Economy Of Movement Research Articles

Computer-assessed performance of psychomotor skills in endoscopic otolaryngology surgery: construct validity of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST)

This study was undertaken to introduce and establish the value of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST) as a customisable, objective real-time scoring system for trainee assessment. The construct validity of the system was assessed by comparing the performance of experienced otolaryngologists with that of otolaryngology trainees, junior doctors and medical students. Forty two subjects (13 Consultants, 8 senior trainees, 13 junior trainees and 8 junior doctors/medical students) completed a single test on DEPOST. The test involved using a 30° rigid endoscope and a probe with position sensor, to identify a series of lights in a complex 3-dimensional model. The system scored subjects for time, success rate, and economy of movement (distance travelled). An analysis of variance and correlation analysis were used for the data analysis, with statistical significance set at 0.05. Increasing experience led to significantly improved performance with the DEPOST (p<0.01). Senior trainees' results were significantly better than those of consultant otolaryngologists in success rate and time (p<0.05 & p<0.05). Consultants were the most efficient in their movement (p=0.051) CONCLUSIONS: The system provides an accurate and customisable assessment of endoscopic skill in otolaryngologists. The DEPOST system has construct validity, with master surgeons and senior trainees completing the tasks more accurately without sacrificing execution time, success rate or efficiency of movement.

Randomized controlled trials: a systematic review of laparoscopic surgery and simulation-based training.

Introduction:This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs.Methods:This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand journal searches identified the studies. This current review of the literature addresses the question of whether laparoscopic simulation translates the acquisition of surgical skills to the operating room (OR).Results:This systematic review of simulation-based training and laparoscopic surgery found that specific skills could be translatable to the OR. Twenty-one studies reported learning outcomes measured in five behavioral categories: economy of movement (8 studies); suturing (3 studies); performance time (13 studies); error rates (7 studies), and global rating (7 studies).Conclusion:Simulation-based training can lead to demonstrable benefits of surgical skills in the OR environment. This review suggests that simulation-based training is an effective way to teach laparoscopic surgery skills, increase translation of laparoscopic surgery skills to the OR, and increase patient safety; however, more research should be conducted to determine if and how simulation can become apart of surgical curriculum.

Effect of spaced training with a box trainer on the acquisition and retention of basic laparoscopic skills

ObjectiveTo investigate whether basic laparoscopic skills acquired via structured spaced training on a box trainer persist after 6months. MethodsIn a prospective study undertaken at the Ege University School of Medicine (Izmir, Turkey) between January 1, 2012, and June 1, 2013, 22 gynecology residents without previous laparoscopy experience were randomly assigned (1:1) to receive training with a box trainer (1hour per week for 4weeks) or to a control group. At baseline and at 5weeks, residents’ performance was assessed via the salpingectomy module of LapSim. The box trainer group was reassessed for skills retention 6months later. ResultsThe box trainer group performed significantly better than the control group in time (P=0.01) and economy of movement (P=0.001) at the final test. Error scores did not differ significantly. Deterioration between final and retention tests in the box trainer group were recorded in time (P=0.041), instrument path length (P=0.013), and instrument angular path (P=0.075). However, time and economy of movement scores were better at the retention assessment than at baseline (P=0.008 and P=0.003, respectively). ConclusionStructured training with a box trainer improved laparoscopic skills, but deterioration was evident within 6months. This deterioration should be considered when planning laparoscopic training programs.

Emotional styles of power: corporate leaders in Finnish business media

Drawing from a growing body of research that focuses on emotions as social and cultural phenomena, this article examines how publicly performed emotions can be employed in the exercise of power. The article uses William Reddy’s ideas on emotional regimes. A qualitative analysis of Finnish business magazine Talouselämä tracks how corporate leaders have performed publicly in Finland from 1940 to 2005. I suggest that corporate capitalism developed an emotional regime of enthusiastic individualism, which challenged the previous regime of paternal managerialism. The article demonstrates how business media such as Talouselämä provided an emotional refuge that became a public platform through which rising corporate sectors could formulate the new emotional regime. The mediated performances of corporate leaders became rituals that borrowed from the affect economy of social movements and fuelled the rise of the new capitalism.

The Acquisition of Neg-V and V-Neg Order in Embedded Clauses in Swedish: A Microparametric Approach

This article examines the acquisition of embedded verb placement in Swedish children, focusing on Neg-V and V-Neg order. It is proposed that a principle of economy of movement creates an overuse of V-Neg order in embedded clauses and that the low frequency of the target-consistent Neg-V order in child-directed speech obstructs children from revising their initial hypothesis about the verb placement in embedded clauses, creating a delay in the acquisition of Neg-V. However, it is also demonstrated that, despite the lack of clear evidence for the Neg-V order in Swedish children's input, the children distinguish between different types of embedded clauses in the acquisition of Neg-V and V-Neg order already between the age of 3 and 4 years, supporting a microparametric approach to language acquisition. Comparing child-directed Swedish and child-directed German, it is further proposed that the presence of clear evidence for verb-final in the input to German children aids error-free acquisition of embedded verb placement in German.

Laparoscopic surgery skills evaluation: analysis based on accelerometers.

Background and Objective:Technical skills assessment is considered an important part of surgical training. Subjective assessment is not appropriate for training feedback, and there is now increased demand for objective assessment of surgical performance. Economy of movement has been proposed as an excellent alternative for this purpose. The investigators describe a readily available method to evaluate surgical skills through motion analysis using accelerometers in Apple's iPod Touch device.Methods:Two groups of individuals with different minimally invasive surgery skill levels (experts and novices) were evaluated. Each group was asked to perform a given task with an iPod Touch placed on the dominant-hand wrist. The Accelerometer Data Pro application makes it possible to obtain movement-related data detected by the accelerometers. Average acceleration and maximum acceleration for each axis (x, y, and z) were determined and compared.Results:The analysis of average acceleration and maximum acceleration showed statistically significant differences between groups on both the y (P = .04, P = .03) and z (P = .04, P = .04) axes. This demonstrates the ability to distinguish between experts and novices. The analysis of the x axis showed no significant differences between groups, which could be explained by the fact that the task involves few movements on this axis.Conclusion:Accelerometer-based motion analysis is a useful tool to evaluate laparoscopic skill development of surgeons and should be used in training programs. Validation of this device in an in vivo setting is a research goal of the investigators' team.

Contributions of lower extremity kinematics to trunk accelerations during moderate treadmill running.

BackgroundTrunk accelerations during running provide useful information about movement economy and injury risk. However, there is a lack of data regarding the key biomechanical contributors to these accelerations. The purpose was to establish the biomechanical variables associated with root mean square (RMS) accelerations of the trunk.MethodsEighteen healthy males (24.0 ± 4.2 yr; 1.78 ± 0.07 m; 79.7 ± 14.8 kg) performed treadmill running with high resolution accelerometer measurement at the lumbar spine and full-body optical motion capture. We collected 60 sec of data at three speeds (2.22, 2.78, 3.33 m∙s−1). RMS was calculated for medio-lateral (ML), anterio-posterior (AP), vertical (VT), and the resultant Euclidean scalar (RES) acceleration. From motion capture, we calculated 14 kinematic variables, including mean sagittal plane joint angles at foot contact, mid-stance, and toe-off. Principal components analysis (PCA) was used to form independent components comprised of combinations of the original variables. Stepwise regressions were performed on the original variables and the components to determine contributions to RMS acceleration in each axis.ResultsSignificant speed effects were found for RMS-accelerations in all axes (p < 0.05). Regressions of the original variables indicated from 4 to 5 variables associated with accelerations in each axis (R2 = 0.71 to 0.82, p < 0.001). The most prominent contributing variables were associated with the late flight and early stance phase. PCA reduced the data into four components. Component 1 included all hip angles before mid-stance and component 2 was primarily associated with propulsion. Regressions indicated key contributions from components 1 and 2 to ML, VT, and RES acceleration (p < 0.05).ConclusionsThe variables with highest contribution were prior to mid-stance and mechanically relate to shock absorption and attenuation of peak forces. Trunk acceleration magnitude is associated with global running variables, ranging from energy expenditure to forces lending to the mechanics of injury. These data begin to delineate running gait events and offer relationships of running mechanics to those structures more proximal in the kinetic chain. These relationships may provide insight for technique modification to maximize running economy or prevent injury.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-162) contains supplementary material, which is available to authorized users.

Marksizm i socjalizm w XXI wieku

The collapse of „real socialism” in b. The USSR and European countries in the 90s of the twentieth century strengthened the counter-revolution, global capitalism and imperialism. Capitalism has entered the era of globalization and subsequent crises that overcomes in Europe through integration, while globally by a new wars. The contradictions of the capitalist, big unemployment, crises, wars and class antagonisms between the bourgeoisie (oligarchy) and the proletariat (prekariatem), the imperialist states and the countries of the so-called. 3rd world contribute to the growth of anti-capitalist forces, including the international communist movement and the search for a new intake of scientific socialism – suitable for the conditions of the knowledge society, globalization and the contradictions of the 21st century. In China and Cuba created new theories which Marxism matched to local conditions for growth. In the international communist movement takes place a multilateral discussion on contemporary Marxism and socialism of the XXI century. The basic problem is to define the main force of the revolutionary, socialist market economy, diversity and unity of the communist movement, the possibility of unity and cooperation communists, socialists and social democrats.

Specific muscle-tendon architecture in elite Kenyan distance runners.

The Achilles tendon moment arm (MA_AT) and foot lever ratio (FLR) can play important roles for force production and movement economy during locomotion. This notion has become more relevant, and suggestion has been given that the Kenyan runners belonging to the world elite would have specific anatomical, mechanical, and functional properties in their lower limbs and that this feature could be responsible for their high running economy. The present study aimed to characterize the AT of elite Kenyan distance runners as compared with Japanese ones, and to examine the potential relationship with their running performance. Ultrasonography was used to measure AT cross-sectional area and AT soleus and gastrocnemius lengths. MA_AT and FLR were calculated from the position of anatomical landmarks using sagittal plane photographs. MA_AT was significantly longer and the FLR lower in Kenyans than in Japanese. Independently of the group, the running performance was positively related to the MA_AT (r = 0.55, P < 0.001) and negatively to the FLR (r = -0.45, P = 0.002). These results suggest that longer MA_AT and lower FLR could be advantageous in elite Kenyan runners, by contributing to effective endurance running performance in a protective and economical way.

Special issue on medical simulation

We would like to welcome you to this Special Issue on Medical Simulation, the first of its kind not only for SIMULATION: Transactions of The Society for Modeling and Simulation International, but for any technical journal. Our respective backgrounds are an indication of the technical and clinical breadth of medical simulation, as we approach the subject as primarily medical image analysis and biomechanics experts respectively, each with a variety of clinical interests spanning virtual reality (VR)–based neuro-, orthopedic and ear-nose-and-throat surgery. Moreover, we believe that the breadth of the papers that comprise this issue reflects an even broader perspective. After all, medical simulation can be seen as encompassing mannequin-based training, as well as nonsurgical areas such as pharmacological and physiological modeling, the latter of which is increasingly multi-scale and integrative. One of the most compelling reasons for publishing an issue dedicated to medical simulation, and for emphasizing this area on a regular basis within the journal SIMULATION, is its inherently open-ended aspect. After all, if we view the current state of medical modeling and simulation (M&S), especially interactive M&S for training, in terms of the degree of its penetration in comparison with the amount of material that must be covered in medical school and in most residency programs, there is a large amount of research still left to be done. Moreover, medical M&S is also characterized by conflicting requirements that will have to be resolved for it to make a serious dent in the requirements of these programs. For example, VR-based medical M&S will require therapy models (e.g., cutting and resection models) that reconcile real-time interactivity with realistic, nonlinear tissue response. It will also need a methodology for generating patient-specific anatomical models of sufficient descriptiveness to meet the exacting requirements of senior clinicians, which entails dealing with another set of conflicting requirements: The need to keep a ceiling on the element count in a simulation, which entails large elements, versus the need to account for critical tissues, which presupposes small elements. New methodologies will have to be perfected for both specifying requirements and validation, in a manner that leads to meaningful simulation-based training that is predictive of future caseloads. From a requirements standpoint, we will have to exploit methods for specifying what goes on in a surgical intervention or medical process in a manner that leads to broadly usable top-down requirements analysis, which in turn may contrast with the artful aspect of clinical or surgical practice. From a validation standpoint, it may not be enough to merely distinguish between expert and novice clinicians, since the economy of movement of the expert in his or her surgical gestures immediately comes into play as soon as we integrate a haptic device into the simulation. As described in the call for papers, the clinical need that justifies pursuing medical simulation with a strong predictive aspect lies in two marked tendencies in modern clinical practice: the compression of training schedules of residents and the constant influx of new therapeutic technologies. Recent compressions in training can adversely affect the development of clinical skill, particularly in the traditional framework whereby residents observe senior clinicians and gradually assume responsibility. Interactive medical simulation can provide a means for accelerating resident training, allowing junior clinicians to take a more active role than in the traditional framework, which can result in measurable improvements to both skill and patient outcome. Increasingly however, if we are successful in reconciling difficult conflicts in requirements (such as interactivity and complex tissue response), we will find that the market for simulation is not merely medical schools looking to train students and residents, but all clinicians who are interested in a patient-specific dynamic exercise in surgical planning, in a manner that leads to finding the best among competing options, for example the surgical path that best spares eloquent and critical tissues to get to a tumor.

The moral economy of the UK student protest movement 2010–2011

The winter of 2010 through to the spring of 2011 saw a number of high profile, nationally and locally organised student protests and occupations of university campuses all around the UK. These were a direct response to the UK government policy to lift the cap on higher education (HE) tuition fees and the reduction in government funding for HE institutions in England. To explain this revolt, I draw on the work of Thompson [1971. The moral economy of the English crowd in the 18th century. Past & Present, 50, 76–136; 1993. Customs in common: Studies in traditional popular culture. New York, NY: New Press] to argue that they were a ‘moral economy’ of protests. This paper draws on a two-and-a-half-year ethnographic study of the student political community. I argue that the student community have mobilised in defence of an embedded tradition – affordable HE – and that they are politically motivated by what they consider to be an entitlement violation.

Test–Retest Reliability of Portable Metabolic Monitoring After Disabling Stroke

Purpose. Impaired economy of gait, prevalent in chronic stroke secondary to residual gait deficits, is associated with intolerance for performing activities of daily living. Gait economy/efficiency is traditionally assessed by determining the rate of oxygen consumption during submaximal treadmill walking. However, the mechanics and energetics of treadmill versus overground walking are very different in stroke survivors with ambulatory deficits. Clearly, overground cardiopulmonary measures are needed to accurately profile movement economy after stroke. An obstacle to obtaining such measures after stroke has been the absence of reliable portable metabolic monitoring equipment. The purpose of this study was to establish the test–retest reliability of a portable metabolic monitoring device during overground walking in hemiparetic stroke survivors. Methods. Twenty-three chronic hemiparetic stroke survivors underwent two 6-minute walk tests while wearing a COSMED K4b2 portable metabolic measurement system. Intraclass correlations coefficients (ICC) were calculated for both cardiopulmonary parameters and distance covered to determine test–retest reliability. An ICC of ≥0.85 was considered reliable. Results. ICCs for relative Vo2 (0.90), absolute Vo2 (0.93), Vco2 (0.93), and minute ventilation (0.95) demonstrated high reliability, but not for heart rate (0.76) or respiratory exchange ratio (0.64). There was no significant difference in the distance each participant walked between the first and second tests, eliminating distance as a potential confounder of our analyses (ICC = 0.99). Conclusions. Our results strongly support the reliability of the K4b2 for quantifying overground gait efficiency after stroke. Use of this device may enable researchers to study how varying poststroke rehabilitation interventions affect this central measure of health and function.

Validating the Use of Smartphone-Based Accelerometers for Performance Assessment in a Simulated Neurosurgical Task

Reductions in working hours affect training opportunities for surgeons. Surgical simulation is increasingly proposed to help bridge the resultant training gap. For simulation training to translate effectively into the operating theater, acquisition of technical proficiency must be objectively assessed. Evaluating "economy of movement" is one way to achieve this. We sought to validate a practical and economical method of assessing economy of movement during a simulated task. We hypothesized that accelerometers, found in smartphones, provide quantitative, objective feedback when attached to a neurosurgeon's wrists. Subjects (n = 25) included consultants, senior registrars, junior registrars, junior doctors, and medical students. Total resultant acceleration (TRA), average resultant acceleration, and movements with acceleration >0.6g (suprathreshold acceleration events) were recorded while subjects performed a simulated dural closure task. Students recorded an average TRA 97.0 ± 31.2 ms higher than senior registrars (P = .03) and 103 ± 31.2 ms higher than consultants (P = .02). Similarly, junior doctors accrued an average TRA 181 ± 31.2 ms higher than senior registrars (P < .001) and 187 ± 31.2 ms higher than consultants (P < .001). Significant correlations were observed between surgical outcome (as measured by quality of dural closure) and both TRA (r = .44, P < .001) and number of suprathreshold acceleration events (r = .33, P < .001). TRA (219 ± 66.6 ms; P = .01) and number of suprathreshold acceleration events (127 ± 42.5; P = .02) dropped between the first and fourth trials for junior doctors, suggesting procedural learning. TRA was 45.4 ± 17.1 ms higher in the dominant hand for students (P = .04) and 57.2 ± 17.1 ms for junior doctors (P = .005), contrasting with even TRA distribution between hands (acquired ambidexterity) in senior groups. Data from smartphone-based accelerometers show construct validity as an adjunct for assessing technical performance during simulation training.

Why does child trafficking policy need to be reformed? The moral economy of children's movement in Benin and Ethiopia

This paper challenges policy discourses that frame children's independent movement as intrinsically exploitative and threatening to their development. Drawing on research with children and adults in Benin and Ethiopia, two countries caught up in current efforts to eradicate child migration and the trafficking with which it has become associated, the paper critiques assumptions about children's vulnerability and physical dependence and contests the idea that appropriate childhood is necessarily fixed spatially within stable family structures. It, thus, situates children's migration within socio-cultural and economic contexts and suggests that it should be understood as part of a moral economy that confounds simplistic paradigms that conflate migration with trafficking. Policy suggestions are offered for how best to secure children's well-being through acknowledgement of the important relationship between mobility and child maturation.

Virtual Reality Robotic Surgical Simulation: An Analysis of Gynecology Trainees

To analyze the learning curves of gynecology trainees on several virtual reality da Vinci Skills Simulator exercises. Prospective cohort pilot study. Academic hospital-based gynecology training program. Novice robotic surgeons from a gynecology training program. Novice robotic surgeons from an academic gynecology training program completed 10 repetitions of 4 exercises on the da Vinci Skills Simulator: matchboard, ring and rail, suture sponge, and energy switching. Performance metrics measured included time to completion, economy of instrument movement, excessive force, collisions, master workspace range, missed targets, misapplied energy, critical errors, and overall score. Statistical analyses were conducted to define the learning curve for trainees and the optimal number of repetitions for each exercise. A total of 34 participants were enrolled, of which 9 were medical students, 22 were residents, and 3 were fellows. There was a significant improvement in performance between the 1st and 10th repetitions across multiple metrics for all exercises. Senior trainees performed the suture exercise significantly faster than the junior trainees during the first and last repetitions (p = 0.004 and p = 0.003, respectively). However, the performance gap between seniors and juniors narrowed significantly by the 10th repetition. The mean number of repetitions required to achieve performance plateau ranged from 6.4 to 9.3. Virtual reality robotic simulation improves ability through repetition at all levels of training. Further, a performance plateau may exist during a single training session. Larger studies are needed to further define the most high-yield simulator exercises, the ideal number of repetitions, and recommended intervals between training sessions to improve operative performance.

Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii

Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo(®) Wii™ and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training. This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentor™ Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05. Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved left-handed economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6. This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic surgical skills.

ALTERG: AN INNOVATIVE TECHNOLOGY IN PHYSICAL ACTIVE REHABILITATION OF SPINAL STENOSIS

BackgroundLumbal spinal stenosis causes back pain spreading as far as the legs and thereby constrains the activities of daily living. By walking in a flexed position patients try to extend...

Relação entre índices fisiológicos aeróbios e desempenho em provas de curta e média

Few studies allow usto verify which physiological responses are associated with performance in anational elite cycling group. Therefore, this study aimed to determine and correlate various physiological and aerobic indices with performance in 4 and 20 km time trials in high-level cyclists. The sample consisted of 14 male professional cyclists of the national elite group (28.5 ± 4.7 years old, 73.47 ± 8.29 kg, 176 ± 6.76cm), who performed a progressive test in laboratory to determine maximal oxygen consumption (VO2max: 62.23 ± 8.28 ml•kg-1•min-1), intensity relative to VO2max (iVO2max: 500.83 ± 58.65w), movement economy (EM: 0.1166 ± 0.0362 ml•kg•min•w-1), and the first and second ventilatory threshold (LV1: 348.21 ±43.26 w; LV2: 417.86 ± 60.79 w, respectively). They also performed two time trial performance tests of 4 and 20km. For the correlation between physiological indices and trial performance, Pearson correlation coefficient (p< 0.05) was used. No correlation was found between the physiological indices (VO2max absolute and relative, iVO2max, EM, LV1 and LV2) and performance in 4 km (r= 0.38; 0.16; -0.33; 0.20; -0.50; -0.20, respectively) and 20 km (r= 0.24; 0.01; -0.13; -0.12; -0.48; -0.19, respectively) time trialin high level athletes. These results suggest that these variables are not able to explain the performance in time trials in the respective lengths, probably due to the subjects’ homogeneity.

Effects of night-float and 24-h call on resident psychomotor performance

IntroductionNight-float work schedules were designed to address growing concerns of the affect of fatigue on resident psychomotor and cognitive skills after traditional 24-h call work schedules. Whether this transition has achieved these results is debatable. This study was designed to compare the psychomotor performance of general surgery residents on both work schedule types. We hypothesized that when measured with novel laparoscopic simulator tasks, residents on a 24-h call schedule would exhibit worse psychomotor performance compared with those on a night-float work schedule. MethodsNine general surgery residents at the post-graduate year (PGY) 2, 3, and 5 levels were recruited and trained on the Simbionix LAP Mentor Simulator (Simbionix, Cleveland, OH). Performance on two tasks was tested before and after a 24-h call work shift and a night-float shift. A survey assessing levels of work shift activity and fatigue were administered after all work shifts. ResultsThere was no statistically significant difference in resident accuracy, speed of movement, economy of movement, and time to completion of the two simulation tasks. The only measures of work shift activity achieving statistically significant difference were number of patients seen and numbers of steps walked on call. There was no statistically significant difference in subjective evaluation of fatigue. ConclusionsIn this study of general surgery residents, a statistically significant difference in psychomotor performance between residents working 24-h call shift versus a 12-h night-float shift could not be found. Psychomotor performance does not appear to suffer after a work shift. Additionally, post-shift subjective evaluations of fatigue are comparable regardless of shift type.

Abstract WP317: High Metabolic Cost of Mobility and Balance Activities in Individuals Post-Stroke

Purpose: Metabolic cost of walking at a comfortable speed for individuals post-stroke is higher than for healthy individuals. However, metabolic cost of other activities, relevant for community activity, such as transfer from sitting to standing and walking over obstacles, has not been reported. Hence, the aim of this study was to measure metabolic cost of mobility and balance activities for individuals post-stroke, and to assess the hypothesis that it will be higher than for healthy individuals. Methods: Eleven post-stroke (7 men, age 49.5±12.2), and 8 healthy (3 men, age 46.8±6.7) individuals of comparable height and weight participated in the study. Gait speed was measured and motor impairment was evaluated using the Fugl-Meyer test. Four activities were tested for their metabolic cost; walking at a comfortable speed, walking over an obstacle course, sit to walk and standing on balance foam while reaching forward. Each activity was performed repeatedly for 8 minutes, while metabolic measures were recorded. In addition, distance covered, or number of repetitions completed, during the activity were recorded. Metabolic cost of each activity was calculated by dividing the mean oxygen consumption of the last four minutes of the activity by the number of repetitions or walking speed. Results: The Fugl-Meyer scores for post-stroke individuals for lower and upper extremities were 23.6±6.5 and 43.6±19.3 respectively. Comfortable gait speed was 0.8±0.3 m/sec. for post-stroke and 1.4±0.1 m/sec. for healthy individuals. Groups were not significantly different in weight and height. Metabolic cost and between-group comparisons are shown in the table. Conclusion: The metabolic cost of the activities was significantly higher for individuals post stroke than for healthy, suggesting that rehabilitation programs should aim to improve economy of movement.