Challenging Balance Research Articles

The IMF or the AMF: Defining the Future of Financing for Investment and Development Projects in Africa

Since independence the government of many African countries have depended on the International Monetary Fund (IMF) and the World Bank as their main sources of finance for major developmental and investment projects in their respective countries. Accordingly, besides the granting of loans to Low Income Countries (LICs) at zero interest rate, the IMF also assists member countries to resolve their balance of payment challenges as well as granting interest-bearing loans to both member and non-member countries. Similarly, the African Monetary Fund (AMF) which is a prototype of the IMF was created by the African Union (AU) and is not yet operational. Just like the IMF, the AMF is intended to fund major developmental projects in Africa. This article examines the IMF loans conditionality and the award of Special Drawing Rights (SDR) to African Countries as seen during the COVID-19 crisis. It argues that the AMF would not be the African countries’ panacea as far as funding for developmental projects in Africa is concerned. In this regard, the article further examines Agenda 2063 as a future development model for Africa, as well as the various sources of project finance as envisioned in the Frameworks Document of Agenda 2063. It concludes that IMF still has the financial muscle to fund developmental projects and resolved balance of payment problems in Africa despite alternative sources of finance recommended by Agenda 2063.

“I’m Getting Older Too”: Challenges and Benefits Experienced by Very Old Parents and Their Children

Very old parents and their “old” children are a growing group in industrialized countries worldwide. Since most very old persons have outlived spouses and friends, their children, many of whom have reached old age themselves, are likely to become their primary social contact and to shoulder the care provision role. However, virtually nothing is known about the nature and implications of this relationship constellation. To fill this gap, the present study explored the challenges and rewards of the very old parent-child relationship. In-depth interviews were conducted with 114 parent-child dyads (parent age ≥ 90; child age ≥ 65). Narrative interview data on challenges and rewards were audiotaped, transcribed, and then systematically reviewed and coded, identifying recurrent themes and defining categories that reflected these themes. While both challenges and rewards were present, more rewards than challenges were reported overall. However, comparing parent and child perspectives revealed that the balance of challenges and rewards was less favorable for children. Narrative data further showed that the sense of burdening their children heavily weighed on at least a fourth of parents, reflecting this as a serious concern not only for children but also for parents. Challenges reported by children were often characterized by references to children’s own advanced age and health problems, and the prolonged caregiving involvement due to their parents’ longevity. Healthcare professionals, policy makers, and families should be made aware of this increasingly common phenomenon, and specific services and policies will be needed to adequately support very old adults and their families.

Dementia caregivers identify challenges and facilitators to attending health care visits

AbstractBackgroundThe 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers identified the need for person‐centered dementia care throughout the care continuum. Challenges include adapting health care to meet the complex needs of persons with dementia and their caregivers across a variety of settings.MethodTo understand dementia caregivers’ experience of the health care system, we conducted qualitative interviews with twenty‐four middle‐to‐older age caregivers of community‐dwelling people with dementia. Data were analyzed using conventional content analysis whereby the coding team sought to identify barriers and facilitators to person‐centered dementia care.ResultWe identified three categories and associated sub‐categories related to caregiver experience: 1) Preparing for the Visit, with sub‐categories Physical Challenges and Emotional Preparation; 2) Visit‐Related Time and Travel, with sub‐categories General Travel Challenges, Physical Limitations, Cognitive Limitations, and Benefits; and, 3) In‐visit Experience, with sub‐categories Physical Challenges and Emotional Preparation. Preparing for visit statements revealed barriers, such as patient resistance to attending visits due to not understanding the need. Visit‐related time and travel statements reflected a balance of challenges and facilitators, including general challenges such as traffic and dementia‐specific challenges such as patient agitation around visit wait times. Facilitators reflected the benefit of visits as opportunities for social participation. In‐visit experience statements reflected a mix of challenges and facilitators. Challenges included person with dementia difficulty participating in the health care visit due to poor insight and inability to answer questions, while facilitators included caregivers’ positive engagement with the care team. Across categories, caregivers assumed high‐level responsibility to accommodate for person with dementia physical and cognitive challenges.ConclusionCategories underscore the complexity of health care management for a person with dementia both in and around actual clinic appointments, highlighting both challenges related to person with dementia cognitive deficits and perceived benefits related to visits as opportunities for social participation and accessing resources. This study offers relevant insights about tailoring health care to accommodate for person with dementia deficits while supporting their caregivers.

Minimal-Dose Resistance Training for Improving Muscle Mass, Strength, and Function: A Narrative Review of Current Evidence and Practical Considerations.

Resistance training (RT) is the only non-pharmacological intervention known to consistently improve, and therefore offset age-related declines in, skeletal muscle mass, strength, and power. RT is also associated with various health benefits that are underappreciated compared with the perceived benefits of aerobic-based exercise. For example, RT participation is associated with reduced all-cause and cancer-related mortality and reduced incidence of cardiovascular disease, hypertension, and symptoms of both anxiety and depression. Despite these benefits, participation in RT remains low, likely due to numerous factors including time constraints, a high-perceived difficulty, and limited access to facilities and equipment. Identification of RT strategies that limit barriers to participation may increase engagement in RT and subsequently improve population health outcomes. Across the lifespan, declines in strength and power occur up to eight times faster than the loss of muscle mass, and are more strongly associated with functional impairments and risks of morbidity and mortality. Strategies to maximise healthspan should therefore arguably focus more on improving or maintaining muscle strength and power than on increasing muscle mass per se. Accumulating evidence suggests that minimal doses of RT, characterised by lower session volumes than in traditional RT guidelines, together with either (1) higher training intensities/loads performed at lower frequencies (i.e. low-volume, high-load RT) or (2) lower training intensities/loads performed at higher frequencies and with minimal-to-no equipment (i.e. resistance 'exercise snacking'), can improve strength and functional ability in younger and older adults. Such minimal-dose approaches to RT have the potential to minimise various barriers to participation, and may have positive implications for the feasibility and scalability of RT. In addition, brief but frequent minimal-dose RT approaches (i.e. resistance 'exercise snacking') may provide additional benefits for interrupting sedentary behaviour patterns associated with increased cardiometabolic risk. Compared to traditional approaches, minimal-dose RT may also limit negative affective responses, such as increased discomfort and lowered enjoyment, both of which are associated with higher training volumes and may negatively influence exercise adherence. A number of practical factors, including the selection of exercises that target major muscle groups and challenge both balance and the stabilising musculature, may influence the effectiveness of minimal-dose RT on outcomes such as improved independence and quality-of-life in older adults. This narrative review aims to summarise the evidence for minimal-dose RT as a strategy for preserving muscle strength and functional ability across the lifespan, and to discuss practical models and considerations for the application of minimal-dose RT approaches.

Stand Up to Excite the Spine: Neuromuscular, Autonomic, and Cardiometabolic Responses During Motor Imagery in Standing vs. Sitting Posture.

Motor imagery (MI) for health and performance strategies has gained interest in recent decades. Nevertheless, there are still no studies that have comprehensively investigated the physiological responses during MI, and no one questions the influence of low-level contraction on these responses. Thus, the aim of the present study was to investigate the neuromuscular, autonomic nervous system (ANS), and cardiometabolic changes associated with an acute bout of MI practice in sitting and standing condition. Twelve young healthy males (26.3 ± 4.4 years) participated in two experimental sessions (control vs. MI) consisting of two postural conditions (sitting vs. standing). ANS, hemodynamic and respiratory parameters, body sway parameters, and electromyography activity were continuously recorded, while neuromuscular parameters were recorded on the right triceps surae muscles before and after performing the postural conditions. While MI showed no effect on ANS, the standing posture increased the indices of sympathetic system activity and decreased those of the parasympathetic system (p < 0.05). Moreover, MI during standing induced greater spinal excitability compared to sitting posture (p < 0.05), which was accompanied with greater oxygen consumption, energy expenditure, ventilation, and lower cardiac output (p < 0.05). Asking individuals to perform MI of an isometric contraction while standing allows them to mentally focus on the motor command, not challenge balance, and produce specific cardiometabolic responses. Therefore, these results provide further evidence of posture and MI-related modulation of spinal excitability with additional autonomic and cardiometabolic responses in healthy young men.

Modulation of bilateral lower-limb muscle coordination when performing increasingly challenging balance exercises

Balance exercises have proven effective in enhancing and regaining neuromuscular control. However, how the bilateral homonymous muscles are coordinated to achieve bipedal equilibrium remains unclear. In terms of increasingly difficult balance tasks, the current study focused on two levels of muscle coordination: individual homonymous muscles and groups of homonymous muscles. In 25 physically active young adults, a cross-correlation between the bilateral electromyographic (EMG) signals of both legs (i.e., bilateral EMG-EMG correlation) was conducted on seven muscles measured when performing bipedal balancing on three different support surface instabilities. Then, the patterns of bilateral EMG-EMG cross-correlation coefficients were determined through a principal component analysis (PCA). It was hypothesized that modulations of bilateral lower-limb muscle coordination should be observed in the specific relevant muscles or in the patterns of bilateral muscle coordination. The results showed that only the first hypothesis was supported as changes in the strength of bilateral EMG-EMG correlation (p ≤ 0.005) and in the time delays (p < 0.001) were mostly restricted in the lower-leg muscles. The dorsiflexor and plantar flexor muscles showed opposite coordination behaviors. Larger bilateral EMG-EMG correlation and shorter time delays appeared only in the tibialis anterior muscle, suggesting that bilateral dorsiflexor muscle coordination is needed for exercising on multiaxial-unstable platforms.

People with persistent postural-perceptual dizziness demonstrate altered postural strategies in complex visual and cognitive environments.

People with PPPD report imbalance, increase in symptoms and impaired function within complex visual environments, but understanding of the mechanism for these behaviors is still lacking. To investigate postural control in PPPD we compared changes in center of pressure (COP) and head kinematics of people with PPPD (N = 22) and healthy controls (N = 20) in response to different combinations of visual and cognitive perturbations during a challenging balance task. Participants stood in a tandem position. Static or moving stars (0.2 Hz, 5 mm or 32 mm amplitude, anterior-posterior direction) were displayed through a head-mounted display (HTC Vive). On half the trials, participants performed a serial-3 subtraction task. We measured medio-lateral and anterior-posterior path and acceleration of COP and head. Controls significantly increased all COP and head parameters with the cognitive task whereas PPPD increased only COP ML path and acceleration. Only controls significantly increased head anterior-posterior & medio-lateral acceleration with moving visual load. Cognitive task performance was similar between groups. We observed altered postural strategies in people with PPPD, in the form of reduced movement with challenge, particularly around the head segment. The potential of this simple and portable head-mounted display setup for differential diagnosis of vestibular disorders should be further explored.

Effects of a Highly Challenging Balance Training Program on Motor Function and Brain Structure in Parkinson's Disease.

Background:Parkinson’s disease (PD) is characterized by motor deficits and brain alterations having a detrimental impact on balance, gait, and cognition. Intensive physical exercise can induce changes in the neural system, potentially counteracting neurodegeneration in PD and improving clinical symptoms.Objective:This randomized controlled trial investigated effects of a highly challenging, cognitively demanding, balance and gait training (HiBalance) program in participants with PD on brain structure.Methods:95 participants were assigned to either the HiBalance or an active control speech training program. The group-based interventions were performed in 1-hour sessions, twice per week over a 10-week period. Participants underwent balance, gait, cognitive function, and structural magnetic resonance imaging assessments before and after the interventions. Voxel-based morphometry was analyzed in 34 HiBalance and 31 active controls. Additionally, structural covariance networks were assessed.Results:There was no significant time by group interaction between the HiBalance and control training in balance, gait, or brain volume. Within-HiBalance-group analyses showed higher left putamen volumes post-training. In repeated measures correlation a positive linear, non-significant relationship between gait speed and putamen volume was revealed. In the HiBalance group we found community structure changes and stronger thalamic-cerebellar connectivity in structural covariance networks. Neither brain volume changes nor topology changes were found for the active controls after the training.Conclusion:Thus, subtle structural brain changes occur after balance and gait training. Future studies need to determine whether training modifications or other assessment methods lead to stronger effects.

COVID-19 as the tipping point for integrating e-assessment in higher education practices.

The COVID‐19 pandemic provoked an urgency for many educators to integrate digital information and communication technologies in their educational practices. We explored how faculty members tackled the task of adapting their assessment practices during the pandemic to identify what is required to sustain and favour future quality development and implementation of e‐assessment in higher education. Employing a qualitative descriptive approach, we conducted semi‐structured interviews with thirty‐one individuals six months into the COVID‐19 pandemic. We identified four major themes in participants' discourse about the integration of e‐assessment during the COVID‐19 pandemic: (a) the considerations they had for the potential consequences on students and how they considered this while deciding how to move forward, (b) the preoccupations for the potential for cheating, (c) the importance of pedagogical alignment, and (d) the affordances available to them. While the COVID‐19 pandemic highlighted the fact that higher education institutions were not prepared for a pivot to‐ or greater integration of‐ e‐assessment, it also provided the tipping‐point to do so. In other words, it offered an unprecedented opportunity to critically appraise and change assessment practices, this opportunity was also a very challenging balancing act of considering the social consequences of assessment, and the alignment within set affordances. Practitioner notesWhat is already known about this topic The advantages of e‐assessment include the opportunity for rapid‐, even immediate‐, feedback.The integration of digital information and communication technologies to assessment practices is a source of stress and anxiety for some students.The move towards e‐assessment increases faculty members' workload. What this paper adds How cheating, anxiety and workload were considered in the context of a forced and rushed change to e‐assessment because of the COVID‐19 pandemic.The COVID‐19 pandemic offered an opportunity to faculty members to take a critical look at their assessment practices and increase their alignment with learning outcomes.Faculty members considered the consequences of their decisions on students when making changes to their assessment. Implications for practice and/or policy Moving to e‐assessment is an opportunity to align the assessment practice with students' future professional practice, or in other words it is an opportunity to increase the authenticity of the assessment.A better integration of information and communication technology to assessment practices will require to provide educators with skills, time, evidence‐informed recommendations, and institutional support among others.

Aging Affects Multi-Objective Optimal Control Strategies during Obstacle Crossing

Obstacle crossing challenges balance and increases the risk of falls in older people. Knowledge of the control strategies adopted by older people will be helpful for the study of the mechanisms of falls during obstacle crossing and the development of fall-prevention approaches. A mechanical model of the body combined with measured gait data was used to study the control strategies adopted by 17 healthy older and 17 young adults when crossing obstacles of different heights, in terms of the best-compromise weighting sets for the objectives of minimizing energy expenditure and maximizing the toe-obstacle and heel-obstacle clearances. The older group showed increased leading toe-obstacle clearance and trailing toe-obstacle distance, but decreased leading heel-obstacle distance. Compared with the young, the crossing strategy of older people emphasized the foot-obstacle clearance to reduce the risk of tripping, at the expense of energy expenditure. It appears that the multi-objective optimal control strategy relies on the muscular strength of the lower extremities and precise end-point control. Therefore, maintaining or improving the muscle strength and the ability of limb position control is critical for safe and successful obstacle-crossing in the older population.

The measurable parameters of balance trainings in case of young healthy adults: Improved balance confidence or better postural stability? A pilot study

AbstractPurposeThe objective of this pilot study was to compare the effects of two parallel balance trainings on postural sway and balance confidence. The study was performed in different contexts with stable vs. unstable base of support and balance confidence was measured with a scale modified for young adults with higher functional level.Materials/methodsTwenty healthy female physiotherapist students volunteered for the study and took part in a six-week balance training intervention. They were randomly assigned to two groups training on different support surfaces. Postural sway was recorded under various conditions: on different surfaces (firm, foam) and with different visual conditions (eyes open (EO), eyes closed (EC)). Modified Activities-specific Balance Confidence (mABC) scale was self-evaluated.ResultsBoth types of training caused a significant improvement in the mABC scores. The sway path increased after the training in the less challenging balance situations. We found a tendency of decreasing sway path only in the more challenging balance situations, that is standing on foam mounted on force plate with EC.ConclusionsConsidering the improved balance confidence in the case of both groups, we suggest that an increase in sway path after balance training may be the behavioural sign of the higher confidence in the less challenging balance situations.

Effect of Highly Challenging Balance Training on Balance in Subjects with Chronic Parkinson’s Disease

Background: Highly challenging balance training has been suggested to induce neuroplasticity inindividuals with chronic Parkinson’s disease (PD So, the present study aims to find the effect of highlychallenging balance training on balance in subjects with chronic Parkinson’s disease.Objective: To determine the effect of highly challenging balance training on balance in subjects withchronic Parkinson’s disease.Method: 30 subjects between the age group of 45-60 years diagnosed with PD were included in thestudy and conveniently allocated to the single group after fulfilling inclusion and exclusion criteria.Baseline data like age, gender, Hoehn &amp;Yahr stage was noted. Subjects underwent Highly ChallengingBalance Training 45minutes per session 4 days/ week for 4 weeks. The pre and post test of balance wasdone by using Berg balance scales(BBS).Results: The highly challenging balance training on balance showed significant improvement inbalance in post-test and also showed significantly improved balance. (p&lt;0.05) in subjects with chronicParkinson’s disease.Conclusion: The result of the present study shows that highly challenging balance training significantlyimproved balance and showed promising transfer effects to everyday living. Long-term follow-upassessments can be done to further explore these effects. The results also show that regular training isrequired for the subjects to maintain progress.

Compromised Brain Activity With Age During a Game-Like Dynamic Balance Task: Single- vs. Dual-Task Performance.

Background: Postural control and cognition are affected by aging. We investigated whether cognitive distraction influenced neural activity differently in young and older adults during a game-like mediolateral weight-shifting task with a personalized task load.Methods: Seventeen healthy young and 17 older adults performed a balance game, involving hitting virtual wasps, serial subtractions and a combination of both (dual-task). A motion analysis system estimated each subject's center of mass position. Cortical activity in five regions was assessed by measuring oxygenated hemoglobin (HbO2) with a functional Near-Infrared Spectroscopy system.Results: When adding cognitive load to the game, weight-shifting speed decreased irrespective of age, but older adults reduced the wasp-hits more than young adults. Accompanying these changes, older adults decreased HbO2 in the left pre-frontal cortex (PFC) and frontal eye fields (FEF) compared to single-tasking, a finding not seen in young adults. Additionally, lower HbO2 levels were found during dual-tasking compared to the summed activation of the two single tasks in all regions except for the right PFC. These relative reductions were specific for the older age group in the left premotor cortex (PMC), the right supplementary motor area (SMA), and the left FEF.Conclusion: Older adults showed more compromised neural activity than young adults when adding a distraction to a challenging balance game. We interpret these changes as competitive downgrading of neural activity underpinning the age-related deterioration of game performance during dual-tasking. Future work needs to ascertain if older adults can train their neural flexibility to withstand balance challenges during daily life activities.

"I'm Getting Older Too": Challenges and Benefits Experienced by Very Old Parents and Their Children.

Very old parents and their "old" children are a growing group in industrialized countries worldwide. However, virtually nothing is known about the nature and implications of this relationship constellation. To fill this gap, this study explored the challenges and rewards of the very old parent-child relationship. In-depth interviews were conducted with 114 parent-child dyads (parent age ≥90; child age ≥65). While both challenges and rewards were present, the balance of challenges and rewards was notably less favorable for children with more challenges experienced overall. Challenges reported by children were often characterized by references to children's own advanced age and health problems, and the prolonged caregiving involvement due to their parents' longevity. Health care professionals, policymakers, and families should be made aware of this increasingly common phenomenon, and specific services and policies will be needed to adequately support very old adults and their families.

An exploration of performance management processes used within Olympic sport programmes

The organizational environment and role delivery of support personnel have been identified as increasingly important to elite athletes’ preparation for, and performance at, pinnacle competitions. As a result, performance management has been identified as a salient research topic within the field of organizational sport psychology. The purpose of this study was to identify the performance management processes used within Olympic sport programmes and explore how these processes interact in an organizational context. Thirteen participants working in senior positions within Olympic sport organizations (e.g., national performance director) across a range of countries were interviewed. Thematic analysis identified performance management processes existing across strategic, operational, and individual levels in Olympic sport programmes. The findings also suggested that these socially dynamic processes are interrelated and influenced by the delivery of the performance leader’s role. A preliminary conceptual framework was developed to highlight these processes and illustrate their interrelated nature. Overall, the findings advance our knowledge and understanding of performance management as an organizational concept within elite sport. Practical implications are provided for sport psychology practitioners to assess and optimize how performance management processes are used within elite sport programmes. Lay summary: While performance management of personnel in traditional workplaces has been researched heavily, there are limited studies exploring the topic in elite sport. Given the importance of the organizational context for performance and well-being in sport, we explore performance management processes within Olympic sport programmes and discuss their potential practical application. Implications for practice The proposed conceptual framework (and the findings it represents) identifies the key performance management processes in Olympic sport programmes which can help practitioners evaluate current processes in place at individual, operational, and strategic levels and better understand the broader organizational context affecting athletes. The findings may help practitioners to more optimally support those operating in senior organizational roles in sports organizations in developing effective performance management processes across their system. Specifically, the training and expertise of sport psychologists can help position them to support those implementing performance management processes at the organizational (e.g., developing codes of conduct), operational (e.g., supporting cultural change), and individual (e.g., providing an optimal balance of challenge and support) levels.

Pediatric Trainees as Parents: Perspectives From a Pandemic.

Resident parents are at the intersection of converging challenges during the coronavirus disease 2019 (COVID-19) pandemic, and their perspective has yet to be explored. This qualitative study aimed to identify themes related to the experience of pediatric resident parents during the COVID-19 pandemic. We performed semistructured interviews with pediatric residents who were also parents. Using thematic analysis, transcripts were analyzed iteratively until theoretical sufficiency was achieved. Twelve residents were interviewed from 9 pediatric residency programs. Five major themes, representing conflicts or tensions experienced by participants, were defined by the data: 1) Duty as a doctor versus duty as a parent; 2) Balance of work obligations versus childcare challenges; 3) Appreciation of added support versus worry about peers' perceptions of accommodations; 4) Gratitude for the recognition of challenges faced by resident parents versus fear of reversion to the norm; and 5) Protective impact of parenthood versus challenges to mental health. Both parents and healthcare workers faced innumerable challenges during the COVID-19 pandemic, and this exploration of the experiences of pediatric resident parents provides a unique lens for examining the tensions that this group faced. Our results may allow residency programs to better support their pediatric resident parents during this crisis.

Middle-age people with multiple sclerosis demonstrate similar mobility characteristics to neurotypical older adults

BackgroundClinical trials often report significant mobility differences between neurotypical and atypical groups, however, these analyses often do not determine which measures are capable of discriminating between groups. Additionally, indirect evidence supports the notion that some mobility impaired populations demonstrate similar mobility deficits. Thus, the current study aimed to provide a comprehensive analysis of three distinct aspects of mobility (walking, turning, and balance) to determine which variables were significantly different and were also able to discriminate between neurotypical older adults (OA) and middle-aged people with multiple sclerosis (PwMS), and between middle-aged neurotypical adults and PwMS. MethodsThis study recruited 21 neurotypical OA, 19 middle-aged neurotypical adults, and 30 people with relapsing remitting MS. Participants came into the laboratory on two separate occasions to complete mobility testing while wearing wireless inertial sensors. Testing included a self-selected pace two-minute walk, a series of 180˚ and 360˚ turns, and a clinical balance test capturing a total of 99 distinct mobility characteristics. We determined significant differences for gait and turning measures through univariate analyses and a series of repeated measures analysis of variance in determining significance for balance conditions and measures. In determining discrimination between groups, the Area Under the Curve (AUC) was calculated for all individual mobility measures with a threshold of 0.80, denoting excellent discrimination. Additionally, a stepwise regression of the top five AUC producing variables was performed to determine whether a combination of variables could enhance discrimination while accounting for multicollinearity. ResultsThe results between neurotypical OA and middle-aged PwMS demonstrated significant differences for three gait and one turning variable, with no variable or combination of variables able to provide excellent discrimination between groups. Between middle-age neurotypical adults and PwMS a variety of mean and variability gait measures demonstrated significant differences between groups; however, no variable or combination of variables met discriminatory threshold. For turning, five 360˚ turn variables demonstrated significant differences and furthermore, the combination of 360˚ mean turn duration and variability of peak turn velocity were able to discriminate between groups. Finally, the majority of postural sway measures demonstrated significant group differences and the ability to discriminate between groups, particularly during more challenging balance conditions where participants stood on a compliant surface. ConclusionThese results offer a comprehensive analysis of mobility differences and measures capable of discriminating between middle-age neurotypical adults and PwMS. Additionally, these results provide evidence that OA and middle-age PwMS display similar movement characteristics and thus a potential indicator of advanced aging from a mobility perspective.

Identifying human postural dynamics and control from unperturbed balance

BackgroundUpright standing requires control of an inherently unstable multi-joint human body within a small base of support, despite biological motor and / or sensory noise which challenge balance. Without applying perturbations, system identification methods have been regarded as inadequate, because the relevant internal biological noise processes are not accessible to direct measurement. As a result, unperturbed balance studies have been limited to investigation of behavioral patterns rather than possible underlying control strategies.MethodsIn this paper, we present a mathemathically rigorous system identification method that is applicable to study the dynamics and control of unperturbed balance. The method is derived from autocorrelation matrices with non-zero time lags and identifies the system matrix of a discrete-time dynamic system in the presence of unknown noise processes, without requiring any information about the strength of the noise.ResultsUnlike reasonable ‘least-squares’ approaches, the performance of the new method is consistent across a range of different combinations of internal and measurement noise strengths, even when measurement noise is substantial. We present a numerical example of a model that simulates human upright balancing and show that its dynamics can be identified accurately. With a biomechanically reasonable choice of state and input variables, a state feedback controller can also be identified.ConclusionsThis study provides a new method to correctly identify the dynamics of human standing without the need for known external perturbations. The method was numerically validated using simulation that included realistic features of human balance. This method avoids potential issues of adaptation or possible reflex responses evoked by external perturbations, and does not require expensive in-lab, high-precision measurement equipment. It may eventually enable diagnosis and treatment of individuals with impaired balance, and the development of safe and effective assistive and / or rehabilitative technologies.

Experience of burnout among pediatric inpatient nurse preceptors

BackgroundThere is a paucity of research describing burnout among nurses who work in the role of a preceptor, in the inpatient setting. In 2017, precepting nurses at an academic children's hospital were surveyed using the Oldenburg Burnout Inventory (OBI). Results of the survey inspired leadership to further explore this phenomenon using key informant interviews. MethodsProspective qualitative description with individual interviews analyzed using conventional content analysis. ResultsIn regard to burnout, five themes illustrated the experiences of precepting nurses. “Feeling the Responsibility” reflected the cognitive stain of precepting. “An Obligation to the Role,” reflected the dimensions of the OBI that addressed distancing and decreased interest in the work. However, preceptors described positive experiences “It Challenges Me Every Day,” awareness of resources “Nursing Response,” and insights for improving the preceptor program, “Future Strategies.” ConclusionsWhile elements of the OBI were salient in the data, three inductive themes highlighted the balance of positive challenges and learning opportunities that inspire preceptors.

Telephone delivery of psychological interventions: Balancing protocol with patient-centred care

Common mental health problems of anxiety and depression affect significant proportions of the global population. Within the UK, and increasingly across western countries, a key policy response has been the introduction of high volume, low intensity psychological assessment and treatment services, such as the NHS’s Improving Access to Psychological Therapies (IAPT) service, the largest service delivery model yet to be implemented at a national level (England). IAPT may be delivered in face-to-face meetings or over the telephone, as well as through other media. In order to increase access and achieve wide reach with efficient use of resources, IAPT’s service models utilise relatively structured and standardised protocols, whilst aiming simultaneously to deliver a tailored and personalised experience for patients. Previous research has revealed that this can be a challenging balance for front-line practitioners to strike. Here we report research into the telephone delivery of guided self-help, low intensity interventions within IAPT, examining the challenges faced in remote delivery when combining structure with personalisation during assessment and treatment sessions. We show the ways in which the lack of flexibility in adhering to a system-driven structure can displace, defer or disrupt the emergence of the patient’s story, thereby compromising the personalisation and responsiveness of the service. Our study contributes new insights to our understanding of the association between personalisation, engagement and patient experience within high volume, low-intensity psychological treatment services. Our research on the telephone delivery of IAPT is particularly timely in view of the current global Covid-19 health crisis, as a result of which face-to-face delivery of IAPT has had to be (temporarily) suspended.