Fitness and Mobility Exercise (FAME) Program for stroke

Given the potential of exercise to positively influence so many physical and psychosocial domains, the Fitness and Mobility Exercise (FAME) Program was developed to address the multiple impairments arising from the chronic health condition of stroke. We present the details of this exercise program and the evidence which has shown that the FAME Program can improve motor function (muscle strength, balance, walking), cardiovascular fitness, bone density, executive functions and memory. The FAME Program can help to improve the physical and cognitive abilities of people living with a stroke and reduce the risk of secondary complications such as falls, fractures and heart disease.     

Effects of motor practice on cognitive disorders in older adults

The demographics of our societies have changed drastically during the past few decades. The general population is aging rapidly as human life spans continue to expand and more adults are set to mature during the next quarter century. This aging process has numerous implications for the way we live and will have particularly important impacts on health and healthcare. In particular, substantial evidence suggests that cognitive–motor function deteriorates considerably as the result of inactive life style, biological aging, and cognitive impairments. The number of individuals with Alzheimer's disease (AD), an aging-related cognitive disorder, is expected to increase significantly during the next 40 years. The development of mild cognitive impairment (MCI) or AD can exaggerate the functional declines observed in cognitive or motor performance. The functional declines affect an array of social, cognitive, mental, physical, and motor activities in our daily lives. However, recent studies suggest that cognitive, physical, motor practice, or skill learning can improve motor speed, smoothness, and accuracy in both MCI and AD patients and their age-matched healthy peers. From theoretical and practical perspectives, this paper addresses several critical aspects of motor deficits and the kinematical characteristics of motor skill development in MCI and AD populations. Empirical data will be presented relative to the sensory–motor functions of MCI and AD, the motor skill acquisition, exercise rehabilitation in older adults with memory loss, as well as the implications for therapies. Finally, this review concludes with thoughts and suggestions for future research in these areas.     

How to improve gait and balance function in elderly individuals—compliance with principles of training

Most balance training regimens for elderly individuals focus on self-controlled exercises, although automatic postural responses after a balance perturbation are not under direct volitional control. We critically review the literature on this topic, and notice that several studies fail to comply with basic principles of training and therefore show little improvement in function. Some present the view that physical function in the too frail and too fit cannot be improved, which we instead argue would be the effect of nonspecific training programs. We propose a concept for balance training that incorporates voluntary exercises as well as perturbation and dual-task exercises to improve balance control. The program is performed on five different levels where levels 1–4 exercises focus on the skill to maintain balance and level 5 adds perturbation exercises that focus on the skill to recover balance as well as dual task exercises providing a cognitive load during execution of a balance motor task. Functional requirements for muscle strength and power are directly incorporated into the program. The feasibility of the concept has been demonstrated on elderly fallers. A randomized control trial is underway to investigate the effects on healthy elderly individuals. Further intervention studies using this concept are encouraged.     

A pilot intervention to promote walking and wellness and to improve the health of college faculty and staff

There is a need to investigate novel interventions that promote worksite physical activity and wellness. OBJECTIVE: The authors' purpose in this study was to evaluate the effectiveness of a 12-week walking program supplemented with a pedometer, computer educational program, and weekly e-mails. METHODS: College faculty and staff participated in a one-group pre-posttest study to determine whether the 12-week walking intervention had an effect on body mass index (BMI), blood pressure, blood glucose, and cholesterol. The authors also determined participant-perceived wellness effects. RESULTS: The authors observed differences between baseline and follow-up in BMI (p = .024), blood glucose (p = .06), and total cholesterol (p = .09). The program had a moderate effect on fitness, mood, health awareness, nutrition, and health. CONCLUSIONS: It is incumbent that experts develop innovative worksite physical activity and wellness programs. A pedometer-monitored walking program is one way that a worksite health initiative can improve the health and wellness of its employees and simultaneously reduce health-care costs.     

The significance of uprightness: parents’ reflections on children’s responses to a hands-free walker for children

The benefits and drawbacks of facilitating independent walking in children with physical mobility impairments, such as cerebral palsy, remain to be determined. This knowledge gap creates decision dilemmas about which mobility practices parents and children should adopt and rehabilitation professionals should foster. These dilemmas are reflected in continuing debates about allocation of time, effort and resources to optimize walking versus encouraging use of manual or powered wheelchairs. Recent studies have reported only modest measurable walking progress for severely disabled children using hands-free walkers. Despite these seemingly disappointing results, parents remained highly motivated to encourage their children to use these walking devices and appraised them very positively. In the present paper, we suggest that parents’ symbolic value of their children assuming upright comportment may explain why they perceive hands-free walkers positively and why they are so motivated to devote much time and effort to improving independent, walking-based mobility of their children.     

Transition strategies for youths with sensory impairments: Educational,vocational and independent living considerations

Students with sensory impairments comprise a heterogeneous group that is often underserved by rehabilitation and other social services. This underserved status has been attributed to poor interagency collaboration and eligibility issues, the low incidence nature of these disabilities, and the shortage of trained professionals to address the specialized needs of these individuals. This article examines important educational and vocational characteristics of this population to assist rehabilitation professionals in supporting more effective transitions into employment and other adult roles. Specific transition considerations include unique learning challenges, assessment issues, assistive technology, and accommodations. The article concludes with strategies for transition planning, community integration, and evaluating transition outcomes.     

Rehabilitation Contexts: A Holistic Approach

Psychosocial rehabilitation involves a gamut of activities that need to be personalized to suit an individual's needs. The context in which rehabilitation occurs greatly influences the range and availability of rehabilitation services and their utilization. This study attempts to highlight the contextual factors, with specific reference to globalization and development, the scope of rehabilitation, and the continuum of rehabilitation services that have a bearing on an individual's recovery. The relevance and effectiveness of the bio-psycho-social-spiritual approach in making services more pertinent and applicable are discussed. Implications for program development and policy interventions are suggested. It is hoped that this study will draw attention to the need for openness to a broad range of services even while using specific interventions.     

Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy

Virtual reality is the use of interactive replication created with computer hardware and software to impart users with opportunities to engage in environments that appear to feel similar to real world objects and events. The commonest rehabilitation program of cerebral palsy children involves stretching, strengthening, mobilization and various other activities, whereas the use of virtual reality based training (VRBT) for rehabilitation of cerebral palsy is not common. To understand the effect of VRBT a study was formulated. Twenty nine subjects participated (study group--14 and control group--15). Outcome measures were MACS, PBS, level of participation, motivation, cooperation and satisfaction of the child. Results revealed that balance and manual ability were significantly improved in both the groups (Balance: study: t-2.28, p<0.05; control: t-3.5, p<0.01; Manual ability: study: t-5.58, p<0.001; control: t-7.06, p<0.001). PBS had significantly greater improvement in the study group (t-t-2.02, p<0.05). Level of participation, motivation, cooperation and satisfaction of the child were also reported to be significantly higher among the study group as compared with control group. To the author's best knowledge, this is the first study on using the VR-based therapy for the postoperative rehabilitation of children with CP which need further elaboration with larger sample size.     

Health, balance, and walking as correlates of climbing steps

The aim of this study was to investigate walking and health among woman age 75 yr or older, in the associations between the highest step up performed without support by an individual and balance, walking, and health among women age 75+. Records of the highest step, balance, walking, and health were made for 307 women age 75-93 yr living in the community. Eighty percent managed to climb steps higher than 20 cm. There was a statistically significant negative relationship between age and stair-climbing capacity. The highest steps registered were significantly and independently associated with a short time on the timed up-and-go test, long functional reach, low body weight, lack of perceived difficulty walking outdoors, low number of "missteps" when walking in a figure of 8, longer time in one-leg stance, ability to carry out tandem stance, no walking aids outdoors, and not being afraid of falling. These variables together explained 67% of the variance in the step-height score.     

Walking Ability is Associated with Social Communication Skills in Infants at High Risk for Autism Spectrum Disorder

Achievement of early motor milestones in infancy affords new opportunities for social interaction and communication. Research has shown that both motor and social deficits are observed in infants who later develop autism spectrum disorder (ASD). This study examined associations between motor and Social communication skills in 12‐month‐old infant siblings of children with ASD who are at heightened risk for developmental delays (N = 86) and low‐risk, typically developing infants (N = 113). Infants were classified into one of three groups based on their walking ability: walkers (walks independently), standers (stands independently), or prewalkers (does not yet stand or walk independently). Social communication and cognitive skills were assessed with two standardized assessments (Communication and Symbolic Behaviors Scales [CSBS] and Mullen Scales of Early Learning) and compared across the three walking groups. Results demonstrated that high‐risk walkers showed superior Social communication skills, but commensurate cognitive skills, compared to high‐risk prewalkers. In contrast, Social communication and cognitive skills were largely comparable for low‐risk infants, regardless of walking status. Findings suggest that for high‐risk infants, who are already vulnerable to developmental delays and ASD, independent walking may facilitate the emergence of Social communication abilities. Pivotal motor milestones may serve as useful indicators of Social communication delays and targets for intervention.     

Neurocognitive deficits as a barrier to psychosocial function in schizophrenia: effects on learning, coping, & self-concept

Recently, research has linked deficits in neurocognition, which emerge early in schizophrenia, with psychosocial impairments. However, it is uncertain how these deficits lead to sustained dysfunction. In this review, we explore how neurocognitive deficits could disrupt function at three levels: learning, coping preference, and self-concept. We offer a model in which neurocognitive impairment may directly limit skills acquisition and the development of a rich personal narrative. We suggest that both limited skills acquisition and an impoverished narrative may subsequently feed into a habitual style of avoidant coping, leading to a cycle of sustained dysfunction. Implications for cognitive, rehabilitation, and psychotherapeutic interventions are discussed.     

Training effects on motor–cognitive dual-task performance in older adults

This systematic review investigated whether healthy older adults benefit from training interventions in motor–cognitive dual-task (DT) situations and which specific aspects of the intervention and/or task selection contribute to training benefits. Training effects were analysed with regard to the training programme (e.g., general ST or DT training) and task conditions (e.g., standing or walking, complexity of secondary cognitive task). Literature was searched via OVIDsp (Medline, EMBASE, PsycINFO). DT studies were included by the following criteria: (1) investigation of at least one motor task, (2) assessment of DT performance outcomes on standing or walking, (3) conduction of an intervention, and (4) investigation of older adults in an experimental–control group design or an old–young comparison. Thirteen studies met all inclusion criteria. Four types of interventions were identified: (1) general single-task (ST) motor training, (2) specific ST motor training, (3) general DT training, and (4) task-related (specific) DT training. For DT standing conditions only DT interventions improved motor performance, whereas DT walking also benefits by ST training. Most benefits on motor and cognitive performance seem to be reached by DT training interventions whereas a GST produced lowest effects. Thus, balance orientated motor and cognitive DT performance in healthy older adults can be improved by performance related exercises. Furthermore, to reach beneficial effects, it seems necessary that the training intervention includes a certain level of exercise load such as rising difficulties, appropriate intensity and duration, a certain level of task specificity, and variable task prioritization. The transfer of training effects into everyday situations needs to be further investigated.     

Development of a logic model for a service learning,dog walking course for college students

Despite overwhelming evidence of the importance of physical activity, only 20% of US adults meet physical activity recommendations. A subsector of the population vulnerable to inactivity is college students. There is a disconnect between evidence-based physical activity programming and dissemination into college communities, which may be overcome through logic model development and evaluation. The purpose of this paper is to discuss logic model development for a service-learning, dog walking program for undergraduates. Participants were undergraduates (18–25 years). Process evaluations and observational data were used in a content analysis to determine major themes to create the logic model. A set of resources were needed to complete program activities, which led to short- and long-term outcomes. The overarching goal of the program is to improve the overall health status of college students and companion animals. This logic model may have significant public health impact as it can serve as a framework for universities wanting to develop, implement, and evaluate a service-learning, dog walking program for students.     

A formative assessment of gender awareness and ability of staff based on the service programs of the All-China Women's Federation: The case of the “3861 My Home” program

In order to achieve “gender mainstreaming” which is a global strategy to promote the development of women, it has in recent years been a major task for the All-China Women's Federation (ACWF) to improve the gender awareness and ability of policy makers and implementers. Thus, researchers should constantly propose and evaluate various possible attempts to improve gender awareness and the ability of individuals. There are few empirical studies on the assessment of gender awareness and the improvement of the ability of staff who have been trained and educated. Research studies focusing on the promotion of gender-sensitive awareness and ability of staff by participating in programs are even rarer.This study presents a specific case, namely the evaluation of promoting social service workers’ gender awareness and ability within the implementation of the “3861 My Home” program. Based on this case, this study examines how to promote gender awareness and ability of social service workers through the implementation of the service program of Women's Federation, and also assesses the quality of the results of this implementation. Moreover, this study also contributes to the literature pertaining to assessing the development of social service workers’ gender awareness and ability. In addition, the study provides an option for enhancing the gender awareness and ability of social service workers in addition to training: The participatory learning or action pertaining to gender awareness and ability based on the Women's Federation programs are able to effectively improve the gender awareness and ability of staff.     

Looking for a ‘cure’: negotiating ‘walking’ in a Turkish rehabilitation hospital

This article explores discourses surrounding ‘walking’ in a Turkish rehabilitation hospital and their impact on in-hospital relationships, patients’ attitudes towards disability, and constructions of ‘bodily normality’. Interviews were conducted with 29 patients, 11 medical personnel, and two non-medical personnel. Three categories of discourses emerged. First, hope for walking is kept alive in doctor–patient relationships, either through a state of silence on the matter or an emphasis on time, determination, and faith in God. Second, patients are virtually assured of the retrieval of walking, mostly through interactions with fellow patients and their accompanying family members (refakatçis). Third, a possible non-walking future is highlighted, either within a framework closer to a disability rights perspective or through an emphasis on gratitude. Diverse discourses on walking emerge due to the informality of in-hospital practices. Still, the ‘normal body’ is predominantly reproduced as the ‘walking body’. Thus, patients refuse discharge before regaining the ability to walk.     

Biomechanical aspects of dynamic stability

Walking is a fundamental motor skill that significantly affects the level of independence in older adults. The amount of variability present in a walking pattern reflects the quality of neuromuscular control. It is well established that a large proportion of falls in older people occurs when walking. The prevention of falls is vital for minimizing disability, preventing injury, and impeding the development of frailty and subsequent deterioration in quality of life. The present literature review focuses on dynamic stability. In dynamic stability, both the base of support and the center of mass are in motion, and effective balance function is required. In general, older adults are expected to have different movement patterns from younger adults, expressed by differences in limb kinematics and kinetics. A better understanding of the biomechanical variables involved can help anticipate and prevent potential falls.     

The treatment of posttraumatic stress disorder in an extended care psychiatric rehabilitation program

This research study intended to determine which patient diagnostic group benefited most from an extended care psychiatric rehabilitation program (Program). Archival data were used to assess the completion rates among those subjected to one or more of the Program's treatment modalities. A correlational design was used to determine whether demographic or diagnostic variables were related to program completion. The results indicate that patients with a diagnosis of posttraumatic stress disorder or bipolar disorder are the most likely diagnostic groups to benefit from participation in an extended care psychiatric rehabilitation program. Those patients with a diagnosis of schizophrenia or substance abuse may not be appropriate for this type of treatment program, and in this study, were the least likely to benefit.     

Effects of multicomponent training on functional fitness in older adults

The purpose of this study was to evaluate the effects of a 9-week supervised multicomponent exercise program on functional fitness and body composition in independent older adults. Forty-two adults age 60-86 years were randomly assigned to an exercise or a control group and were evaluated before and after training. The training program consisted of 3 sessions of walking, strengthening, and flexibility exercises per week. The multicomponent training program resulted in significant (p < .005) improvements on the chair stand, arm curl, 6-min walk, and up-and-go tests. The findings of this study indicate that a 9-week training program increased upper and lower body strength, aerobic endurance, and agility/dynamic balance in older adults. The most affected components of functional fitness were lower body strength and aerobic endurance. There was no effect of the 9-week training on body composition.     

Low-floor bus design preferences of walking aid users during simulated boarding and alighting

Low-floor buses represent a significant improvement in accessible public transit for passengers with limited mobility. However, there is still a need for research on the inclusive design of transit buses to identify specific low-floor bus design conditions that are either particularly accommodating or challenging for passengers with functional and mobility impairments. These include doorway locations, seating configuration and the large front wheel-well covers that collectively impact boarding, alighting and interior movement of passengers. Findings from a laboratory study using a static full-scale simulation of a lowfloor bus to evaluate the impact of seating configuration and crowding on interior movement and accessibility for individuals with and without walking aids are presented (n=41). Simulated bus journeys that included boarding, fare payment, seating, and alighting were performed. Results from video observations and subjective assessments showed differences in boarding and alighting performance and users' perceptions of task difficulty. The need for assistive design features (e.g. handholds, stanchions), legroom and stowage space for walking aids was evident. These results demonstrate that specific design conditions in low-floor buses can significantly impact design preference among those who use walking aids. Consideration of ergonomics and inclusive design can therefore be used to improve the design of low-floor buses.