeeded depends on how secure they feel how well they communicate their needs to their network and how sensitive their network is to their spoken and unspoken needs. The findings provide an insight into what kind of problems women and men may experience after myocardial infarction and how caregivers can aid them to increase security in their daily life. Some risk characteristics that may have increased their problems in daily life are suggested, for women and men respectively.

Biomechanics of successful recovery from a stumble

Balance is an essential capability to ensure upright standing and locomotion. Various external perturbations challenge our balance in daily life and increase the risk for falling and associated injury. Researchers try to identify the human mechanisms to maintain balance by intentional perturbations. The objectives of this work were to point out which areas of perturbation based research are well covered and not well covered and to extract which coping mechanisms humans use to respond to external perturbations. A literature review was performed to analyze mechanisms in response to external perturbations such as pushes to the body or ground level changes during standing, walking, running and hopping. To get a well-structured overview on the two dimensions, the perturbation type and the task, the Perturbation Matrix (PMA) was designed. We found that multiple studies exist for the tasks walking and standing, while hopping and running are covered less. However, all tasks still offer opportunities for both in-depth and fundamental research. Regarding the recovery mechanisms we found that humans can recover from various types of perturbations with versatile mechanisms using combinations of trunk, as well as upper and lower limb movements. The recovery movements will adapt depending on the perturbation intensity, direction and timing. Changes in joint kinetics, joint kinematics and muscle activity were identified on the joint level and leg stiffness and leg length on the global leg level. We believe that the insights from the extracted mechanisms may be applied to the hardware and control of robotic limbs or lower limb exoskeletons to improve the balance and robustness during standing or locomotion.