Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention.

BACKGROUND: Admission to hospital can lead to persistent deterioration in physical functioning, particularly for the more vulnerable older population. As a result of this physical deterioration, older people who have been recently discharged from hospital may be particularly high users of health and social support services. Quantify usage and costs of services in older adults after hospitalisation and explore the impact of a home-exercise intervention on service usage. METHOD: The present study was a secondary analysis of data from a randomised controlled trial (ACTRN12607000563460). The trial involved 340 participants aged 60 years and over with recent hospitalisation. Service use and costs were compared between intervention (12 months of home-exercise prescribed in 10 visits from a physiotherapist) and control groups. RESULTS: 33 % of participants were re-admitted to hospital, 100 % consulted a General Medical Practitioner and 63 % used social services. 56 % of costs were associated with hospital admission and 22 % with social services. There was reduction in General Medical Practitioner services provided in the home in the intervention group (IRR 0.23, CI 0.1 to 0.545, p < 0.01) but no significant between-group difference in service use or in costs for other service categories. CONCLUSION: There appears to be substantial hospital and social service use and costs in this population of older people. No significant impact of a home-based exercise program was evident on service use or costs. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry ACTRN12607000563460 >TrialSearch.

Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years.

OBJECTIVE: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. DESIGN: A nonrandomized ABA trial. SETTING: Sydney school. SUBJECTS: Eight children with cerebral palsy, aged 4-8 years, seven with diagnosis of spastic diplegia, one of spastic/ataxic quadriplegia. INTERVENTION: Four weeks of after-school exercise class, conducted for one hour twice weekly as group circuit training. Each work station was set up for intensive repetitive practice of an exercise. Children moved between stations, practising functionally based exercises including treadmill walking, step-ups, sit-to-stands and leg presses. MAIN OUTCOME MEASURES: Baseline test obtained two weeks before training, a pre-test immediately before and a post-test following training, with follow-up eight weeks later. Lower limb muscle strength was tested by dynamometry and Lateral Step-up Test; functional performance by Motor Assessment Scale (Sit-to-Stand), minimum chair height test, timed 10-m test, and 2-minute walk test. RESULTS: Isometric strength improved pre- to post-training by a mean of 47% (SD 16) and functional strength, on Lateral Step-up Test, by 150% (SD 15). Children walked faster over 10 m, with longer strides, improvements of 22% and 38% respectively. Sit-to-stand performance had improved, with a reduction of seat height from 27 (SD 15) to 17 (SD 11) cm. Eight weeks following cessation of training all improvements had been maintained. CONCLUSIONS: A short programme of task-specific strengthening exercise and training for children with cerebral palsy, run as a group circuit class, resulted in improved strength and functional performance that was maintained over time.

Comparison of singer's formant, speaker's ring, and LTA spectrum among classical singers and untrained normal speakers.

Many studies have described and analyzed the singer's formant. A similar phenomenon produced by trained speakers led some authors to examine the speaker's ring. If we consider these phenomena as resonance effects associated with vocal tract adjustments and training, can we hypothesize that trained singers can carry over their singing formant ability into speech, also obtaining a speaker's ring? Can we find similar differences for energy distribution in continuous speech? Forty classically trained singers and forty untrained normal speakers performed an all-voiced reading task and produced a sample of a sustained spoken vowel /a/. The singers were also requested to perform a sustained sung vowel /a/ at a comfortable pitch. The reading was analyzed by the long-term average spectrum (LTAS) method. The sustained vowels were analyzed through power spectrum analysis. The data suggest that singers show more energy concentration in the singer's formant/speaker's ring region in both sung and spoken vowels. The singers' spoken vowel energy in the speaker's ring area was found to be significantly larger than that of the untrained speakers. The LTAS showed similar findings suggesting that those differences also occur in continuous speech. This finding supports the value of further research on the effect of singing training on the resonance of the speaking voice.

Walking speed over 10 metres overestimates locomotor capacity after stroke.

OBJECTIVE: To examine 10-m comfortable walking speed and 6-minute distance in healthy individuals and individuals after stroke and to assess the level of disability associated with poor walking endurance after stroke. DESIGN: Descriptive study in which comfortable walking speed over 10 m and distance covered in 6 minutes (6-minute walk test) were compared between healthy subjects and subjects after stroke. SUBJECTS: Twelve healthy subjects and 14 subjects after stroke. MAIN OUTCOME MEASURES: Walking speed and 6-minute distances were compared between groups. In addition, for each group, actual distance walked in 6 minutes was compared with the distance predicted by the 10-m walking speed test and the distance predicted by normative reference equations. RESULTS: Subjects after stroke had significant reductions in 10-m speed and 6-minute distance compared with healthy subjects (p < 0.05). Subjects after stroke were not able to maintain their comfortable walking speed for 6 minutes, whereas healthy subjects walked in excess of their comfortable speed for 6 minutes. The average distance walked in 6 minutes by individuals after stroke was only 49.8+/-23.9% of the distance predicted for healthy individuals with similar physical characteristics. CONCLUSION: In our subjects after stroke, walking speed over a short distance overestimated the distance walked in 6 minutes. Both walking speed and endurance need to be measured and trained during rehabilitation.

The adjustable laryngeal implant.

An adjustable laryngeal implant made of titanium has been developed for the treatment of unilateral vocal fold paralysis. The implant includes three parts: a plate that allows fixation to the thyroid cartilage, a block of titanium which includes the adjustable part, and a micrometric screw in the middle of the lateral side of the block, which moves the adjustable part. Precise medialization is accomplished by regulating the screw which also permits easy secondary adjustments, if needed in the future. This retrospective study assesses clinical outcomes of medialization laryngoplasty with the titanium adjustable implant, in patients with unilateral vocal fold paralysis. This study has the limitations of a retrospective study. However, preliminary results are encouraging. Analysis of subjective responses confirmed marked improvement in laryngeal function, speech, and swallowing. Objective voice analysis confirmed improvement in the aerodynamic measures. The adjustable laryngeal implant has many advantages including: precise medialization, ease of secondary adjustment, and preseveration of the mucosal wave. This implant is biocompatible, no migration is possible (it is fixed to the cartilage) and no extrusion of the implant has occurred. Titanium is magnetic resonance imaging (MRI)-safe.

Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial.

OBJECTIVE: To evaluate the immediate and retention effects of a 4-week training program on the performance of locomotor-related tasks in chronic stroke. DESIGN: Randomized, controlled pilot study with 2-month follow-up. SETTING: Rehabilitation center. SUBJECTS: A convenience sample consisting of 12 chronic stroke subjects was used. Subjects were randomly assigned to the experimental or the control group. Three subjects withdrew from the study. INTERVENTION: Both experimental and control groups participated in exercise classes three times a week for 4 weeks. The exercise class for the experimental group focused on strengthening the affected lower limb and practicing functional tasks involving the lower limbs, while the control group practiced upper-limb tasks. MAIN OUTCOME MEASURES: Lower-limb function was evaluated by measuring walking speed and endurance, peak vertical ground reaction force through the affected foot during sit-to-stand, and the step test. RESULTS: The experimental group demonstrated significant immediate and retained (2-month follow-up) improvement (p < or = .05) compared with the control group in walking speed and endurance, force production through the affected leg during sit-to-stand, and the number of repetitions of the step test. CONCLUSION: The pilot study provides evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke.

Sitting balance II: reach direction and thigh support affect the contribution of the lower limbs when reaching beyond arm's length in sitting.

The effects of reach direction and extent of thigh support on the contribution of the lower limbs during seated reaching were examined. Twelve healthy subjects aged 59-79 years performed self-paced reaching forwards and diagonally to both sides and under three thigh support conditions. Vertical ground reaction forces (GRF) and leg muscle activity were monitored bilaterally. Reach direction affected both the magnitude of peak vertical GRF and the relative distribution of vertical GRF through the feet, demonstrating that the lower limbs work cooperatively to control the motion of the body mass. Extent of thigh support also affected the magnitude of peak vertical GRF through the feet. In addition, the EMG data confirmed the active contribution of the lower limbs when reaching beyond arm's length, with muscles in both lower limbs activated in all trials.

Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial.

BACKGROUND AND PURPOSE: After stroke, the ability to balance in sitting is critical to independence. Although impairments in sitting balance are common, little is known about the effectiveness of rehabilitation strategies designed to improve it. The purpose of this randomized placebo-controlled study was to evaluate the effect of a 2-week task-related training program aimed at increasing distance reached and the contribution of the affected lower leg to support and balance. METHODS: Twenty subjects at least 1 year after stroke were randomized into an experimental or control group. The experimental group participated in a standardized training program involving practice of reaching beyond arm's length. The control group received sham training involving completion of cognitive-manipulative tasks within arm's length. Performance of reaching in sitting was measured before and after training using electromyography, videotaping, and two force plates. Variables tested were movement time, distance reached, vertical ground reaction forces through the feet, and muscle activity. Subjects were also tested on sit-to-stand, walking, and cognitive tasks. Nineteen subjects completed the study. RESULTS: After training, experimental subjects were able to reach faster and further, increase load through the affected foot, and increase activation of affected leg muscles compared with the control group (P < .01). The experimental group also improved in sit-to-stand. The control group did not improve in reaching or sit-to-stand. Neither group improved in walking. CONCLUSIONS: This study provides strong evidence of the efficacy of task-related motor training in improving the ability to balance during seated reaching activities after stroke.