Use Of Handrails Research Articles

Identifying demographic and home features influencing older adults’ home functioning by using machine learning models

This study aimed to identify demographic and housing features associated with functional difficulties experienced by older adults in their homes. Individuals aged ≥ 65 years who completed American Housing Survey (AHS) questionnaires. We selected one random person per household and excluded participants with missing data for the 12 AHS functional challenge items. Multiple machine learning models were compared to identify the best-performing model, which was then used to analyze the impact of demographic and housing features on older adults' functional difficulties at home. The random forest model was selected for its preferred predictive performance (accuracy: 85.8%, sensitivity: 94.4%, specificity: 60.2%, precision: 87.6%, and negative predictive value: 78.2%). The top five variables that significantly influenced the model were: 1) walking disability, 2) presence or use of a cane or walker, 3) presence or use of handrails or grab bars in the bathroom, 4) go-outside-home disability, and 5) self-care disability. These variables had a stronger impact on the model than the householder's health and age. Home modifications and environmental adaptations may be critical in enhancing functional abilities and independence among older adults. These findings could inform the development of interventions that promote safe and accessible living environments for older adults, thereby improving their quality of life.

Experimental data about the evacuation of preschool children from nursery schools, Part II: Movement characteristics and behaviour

This article presents experimental data sets about the evacuation movement and behaviour of preschool children observed during 15 evacuation drills in 10 nursery schools in the Czech Republic involving 970 children (3–7 years of age) and 87 staff members. The movement characteristics and behaviour of the children were studied in 100 measurement areas defined on evacuation routes in corridors, on staircases, and in doorways. A total of 23000 data points were gathered to investigate travel speeds, specific flows, densities, and their relationships, as well as movement behaviour and procedures during the evacuation drills. Variables of interest included the levels of physical assistance provided to children, hand holding behaviour, use of handrails, and footstep patterns on staircases (i.e., “marking time” patterns). The observations revealed that the movement characteristics of preschool-age children were age-dependent. On horizontal routes, higher travel speeds were measured in corridors (mean value 1.9 m s−1) than for landings of straight staircases (mean value 0.96 m s−1) and doorways (mean value 0.99 m s−1). Nine behavioural statements summarising the evacuation movement behaviour of preschool children observed in this study are presented in order to enrich future applicability of the findings in engineering applications (e.g., evacuation modelling).

Postural Control Strategies in Standing With Handrail Support and Active Assistance From Robotic Upright Stand Trainer (RobUST).

In people with severe neuromotor deficits of trunk and lower extremities, regaining balance in standing is often performed in rehabilitation with manual assistance, rigid body supports or by the use of handrails. To investigate and further expand postural control training in standing, we developed a Robotic Upright Stand Trainer (RobUST). In this study, we used RobUST to deliver trunk perturbations while simultaneously providing postural assistive forces on the pelvis in 10 able-bodied adults. Posture control responses with 'pelvic support' was then compared to 'no support' and 'hand supported' standing, with and without assistance from RobUST. We characterize postural imbalance with kinematic displacements and center of pressure (COP) outcomes, such as amplitude and root mean square of the excursions of COP. Surface electromyography (sEMG) was also applied to investigate muscle control. We additionally investigated ground reaction and handrail forces during standing to analyze how postural strategies and muscle mechanisms with 'pelvic support' via RobUST would differ from standing with 'no support' and with the 'handrail support'. Our results show that during perturbations, pelvic assistive support decreased kinematic and COP excursions compared to standing with no support. The pelvic assistance from RobUST showed similar level of COP changes as the use of handrail support but without reducing muscle activity or ground reaction forces. As expected, the maximum level of postural stability was observed when participants used the handrail and received pelvic assistive forces. In conclusion, RobUST demonstrates potential as a training device since it enhances postural balance without significantly removing muscular control mechanisms that are of interest in re-training postural control strategies in standing.

What are the perceptions of staff who work in, and professionals who advise on the design of, Australian aged care facilities on the value and use of handrails in corridors?

To investigate the perceived value of handrails and how they are used in Australian aged care facilities (ACFs). Such information aims to contribute to the body of knowledge available about handrails, their design features and application. This study adopted a descriptive cross-sectional research design. Online surveys were distributed to members of Australian professional networks, collecting information about handrail use, mobility supports and handrail design in ACFs. There were 112 participants (80% female), aged 18-55years or older. Many identified that handrails in ACF corridors are used by a residents, staff and visitors, and that circular-shaped handrails should be installed in ACF corridors to assist with mobility and safety. Handrails in ACF corridors offer an alternate support to those who experience an unexpected loss of balance and those without or unable to use a mobility aid, ultimately enabling users' mobility and assisting staff to carry out work duties.

Extending the center of pressure to incorporate handhold forces: Derivation and sample application

Measures describing movement of the center of pressure (CoP) are frequently used to characterize postural control. Estimates of CoP often focus on forces that individuals exert in a single plane through the feet (standing on force plates). However, balance may also be supported by forces other than those developed at the feet, especially when walkers, handrails, and other aids are used. In these cases, it is common to neglect the contributions of handheld supports. Here, we derive and apply equations for an extended CoP that incorporates handhold forces. We then examine the influence of CoP definition (i.e., including or ignoring handhold forces) on common metrics (path length; RMS and maximum excursion; average and maximum velocity) for 12 younger adults with a handrail located lateral to the participants’ dominant hand. Participants attempted balance recovery in response to a range of small, medium and large forward and backward platform translations. Significant interactions between perturbation magnitude and CoP definition were found for most metrics. Notably, the interaction of CoP definition and perturbation magnitude significantly affected path length (p-values < 0.001). Post-hoc analyses revealed larger CoP path length when handrail forces were incorporated in CoP estimates compared to ignoring handrail forces at medium (backward: 59.9 vs. 19.0% height; forward: 70.5 vs 22.4% height) and large perturbation magnitudes (backward: 69.9 vs 22.4% height; forward: 103.5 vs 24.6% height). Incorporation of hand forces in CoP calculations can present a different view of postural balance control than relying on a feet-only CoP. This measure could be useful in assessing balance control tasks that involve the use of handrails or hand-held mobility devices.

Impact of a Half Dome Cable Permitting Process on Search and Rescue Activity, Hiker Mortality Rates, and Operational Costs Above Little Yosemite Valley

The summit of Yosemite's Half Dome is reached using cable handrails for the final 146 m (480 ft). Access to these cables was restricted to users with permits in 2010. The authors aim to describe the impact of permitting on search and rescue (SAR) in the region of the park most affected by permitting. An observational study from 2005 to 2009 and 2011 to 2015 comparing the number of incidents, major incidents (exceeding $500), victims, and fatalities before and after permitting the use of cable handrails on Half Dome in the area above Little Yosemite Valley (LYV) and parkwide. Each year was analyzed separately with t tests and Mann-Whitney U tests. Data are presented as mean±SD. The number of hikers in the study area was reduced by up to 66% by permitting. Above LYV from 2005 to 2009, there were 85 SAR incidents, 134 victims, 8 fatalities, 38 major incidents, and annual SAR costs of $44,582±28,972. From 2011 to 2015, the same area saw 54 SAR incidents, 156 victims, 4 fatalities, 35 major incidents, and annual SAR costs of $27,027±19,586. No parameter showed statistical significance. Parkwide SAR incidents decreased from 232 to 198 annual incidents (P=0.013) during the same time period, with parkwide mortality increasing from 8 to 12 deaths annually (P=0.045). SAR incidents, victims, fatalities, or costs above LYV did not decrease after cable handrail permitting. Parkwide SAR activity decreased during the same intervals. This strongly suggests that overcrowding is not the key factor influencing safety on Half Dome. This discordant trend warrants close observation over 5 to 10 y.

Use of handrails for balance and stability: Characterizing loading profiles in younger adults

Well-designed handrails significantly enhance balance recovery, by allowing users to apply high forces to the rail and stabilize their center of mass. However, data on user-applied handrail forces during balance recovery are limited. We characterized the peak forces that 50 young adults applied to a handrail during forward and backward falling motions; quantified effects of handrail height (34, 38, 42 inches) and position prior to balance loss (standing beside the rail with or without hand contact, or facing the handrail with two-handed contact); and examined the relationship between handrail forces and individual mass. The testing environment consisted of a robotic platform that translated rapidly to destabilize participants, and a height-adjustable handrail that was mounted to the platform. Our findings support our hypotheses that starting position and handrail height significantly affect peak handrail forces in most axes. The highest handrail forces were applied when participants faced the handrail and grasped with two hands. In these cases, increased handrail height was associated with increased anterior forces and decreased downward, upward and resultant forces. As hypothesized, peak handrail forces correlated strongly with individual weight in most axes. Implications of these findings for handrail design are discussed.

Walking and balance outcomes for stroke survivors: a randomized clinical trial comparing body-weight-supported treadmill training with versus without challenging mobility skills

BackgroundTreadmill training, with or without body-weight support (BWSTT), typically involves high step count, faster walking speed, and higher heart-rate intensity than overground walking training. The addition of challenging mobility skill practice may offer increased opportunities to improve walking and balance skills. Here we compare walking and balance outcomes of chronic stroke survivors performing BWSTT with BWSTT including challenging mobility skills.MethodsSingle-blind randomized clinical trial comparing two BWSTT interventions performed in a rehabilitation research laboratory facility over 6 weeks. Participants were 18+ years of age with chronic (≥5 months) poststroke hemiparesis due to a cortical or subcortical ischemic or hemorrhagic stroke and walking speeds < 1.1 m/s at baseline. A hands-free group (HF; n = 15) performed BWSTT without assistance from handrails or assistive devices, and a hands-free plus challenge group (HF + C; n = 14) performed the same protocol while additionally practicing challenging mobility skills. The primary outcome was change in comfortable walking speed (CWS), with secondary outcomes of fast walk speed (FWS), six-minute walk distance, Berg Balance Scale (BBS) scores, and Activities Specific Balance Confidence (ABC) scores.ResultsSignificant pre-post improvement of CWS (Z = − 4.2, p ≤ 0.0001) from a median of 0.35 m/s (range 0.10 to 1.09) to a median of 0.54 m/s (range 0.1 to 1.17), but no difference observed between groups (U = 96.0, p = 0.69). Pre-post improvements across all participants resulted in reclassified baseline ambulation status from sixteen to ten household ambulators, three to seven limited community ambulators, and ten to twelve community ambulators. Secondary outcomes showed similar pre-post improvements with no between-group differences.ConclusionsThe addition of challenging mobility skills to a hands-free BWSTT protocol did not lead to greater improvements in CWS following 6 weeks of training. One reason for lack of group differences may be that both groups were adequately challenged by walking in an active, self-driven treadmill environment without use of handrails or assistive devices.Trial registrationNCT02787759 Falls-based Training for Walking Post-Stroke (FBT); retrospectively registered June 1st, 2016.

Treadmill training and body weight support for walking after stroke.

Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of the Cochrane review first published in 2003 and updated in 2005 and 2014. To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait-training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. We searched the Cochrane Stroke Group Trials Register (last searched 14 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (the Cochrane Library 2017, Issue 2), MEDLINE (1966 to 14 February 2017), Embase (1980 to 14 February 2017), CINAHL (1982 to 14 February 2017), AMED (1985 to 14 February 2017) and SPORTDiscus (1949 to 14 February 2017). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists, and contacted trialists to identify further trials. Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. Two review authors independently selected trials, extracted data, and assessed risk of bias and methodological quality. The primary outcomes investigated were walking speed, endurance, and dependency. We included 56 trials with 3105 participants in this updated review. The average age of the participants was 60 years, and the studies were carried out in both inpatient and outpatient settings. All participants had at least some walking difficulties and many could not walk without assistance. Overall, the use of treadmill training did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; 18 trials, 1210 participants; P = 0.94; I² = 0%; low-quality evidence). Overall, the use of treadmill training in walking rehabilitation for people after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.06 m/s (95% CI 0.03 to 0.09; 47 trials, 2323 participants; P < 0.0001; I² = 44%; moderate-quality evidence) and the pooled MD for walking endurance was 14.19 metres (95% CI 2.92 to 25.46; 28 trials, 1680 participants; P = 0.01; I² = 27%; moderate-quality evidence). Overall, the use of treadmill training with body weight support in walking rehabilitation for people after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up. The pooled MD (random-effects model) for walking velocity was 0.03 m/s (95% CI -0.05 to 0.10; 12 trials, 954 participants; P = 0.50; I² = 55%; low-quality evidence) and the pooled MD for walking endurance was 21.64 metres (95% CI -4.70 to 47.98; 10 trials, 882 participants; P = 0.11; I² = 47%; low-quality evidence). In 38 studies with a total of 1571 participants who were independent in walking at study onset, the use of treadmill training increased the walking velocity significantly. The pooled MD (random-effects model) for walking velocity was 0.08 m/s (95% CI 0.05 to 0.12; P < 0.00001; I2 = 49%). There were insufficient data to comment on any effects on quality of life or activities of daily living. Adverse events and dropouts did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. Overall, people after stroke who receive treadmill training, with or without body weight support, are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve slightly in the short term. Specifically, people with stroke who are able to walk (but not people who are dependent in walking at start of treatment) appear to benefit most from this type of intervention with regard to walking speed and walking endurance. This review did not find, however, that improvements in walking speed and endurance may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations, or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory participants, but not in dependent walkers.

An observational comparison of the older and younger bus passenger experience in a developing world city

This study was an unobtrusive observational analysis of 333 older and younger bus passengers in Guadalajara, Mexico. A set of data were collected for each observed passenger, as well as more general observations related to driver behaviour, bus design and bus service characteristics. There were significant differences between older and younger passengers in terms of boarding and alighting times, use of handrails, seat location preferences, passenger stability and coping strategies in order to maintain postural stability. The conditions of travel are conducive to a poor passenger experience for the older passengers in particular. Although the problems may be attributed to bus design and driver behaviour typical of that in developing countries, they are also influenced by the wider transport infrastructure, and a lack of a regulatory regime which places drivers under time pressure and in direct competition with each other.Practitioner Summary: Bus services must cater for all ages of passengers, including the elderly. This unobtrusive observational study investigated the passenger experience in a developing world city. Bus and wider service design were found to compromise the journey experience, with the older users being particularly negatively impacted. Design recommendations are provided.

Effect of handrail use while performing treadmill walking on the gait of stroke patients.

[Purpose] The purpose of this study was to investigate how the use of handrails during treadmill walking affects the gait parameters of stroke patients. [Subjects and Methods] The participants, 30 hemiplegic stroke patients, were randomly allocated to one of three groups: the NHG group (No Handrail group, n=10), the FHG group (Front handrail group, n=10), and BHG group (Bilateral Handrail group, n=10). All the subjects’ performed treadmill walking for 30 min, five days a week, for a period of eight weeks. Gait parameters were evaluated using the RS-scan system. [Results] A statistically significant difference in the HM (heel-medial) area of plantar foot pressure was observed between BHG and NHG. Statistically significant difference in the HL (heel-lateral) area of plantar foot pressure was observed between BHG and NHG, and between FHG and NHG. A statistically significant difference in contact area of the rear foot was observed between BHG and NHG. [Conclusion] The results of this study show that holding handrails during treadmill training may enhance the improvement in the quality of patients’ gait (plantar foot pressure, contact area of foot).

WIND TUNNEL TEST FOR CALCULATING WIND FORCES ON SCAFFOLDS WITH BASEBOARD HEIGHT AS A PARAMETER

The Japanese Industrial Safety and Health Law was revised in March 2009 to introduce new measures concerning accidental falls in the construction industry. This revision mandates the use of guard rails, handrails, and other scaffold components. The wind load criteria and structural specifications of scaffolds are regulated by current design codes. Nevertheless, these provisions do not necessarily comply with the newly incorporated legal requirements because they apply to old-style scaffolds. This study examined the wind force on scaffolds by wind tunnel test, with baseboard height used as a parameter. The wind force coefficient of one story of scaffolds was calculated. Wind force coefficient increased as baseboard height increased. The wind force on the scaffolds equipped with baseboards is 9.2 times that on the scaffolds without baseboards. The baseboard must be greater than or equal to 15 cm to satisfy regulation requirements. The wind force coefficient of scaffolds with a 15 cm baseboard is 1.5 times that of the scaffolds without a baseboard. In scaffold design, baseboard height should be considered to guarantee a suitable wind force coefficient.

Treadmill training and body weight support for walking after stroke.

Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane review first published in 2005. To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. We searched the Cochrane Stroke Group Trials Register (last searched June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (The Cochrane Library 2013, Issue 7), MEDLINE (1966 to July 2013), EMBASE (1980 to July 2013), CINAHL (1982 to June 2013), AMED (1985 to July 2013) and SPORTDiscus (1949 to June 2013). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists and contacted trialists to identify further trials. Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. Two authors independently selected trials, extracted data and assessed methodological quality. The primary outcomes investigated were walking speed, endurance and dependency. We included 44 trials with 2658 participants in this updated review. Overall, the use of treadmill training with body weight support did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; P = 0.94; I² = 0%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.07 m/s (95% CI 0.01 to 0.12; P = 0.02; I² = 57%) and the pooled MD for walking endurance was 26.35 metres (95% CI 2.51 to 50.19; P = 0.03; I² = 60%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up significantly. The pooled MD (random-effects model) for walking velocity was 0.04 m/s (95% CI -0.06 to 0.14; P = 0.40; I² = 40%) and the pooled MD for walking endurance was 32.36 metres (95% CI -3.10 to 67.81; P = 0.07; I² = 63%). However, for ambulatory patients improvements in walking endurance lasted until the end of scheduled follow-up (MD 58.88 metres, 95% CI 29.10 to 88.66; P = 0.0001; I² = 0%). Adverse events and drop outs did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. Overall, people after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve. Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to benefit most from this type of intervention. This review found that improvements in walking endurance in people able to walk may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory patients, but not in dependent walkers.

Fall Injuries: An Important Preventable Cause of Trauma

Fall is one of the most common causes of major injuries and responsible for many hospital admissions in Iran (1, 2). Falling may happen at any age, but children and the aged people are at higher risk for it. Approximately 47000 children fall to their death annually, but hundreds of thousands more sustain less serious injuries from a fall (3). Falls represent the third leading cause of death in children and are responsible for 5.9% of childhood deaths due to trauma (4). Generally, death due to falls is resulted from head injury (5). Falls in children tend to be from terraces, tables, windows, and trees, and most frequently have a tendency to occur in homes, followed by playgrounds and schoolyards (6). Non-occupational falls from ladders and scaffolds have increasing incidence with increasing age. One-fifth of the cases result in hospitalization (7). Commonly, falls in the elderly occur during daily living activities. Older adults are five times more likely to be hospitalized due to falls than to injuries from other causes (8). Personal factors such as gait disturbance and muscle weakness, osteoarthritis, visual deficit, medications and cognitive impairment are the main causes of ground-level and stair falls, but such environmental elements as poor lighting and absence of handrails may enhance the frequency (4). In our country, Iran, injuries are responsible for most of YLD (Years Lived with Disability) in the population older than 80 years. This is most notably due to falls, and is often worsened by osteoporosis (9). Fall may occur in different places and for different reasons. In occupational settings, the most frequent type of accidents is fall from a height (10). In most cases (like ladder injuries), ignoring safety precautions result in fall. For example, fall from walnut trees is responsible for significant mortality and morbidity amongst those engaged in agricultural activities, and every year many victims of falling from walnut and almond trees are admitted to our trauma center during harvest season. The same can be seen in those involved in high altitude working activities e.g. construction workers. Almost in all cases some evidence of poor safety measures are observed. On the other hand, there are occasional cases of fall for such accidents as defective equipments in the entertainments parks. Many of the fall cases occur at home setting. For example, during the weeks ending to Norouz (Iranian New Year) it is customary for the Iranians to do some special home cleaning activities which is known as Khaneh Takani. Indeed, women will be involved in cleaning every part of their home which are not routinely paid attention, and during this process falling scenarios are not uncommon. The head, spine, and extremities are the most commonly injured parts during fall. Unfortunately, among all these injuries, spinal injuries have the worst outcome. These injuries may cause life-long physical disabilities as well as consequential psychological problems like depression and impose a heavy burden to the patients and their family. Fortunately, most of these accidents are preventable. Following these simple precautions may help preventing fall in children: using protective bars on windows, safety strap on highchairs and other infant seats, stair gates to prevent falling for infants and toddlers, keeping the maximum height of playgrounds equipment less than 1.5 - 2 meters, setting absorption level for a playground with sand or shredded rubber. Some environmental re-arrangements for hazard reduction with the use of handrails in bathrooms and stairs, monitoring and adjusting medications and providing appropriate light in living places may decrease fall frequency in older people. In occupational settings employers must organize a safe workplace and provide necessary information, instruction, equipments, training and supervision. Workers are also required to run the risk of fall prevention protocols such as using safe work systems, avoiding drug use before working at height and appropriate selection and use of personal protective equipments. The problem to achieve these measures is both social and personal acceptance and commitment for their application. Such an event does not seem to be accessible without solid legislative support. In the hope of having no more fall injuries in the new future.

Transfer movement from bed to wheelchair of hemiplegic patients : Focus on the use of handrails

Transfer movement from bed to wheelchair of hemiplegic patients : Focus on the use of handrails

Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention

balancing reactions that involve rapid stepping or reaching movements are critical for preventing falls. These compensatory reactions are much more rapid than volitional limb movements and can be very effective in decelerating the centre-of-mass motion induced by sudden unpredictable balance perturbation; however, age-related deterioration in the neural, sensory and/or musculoskeletal systems may impede the ability to execute these reactions effectively. this paper summarises recent research regarding age-related changes in compensatory stepping and reaching reactions and the practical implications of these findings for fall prevention programmes. even healthy older adults experience pronounced difficulties. For stepping reactions, the main problems pertain to control of lateral stability--arresting the lateral body motion that occurs during forward and backward steps, and controlling lateral foot movement so as to avoid collision with the stance limb during lateral steps. Older adults appear to be more reliant on arm reactions than young adults but are less able to execute reach-to-grasp reactions rapidly. it is important for clinicians to assess compensatory stepping and reaching, in order to identify individuals who are at risk of falling and to pinpoint specific control problems to target for balance or strength training or other intervention. More effective use of stepping and reaching reactions can be promoted through improved design and appropriate use of sensory aids, mobility aids, footwear, handrails and grab-bars. It is particularly important to address the problems associated with the control of lateral stability because it is the lateral falls that are most likely to result in hip fracture.

Experimental study on the grip and hold strength for stanchions and handrails in buses.

The purpose of this study was to investigate the effective use of stanchions and handrails in buses. We constructed experimental equipment resembling bus stanchions and handrails and examined the grip and hold strength exerted when used. The total number of subjects was 80: 30 elderly and 19 young males, and 22 elderly and 9 young females. The experimental equipment comprised four parts: a handle part to imitate safety devices in buses such as stanchions, handrails, and straps, which was pulled by a winch at a constant speed; and a load cell wired with an analyzing processor, which output the strength exerted. The handle part was designed to measure grip and hold strengths against pulling forces in three directions, that is, forward, in the direction of the back of the hand, and in the direction of the palm. The subjects were asked to grasp the handle part against a pulling force. The maximum grip and hold strengths were recorded and analyzed. The strengths when pulled forward were the largest independent of the sex and age of the subjects. The results indicate that standing bus passengers should grip the fixtures, such as a stanchion, with their right hand when they are standing on the right side in a bus facing the windows.

Usefulness of a branching treadmill protocol for evaluation of cardiac functional capacity

A branching treadmill protocol was designed to measure functional capacity in patients with low work capacity and varying ability to walk at speeds used in traditional protocols. A comfortable walking pace is first selected (2.0 to 3.5 mph, 0.25 mph increments) and the workload is then increased every 2 minutes in 1 MET increments (a multiple of the resting oxygen uptake [1 MET = 3.5 ml O 2/kg/ min]) by adjusting grade. Nine trained (maximal MET = 7.6 ± 1.6, mean ± standard deviation) male subjects (age 59 ± 7 years) with previous myocardial infarction and 9 trained (maximal MET = 11.7 ± 2.5) male control subjects (age 56 ± 8 years) completed submaximal and maximal workloads without handrail support. The measured oxygen consumption, volume of oxygen in ml/kg/min (VO 2), was compared with the predicted VO 2 cost of treadmill walking calculated from speed and grade. A linear regression analysis of predicted versus measured VO 2 was performed. There were no significant differences between myocardial infarction and control regression lines. Therefore, a simplified prediction equation for estimated VO 2 in myocardial infarction and control subjects is proposed. Overall VO 2 prediction = 1.61 + 0.99 x. The main advantage of the branching protocol format is the selection of a stable, brisk walking pace compatible with age and gait, which may improve mechanical efficiency through impedance matching. The protocol is adaptable enough in design so that most patients can complete the exercise test without use of handrails, which is essential for an accurate estimate of VO 2 from treadmill speed and grade.