Functional Performance In People Research Articles

Functional Capacity, Functional Performance, and Symptoms in People With Heart Failure: An Integrative Review.

Heart failure (HF) is a clinical syndrome that has a negative effect on functional status, a multidimensional concept characterizing one's ability to provide for the necessities of life. Symptoms might be associated with different aspects of functional status in HF. However, the terms functional capacity and performance have been misused interchangeably, and no previous review has focused on the extent to which symptoms contribute to functional capacity and performance among people with HF. The aim of this study was to comprehensively review and synthesize the existing literature on the relationship between symptoms, functional capacity, and functional performance in people with HF. We conducted an integrated review of observational studies in which authors examined the relationship between at least 1 symptom and at least 1 aspect of functional capacity or performance in people with HF 18 years or older. The Joanna Briggs Institute's critical appraisal tools were used to analyze the quality of studies. We included 23 studies with 7219 participants and an age range of 40 to 86 years. Fifteen symptom measures were used to measure dyspnea, fatigue, pain, insomnia symptoms, depressive symptoms, and anxiety symptoms. Three functional capacity measures were assessed in 9 studies, and 7 functional performance measures were assessed in 17 studies. As often measured with the Six-Minute Walk Test, functional capacity was inversely associated with pain/discomfort, insomnia symptoms, and psychological symptoms. Functional performance, often measured by the New York Heart Association functional class and Medical Outcome Scale Short Form 36, was associated with sleep difficulties, fatigue, depressive symptoms, and anxiety. Four studies combined functional capacity and performance measures to elicit functional status. Depressive symptoms, fatigue, pain, and insomnia symptoms are associated with decreased functional performance and capacity. Commonly, symptoms experienced in HF are associated with declining functional status. However, this finding depends on the measures or metrics used to assess symptoms, functional capacity, and performance. The observed dissimilarities in the relationship between symptoms and functional capacity and performance highlight the conceptual distinctions, suggesting that authors of future studies should judiciously select appropriate dimensions and measures of functional status based on the study's purposes, design, and available resource.

Markerless motion capture technology to quantify functional performance in dementias: a systematic review

AbstractBackgroundQuantifying functional performance objectively and unobtrusively could offer vital insights for clinical decision making on the level of support required by people living with dementia and other neurodegenerative conditions. Markerless motion capture (MMC) is more suitable for deployment in clinical and real‐world settings because single sensor MMC systems are less expensive and less complex compared to marker‐based systems. The aim of this study was to complete a systematic review of published literature on the use of MMC with full‐body tracking in people with dementias.MethodWe systematically searched for relevant articles using the search terms motion capture, motion analysis and movement analysis combined with dementia, mild cognitive impairment (MCI) and Parkinson’s disease (PD) which yielded a total of 1103 results. Inclusion criteria were MMC and full‐body tracking. Studies evaluating marker‐based motion capture, body‐worn sensors or Inertial Measurement Units, virtual reality, kinetics and interventions like DBS or exercises were excluded. 134 studies were included for full article screening out of which 17 eligible studies that met the selection criteria were included in the review.ResultMMC devices used in the reviewed studies included Microsoft Kinect (n = 15) and unspecified 2D motion camera (n = 2). Patient groups included in the studies were PD (n = 12), dementia (n = 4) and MCI (n = 1). Functional performance components evaluated were gait (n = 16), sit to stand (n = 2), turning (n = 1) and stepping in place (n = 1). About half the studies used advanced machine learning methods whereas the other half used descriptive statistical methods. The lack of standardisation in the measures used prevented us from comparing and synthesizing study results.ConclusionAlthough MMC has the potential to be used for quantifying functional performance in people with dementia, MCI and PD, there appears to be significant variation in the methods used in its evaluation. Although features of mobility were measured, none of the reviewed studies analysed activities of daily living tasks, a key component of functional performance. Standardising the process for extracting features and assessing accuracy would enable more effective validation of real‐world impact. Further research is required in people with neurodegenerative conditions for MMC to be routinely used in clinical and real‐world applications.

Does hip muscle strength and functional performance differ between football players with and without hip dysplasia?

ObjectiveTo compare hip muscle strength and functional performance in football players with and without hip dysplasia and investigate if the relationships were modified by sex. DesignCross-sectional study. MethodsThis study compared football players with hip dysplasia (HD group) and without hip dysplasia (control group). Hip muscle strength (Nm/kg) and functional task performance were assessed in both groups. Linear regression with generalized estimating equations were used to assess differences between groups. Sex was assessed as a potential effect modifier. Results101 football players were included (HD group, n = 50, control group, n = 51). There was no difference in hip muscle strength or functional performance between the HD group and the control group. Results ranged from hip extension strength (Estimate −0.13.95%CI: 0.29 to 0.02, P = 0.087) to hip external rotation strength (Estimate 0.00.95%CI: 0.05 to 0.05, P = 0.918). No relationships were modified by sex or age. ConclusionsSimilar levels of hip muscle strength and functional performance were found in active football players with and without hip dysplasia. These findings differ from other studies. This may be due to our cohort having less advanced hip dysplasia than the surgical populations that have been previously investigated, or due to a beneficial effect of football participation on muscle strength and functional performance in people with hip dysplasia.

Deep Learning in Left and Right Footprint Image Detection Based on Plantar Pressure

People with cerebral palsy (CP) suffer primarily from lower-limb impairments. These impairments contribute to the abnormal performance of functional activities and ambulation. Footprints, such as plantar pressure images, are usually used to assess functional performance in people with spastic CP. Detecting left and right feet based on footprints in people with CP is a challenge due to abnormal foot progression angle and abnormal footprint patterns. Identifying left and right foot profiles in people with CP is essential to provide information on the foot orthosis, walking problems, index gait patterns, and determination of the dominant limb. Deep learning with object detection can localize and classify the object more precisely on the abnormal foot progression angle and complex footprints associated with spastic CP. This study proposes a new object detection model to auto-determine left and right footprints. The footprint images successfully represented the left and right feet with high accuracy in object detection. YOLOv4 more successfully detected the left and right feet using footprint images compared to other object detection models. YOLOv4 reached over 99.00% in various metric performances. Furthermore, detection of the right foot (majority of people’s dominant leg) was more accurate than that of the left foot (majority of people’s non-dominant leg) in different object detection models.

Efficacy of Patellar Taping and Electromyographic Biofeedback Training at Various Knee Angles on Quadriceps Strength and Functional Performance in Young Adult Male Athletes with Patellofemoral Pain Syndrome: A Randomized Controlled Trial.

Background The severity of the articular lesion is the single most essential element in investigating the extent of flexion that is required for activities. However, a prior study found no differences in muscle strength gains of quadriceps muscles at different knee angles in people with patellofemoral pain syndrome (PFPS). Objective The effects of patellar taping and electromyographic biofeedback (EMG-BF)-guided isometric quadriceps strengthening at different knee angles (e.g., 30°, 60°, and 90° of knee flexion) on quadriceps strength and functional performance in people with PFPS were compared in this single-blind randomized controlled parallel trial. Methods Sixty adult male athletes with PFPS (age: 26.9 ± 1.4 years) were randomly divided into two groups. The experimental group (n = 30) received patellar taping and EMG-BF-guided isometric contraction exercise at 30°, 60°, and 90° angles, and the control group (n = 30) received sham patellar taping without EMG-BF-guided exercises for six weeks. Pain intensity, knee function, muscle strength, and the single-leg triple hop (SLTH) test were assessed. Results The pain intensity and SLTH scores between the groups were significantly different at the end of the trial (p ≤ 0.001). The EMG-BF and control groups had mean pain scores of 1.3 (0.8) and 4.5 (0.8), respectively. The EMG-BF and control groups had mean functional scores of 80.4 (5.1) and 69.1 (6.1), respectively. The mean SLTH score for the EMG-BF group was 540.7 (51.2) and for the control group it was 509.4 (49.8) after the trial. Quadriceps muscle strength was significantly higher in those who performed quadriceps strength training at 60° of knee flexion after six weeks than in those who performed strength training at 30° or 90° of knee flexion. Conclusion The findings indicated that individuals who trained their quadriceps at a 60° knee angle had significantly stronger quadriceps muscles than individuals who trained at 30° or 90° of knee flexion. Trial Registration. This trial is registered at Clinical Trials.gov under the identifier NCT05055284.

The role of education in executive functions, behavioral problems and functional performance in people with schizophrenia.

This cross-sectional study examined the influence of education on executive functions, behavioral problems and functional performance in people with chronic schizophrenia. Our sample was composed of 116 subjects with a schizophrenia diagnosis (evolution time = 17.5 ± 9.5 years) from consecutive referrals to the Rehabilitation Unit of Benito Menni Hospital (Valladolid, Spain). All participants completed an extensive standardized protocol including a neuropsychological testing of executive functions (processing speed, working memory, inhibition, interference control, mental flexibility), the assessment of behavioral symptoms, and functional performance. Hierarchical regression models (HRMs) were carried out to determine whether education (in years) relates to executive functions after controlling for the effect of demographics, IQ, and clinical factors. Both IQ and years of education were associated with a later onset of the illness. Specifically, high education (in years) significantly correlated with fewer behavioral problems and better functional performance in daily life. Further, HRMs showed that education was associated with digit span and sematic verbal fluency tasks after controlling for the effect of age, sex, and IQ as covariates. Higher education may ameliorate executive deficits in patients with chronic schizophrenia and, in turn, diminish the behavioral and functional problems of the illness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Daily activity and functional performance in people with chronic disease: A cross-sectional study

The aim of this study was to describe the physical activity profiles, in patients with stroke, Parkinson’s disease, multiple sclerosis and rheumatoid arthritis and to investigate the association be...

Relationship Between Balance, Gait, and Activities of Daily Living in Older Adults With Dementia.

Introduction:Gait characteristics are closely associated with executive functions including basic and high-level cognitive processes such as attention, working memory, decision-making, and problem-solving. Impaired cognitive function resulting from dementia is associated with loss of balance and poor activities of daily living (ADLs). If associations between gait parameters, balance, and ADLs are observed, then quantitative gait analysis may be optimal for reinforcing balance and ADL assessments in people with dementia. This study aimed to determine the association between balance, gait, and ADLs in older adults with dementia.Materials and Methods:A cross-sectional study was conducted in 46 older adults who have been diagnosed with dementia. Measurements including the Mini-Mental Statement Examination-Korean version (MMSE-K), Berg Balance Scale (BBS), 10-meter walk test (10MWT), Modified Barthel index (MBI), and GAITRite were used to assess cognitive function, balance, walking speed, ADLs, and gait parameters, respectively. The Pearson product correlation coefficient (r) was used for correlation analysis.Results and Discussion:Among the gait parameters, velocity was positively associated with the BBS, 10MWT, and MBI (r = 0.341-0.516, P > .05). Step length (r = 0.301-0.586, P > .05), stride length (r = 0.329-0.580, P > .05), and walk ratio (r = 0.324-0.556, P > .05) were positively associated with the MMSE-K, BBS, 10MWT, and MBI. A moderate positive association between single support time and MBI was observed (r = 0.308, P = .039). Additionally, a moderate negative association between double support time and the MBI was observed (r = −0.349, P = .019). This study presents the first empirical evidence on the association between balance, gait, and ADLs in older adults with dementia.Conclusions:This study identified important associations between balance, gait, and ADL assessments in people with dementia. Further studies involving targeted interventions addressing gait parameters and improving balance and functional performance in people with dementia are required in the future.

Physical exercise training for type 3 spinal muscular atrophy.

Physical exercise training might improve muscle and cardiorespiratory function in spinal muscular atrophy (SMA). Optimization of aerobic capacity or other resources in residual muscle tissue through exercise may counteract the muscle deterioration that occurs secondary to motor neuron loss and inactivity in SMA. There is currently no evidence synthesis available on physical exercise training in people with SMA type 3. To assess the effects of physical exercise training on functional performance in people with SMA type 3, and to identify any adverse effects. On 8 May 2018, we searched the Cochrane Neuromuscular Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, AMED, and LILACS. On 25 April 2018 we searched NHSEED, DARE, and ClinicalTrials.gov and WHO ICTRP for ongoing trials. We included randomized controlled trials (RCTs) or quasi-RCTs lasting at least 12 weeks that compared physical exercise training (strength training, aerobic exercise training, or both) to placebo, standard or usual care, or another type of non-physical intervention for SMA type 3. Participants were adults and children from the age of five years with a diagnosis of SMA type 3 (Kugelberg-Welander syndrome), confirmed by genetic analysis. We used standard Cochrane methodological procedures. We included one RCT that studied the effects of a six-month, home-based, combined muscle strength and recumbent cycle ergometry training program versus usual care in 14 ambulatory people with SMA. The age range of the participants was between 10 years and 48 years. The study was evaluator-blinded, but personnel and participants could not be blinded to the intervention, which placed the results at a high risk of bias. Participants performed strength training as prescribed, but 50% of the participants did not achieve the intended aerobic exercise training regimen. The trial used change in walking distance on the six-minute walk test as a measure of function; a minimal detectable change is 24.0 m. The change from baseline to six months' follow-up in the training group (9.4 m) was not detectably different from the change in the usual care group (-0.14 m) (mean difference (MD) 9.54 m, 95% confidence interval (CI) -83.04 to 102.12; N = 12). Cardiopulmonary exercise capacity, assessed by the change from baseline to six months' follow-up in peak oxygen uptake (VO2max) was similar in the training group (-0.12 mL/kg/min) and the usual care group (-1.34 mL/kg/min) (MD 1.22 mL/kg/min, 95% CI -2.16 to 4.6; N = 12). A clinically meaningful increase in VO2max is 3.5 mL/kg/min.The trial assessed function on the Hammersmith Functional Motor Scale - Expanded (HFMSE), which has a range of possible scores from 0 to 66, with an increase of 3 or more points indicating clinically meaningful improvement. The HFMSE score in the training group increased by 2 points from baseline to six months' follow-up, with no change in the usual care group (MD 2.00, 95% CI -2.06 to 6.06; N = 12). The training group showed a slight improvement in muscle strength, expressed as the manual muscle testing (MMT) total score, which ranges from 28 (weakest) to 280 (strongest). The change from baseline in MMT total score was 6.8 in the training group compared to -5.14 in the usual care group (MD 11.94, 95% CI -3.44 to 27.32; N = 12).The trial stated that training had no statistically significant effects on fatigue and quality of life. The certainty of evidence for all outcomes was very low because of study limitations and imprecision. The study did not assess the effects of physical exercise training on physical activity levels. No study-related serious adverse events or adverse events leading to withdrawal occurred, but we cannot draw wider conclusions from this very low-certainty evidence. It is uncertain whether combined strength and aerobic exercise training is beneficial or harmful in people with SMA type 3, as the quality of evidence is very low. We need well-designed and adequately powered studies using protocols that meet international standards for the development of training interventions, in order to improve our understanding of the exercise response in people with SMA type 3 and eventually develop exercise guidelines for this condition.

Preface: Physical Fitness and Functional Performance in People with Musculoskeletal and Neurologic Disorders and Challenges to Rehabilitation in Middle-Income Countries

Preface: Physical Fitness and Functional Performance in People with Musculoskeletal and Neurologic Disorders and Challenges to Rehabilitation in Middle-Income Countries

Pharmacological interventions for apathy in Alzheimer's disease.

Despite the high prevalence of apathy in Alzheimer's disease (AD), and its harmful effects, there are currently no therapies proven to treat this symptom. Recently, a number of pharmacological therapies have been investigated as potential treatments for apathy in AD. Objective 1: To assess the safety and efficacy of pharmacotherapies for the treatment of apathy in Alzheimer's disease (AD).Objective 2: To assess the effect on apathy of pharmacotherapies investigated for other primary outcomes in the treatment of AD. We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (ALOIS), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, ClinicalTrials.gov and the World Health Organization (WHO) portal, ICTRP on 17 May 2017. Eligible studies were double-blind, randomized, placebo-controlled trials (RCTs) investigating apathy as a primary or secondary outcome in people with AD. Three review authors extracted data. We assessed the risks of bias of included studies using Cochrane methods, and the overall quality of evidence for each outcome using GRADE methods. We calculated mean difference (MD), standardized mean difference (SMD) or risk ratio (RR) with 95% confidence intervals on an intention-to-treat basis for all relevant outcome measures. We included 21 studies involving a total of 6384 participants in the quantitative analyses. Risk of bias is very low to moderate. All studies reported appropriate methods of randomization and blinding. Most studies reported appropriate methods of allocation concealment. Four studies, three with methylphenidate and one with modafinil, had a primary aim of improving apathy. In these studies, all participants had clinically significant apathy at baseline. Methylphenidate may improve apathy compared to placebo. This finding was present when apathy was assessed using the apathy evaluation scale (AES), which was used by all three studies investigating methylphenidate: MD -4.99, 95% CI -9.55 to -0.43, n = 145, 3 studies, low quality of evidence, but not when assessed with the neuropsychiatric inventory (NPI)-apathy subscale, which was used by two of the three studies investigating methylphenidate: MD -0.08, 95% CI -3.85 to 3.69, n = 85, 2 studies, low quality of evidence. As well as having potential benefits for apathy, methylphenidate probably also slightly improves cognition (MD 1.98, 95% CI 1.06 to 2.91, n = 145, 3 studies, moderate quality of evidence), and probably improves instrumental activities of daily living (MD 2.30, 95% CI 0.74 to 3.86, P = 0.004, n = 60, 1 study, moderate quality of evidence), compared to placebo. There may be no difference between methylphenidate and placebo in the risk of developing an adverse event: RR 1.28, 95% CI 0.67 to 2.42, n = 145, 3 studies, low quality of evidence. There was insufficient evidence from one very small study of modafinil to determine the effect of modafinil on apathy assessed with the FrSBe-apathy subscale: MD 0.27, 95% CI -3.51 to 4.05, n = 22, 1 study, low quality of evidence. In all other included studies, apathy was a secondary outcome and participants were not selected on the basis of clinically significant apathy at baseline. We considered the evidence on apathy from these studies to be indirect and associated with publication bias. There was low or very low quality of evidence on cholinesterase inhibitors (ChEIs) (six studies), ChEI discontinuation (one study), antipsychotics (two studies), antipsychotic discontinuation (one study), antidepressants (two studies), mibampator (one study), valproate (three studies) and semagacestat (one study). Methylphenidate may demonstrate a benefit for apathy and may have slight benefits for cognition and functional performance in people with AD, but this finding is associated with low-quality evidence. Our meta-analysis is limited by the small number of studies within each drug class, risk of bias, publication bias, imprecision and inconsistency between studies. Additional studies should be encouraged targeting people with AD with clinically significant apathy which investigate apathy as a primary outcome measure, and which have a longer duration and a larger sample size. This could increase the quality of evidence for methylphenidate, and may confirm whether or not it is an effective pharmacotherapy for apathy in AD.

Skeletal muscle training for spinal muscular atrophy type 3

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of skeletal muscle training on functional performance in people with spinal muscular atrophy (SMA) type 3 and to identify any adverse effects.

Hip abductor strength in people with knee osteoarthritis: A cross-sectional study of reliability and association with function

BackgroundTo investigate the clinical importance of hip abductor (HA) strength in people with knee osteoarthritis (OA), the purposes of this study were to 1) compare the association of HA strength and physical function to that of knee extensor (KE) strength and physical function, and 2) determine the reliability of the assessment of HA strength using a hand-held dynamometer. MethodsThirty-five individuals [58 years standard deviation 10 years old] with knee osteoarthritis participated. Physical function was assessed with performance-based [Get-Up and Go (GUG), stair climb and descent (SC), and five times chair rise (CR)] and self-reported (WOMAC function) measures. The relationship between strength and function was assessed using bivariate correlation and hierarchical multiple regression models. Reliability across sessions was assessed in 25 subjects. ResultsIn the bivariate models, both KE and HA strength were both significantly associated with performance-based measures of function, but not WOMAC function. After controlling for anthropometric factors and KE strength in the hierarchical models, HA made significant independent contributions to the prediction of GUG and SC, but not CR or WOMAC function. The reliability of HA strength was excellent (ICC2, 3=0.94; 95% CI=0.86–0.97), while the minimum detectable change (MDC95) was 0.29Nm/kg (95% CI=0.23–0.41). ConclusionHA strength can be reliably measured and is closely associated with functional performance in people with knee OA. Clinical RelevanceThese results provide preliminary evidence suggesting that HA strength may be an important rehabilitation target for the conservative management of knee OA.

Effects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis – a randomized controlled trial

Background: Stepping impairments increase fall risk in people with MS. No studies have evaluated step training for reducing fall risk in this population. Objectives: To determine if step training can improve physical and neuropsychological measures associated with falls in MS. Methods: 50 PwMS with moderate disability participated in a randomized controlled trial in which intervention group participants (n = 28) performed step training for 12 weeks while controls (n = 22) continued usual physical activity. The primary outcomes were choice stepping reaction time (CSRT) and Stroop stepping test (SST) time. Secondary outcomes included balance test (postural sway, CSRT components), gait speed and cognitive tests, nine-hole peg test (9-HPT) and MS functional composite (MSFC) score. Results: 44 participants completed the study and no adverse events were reported. Compared with the control group, the intervention group performed significantly better at retest in CSRT and SST times, and tests of sway with eyes open, 9-HPT, single and dual task gait speed and MSFC score. There was a non-significant trend for fewer falls in the intervention group. Conclusions: The findings indicate that the step training programme is feasible, safe and effective in improving stepping, standing balance, coordination and functional performance in people with MS.

Reliability in One-Repetition Maximum Performance in People with Parkinson's Disease

Strength training is an effective modality to improve muscular strength and functional performance in people with Parkinson's disease (PWP). One-repetition maximum (1-RM) is the gold standard assessment of strength; however, PWP suffer from day-to-day variations in symptom severity and performance characteristics, potentially adversely affecting the reliability of 1-RM performance. Herein, we assessed the reliability of 1-RM in PWP. Forty-six participants completed two sessions of 1-RM testing of knee extension, knee flexion, chest press, and biceps curl at least 72 hours apart. Significantly differences between testing sessions were identified for knee extension (P < 0.001), knee flexion (P = 0.042), and biceps curl (P = 0.001); however, high reliability (ICC > 0.90) was also identified between sessions. Interestingly, almost third of subjects failed to perform better on the second testing session. These findings suggest that 1-RM testing can be safely performed in PWP and that disease-related daily variability may influence 1-RM performance.

Feasibility and Impact of a Function Focused Care Intervention for Parkinson's Disease in the Community

Parkinson's disease (PD) results in a progressive loss of function such that family caregivers provide a large percentage of the personal care to PD patients living in the home setting. The aim of this study was to test the feasibility and impact of function-focused care for PD (FFC-PD) developed to optimize function and physical activity among people with PD who live in the community. This pilot study was a single-group, 2 pretest, 3 posttest repeated-measures design to investigate the impact of the FFC-PD intervention over a 12-month period. Measurements included the Self-Efficacy and Outcome Expectations for Exercise and Functional Activities, Yale Physical Activity Scale, Unified Parkinson's Disease Rating Scale, Barthel Index, Schwab & England, Timed Chair Rise, Parkinson's Disease Questionnaire-39, and Geriatric Depression Scale. The impact of FFC-PD on a person with PD showed a statistically significant increase in outcome expectations for exercise, F(3, 60) = 3.09, p = .034; hours a week exercising, F(1, 24) = 4.95, p = .004; mean weekly energy expenditure, F(2,43) = 4.32, p = .017; hours spent in overall activities, F(3, 60) = 6.06, p = .001; decreased disability based on the Unified Parkinson's Disease Rating Scale, F(2, 40) = 9.48, p < .001; improved Parkinson's Disease Questionnaire-39 score, F(3, 60) = 3.81, p = .014; and a trend toward significance on Barthel Index, F(1.6, 31) = 3.47, p = .055. Function-focused care for PD has a significant effect on increasing and on strengthening outcome expectations related to exercise, time spent in exercise, and physical activity and in improving functional performance in people with PD. Further research is needed to explore the use of objective measurements of functional performance and activity and to test FFC-PD in a randomized controlled trial.

Multisensory stimulation to improve functional performance in moderate to severe dementia--interim results.

Dementia is a growing problem worldwide and interventions to effectively manage and promote function are urgently required. Multisensory environments (MSEs) have been used extensively with people with dementia; however, no studies have been conducted to explore the efficacy of sensory stimulation on functional performance. This study explores to what extent multisensory stimulation influences functional performance in people with moderate-to-severe dementia using an MSE compared with a control activity. Thirty participants with moderate-to-severe dementia were recruited from the South of England. Following baseline assessment and design of a bespoke intervention, each participant attended their allocated intervention (3 x week, for 4 weeks). Assessments were carried out pre and postsession using the Assessment of Motor and Process Skills. Results indicate significant improvement in functional performance in both the MSE and the control activity. Findings support the use of MSEs as a strategy for enhancing functional performance in dementia.

Associations of the Stair Climb Power Test With Muscle Strength and Functional Performance in People With Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

The Stair Climb Power Test (SCPT) is a functional test associated with leg muscle power in older people. The purposes of this study were to compare the results of the SCPT in people with chronic obstructive pulmonary disease (COPD) and people who were healthy and to explore associations of the SCPT with muscle strength (force-generating capacity) and functional performance. The study was a cross-sectional investigation. Twenty-one people with COPD and a predicted mean (SD) percentage of forced expiratory volume in 1 second of 47.2 (12.9) and 21 people who were healthy and matched for age, sex, and body mass were tested with the SCPT. Knee extensor and flexor muscle torque was assessed with an isokinetic dynamometer. Functional performance was assessed with the Timed "Up & Go" Test (TUG) and the Six-Minute Walk Test (6MWT). People with COPD showed lower values on the SCPT (28%) and all torque measures (∼ 32%), except for eccentric knee flexor muscle torque. In people with COPD, performance on the TUG and 6MWT was lower by 23% and 28%, respectively. In people with COPD, the SCPT was moderately associated with knee extensor muscle isometric and eccentric torque (r ≥.46) and strongly associated (r=.68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r ≥.66); however, no significant relationship between the SCPT and measures of functional performance was found. The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings. The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT is only moderately associated with muscle torque and thus cannot be used as a simple surrogate for muscle strength in people with COPD.

Vibration therapy in multiple sclerosis: a pilot study exploring its effects on tone, muscle force, sensation and functional performance

Objective: To examine the effectiveness of whole body vibration (WBV) on tone, muscle force, sensation and functional performance in people with multiple sclerosis. Design: A randomized cross-over pilot study. Setting: Revive MS Support Therapy Centre. Glasgow, UK. Subjects: Sixteen people with multiple sclerosis were randomly allocated to one of two groups. Intervention: Group 1 received four weeks of whole body vibration plus exercise three times per week, two weeks of no intervention and then four weeks of exercise alone three times per week. Group 2 were given the two treatment interventions in the reverse order to group 1. Main measures: Ten-metre walk, Timed Up and Go Test, Modified Ashworth Scale, Multiple Sclerosis Spasticity Scale (MSSS-88), lower limb muscle force, Nottingham Sensory Assessment and Multiple Sclerosis Impact Scale (MSIS-29) were used before and after intervention. Results: The exercise programme had positive effects on muscle force and well-being, but there was insufficient evidence that the addition of whole body vibration provided any further benefit. The Modified Ashworth Scale was generally unaffected by either intervention, although, for each group, results from the MSSS-88 showed whole body vibration and exercises reduced muscle spasms (P = 0.02). Although results for the 10-m walk and Timed Up and Go Test improved, this did not reach statistical significance (P = 0.56; P = 0.70, respectively). For most subjects sensation was unaffected by whole body vibration. Conclusion: Exercise may be beneficial to those with multiple sclerosis, but there is limited evidence that the addition of whole body vibration provides any additional improvements. Further larger scale studies into the effects of whole body vibration in people with multiple sclerosis are essential.

Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study.

There has been limited study of yoga training as a complementary exercise strategy to manage the symptom of dyspnea in patients with chronic obstructive pulmonary disease (COPD). The primary purpose of this pilot study was to evaluate a yoga program for its safety, feasibility, and efficacy for decreasing dyspnea intensity (DI) and dyspnea-related distress (DD) in older adults with COPD. Clinically stable patients with COPD (n = 29; age 69.9 +/- 9.5; forced expiratory volume in 1 second (FEV(1)) 47.7 +/- 15.6% predicted; female = 21) were randomized to a 12-week yoga program specifically designed for people with COPD or usual-care control (UC). The twice-weekly yoga program included asanas (yoga postures) and visama vritti pranayama (timed breathing). Safety measure outcomes included heart rate, oxygen saturation, dyspnea, and pain. Feasibility was measured by patient-reported enjoyment, difficulty, and adherence to yoga sessions. At baseline and at 12 weeks, DI and DD were measured during incremental cycle ergometry and a 6-minute walk (6MW) test. Secondary efficacy outcomes included physical performance, psychologic well-being, and health-related quality of life (HRQoL). Yoga training was safe and feasible for patients with COPD. While yoga training had only small effects on DI after the 6MW test (effect size [ES], 0.20; p = 0.60), there were greater reductions in DD in the yoga group compared to UC (ES, 0.67; p = 0.08). Yoga training also improved 6MW distance (+71.7 +/- 21.8 feet versus -27.6 +/- 36.2 feet; ES = 0.78, p = 0.04) and self-reported functional performance (ES = 0.79, p = 0.04) compared to UC. There were small positive changes in muscle strength and HRQoL. Elderly patients with COPD participated safely in a 12-week yoga program especially designed for patients with this chronic illness. After the program, the subjects tolerated more activity with less DD and improved their functional performance. These findings need to be confirmed in a larger, more sufficiently powered efficacy study.