Anticipatory weight shift between arms when reaching from a crouched posture.

Reaching movements performed from a crouched body posture require a shift of body weight from both arms to one arm. This situation has remained unexamined despite the analogous load requirements during step initiation and the many studies of reaching from a seated or standing posture. To determine whether the body weight shift involves anticipatory or exclusively reactive control, we obtained force plate records, hand kinematics, and arm muscle activity from 11 healthy right-handed participants. They performed reaching movements with their left and right arm in two speed contexts, "comfortable" and "as fast as possible," and two postural contexts, a less stable knees-together posture and a more stable knees-apart posture. Weight-shifts involved anticipatory postural actions (APAs) by the reaching and stance arms that were opposing in the vertical axis and aligned in the side-to-side axis similar to APAs by the legs for step initiation. Weight-shift APAs were correlated in time and magnitude, present in both speed contexts, more vigorous with the knees placed together, and similar when reaching with the dominant and nondominant arm. The initial weight-shift was preceded by bursts of muscle activity in the shoulder and elbow extensors (posterior deltoid and triceps lateral) of the reach arm and shoulder flexor (pectoralis major) of the stance arm, which indicates their causal role; leg muscles may have indirectly contributed but were not recorded. The strong functional similarity of weight-shift APAs during crouched reaching to human stepping and cat reaching suggests that they are a core feature of posture-movement coordination.NEW & NOTEWORTHY This work demonstrates that reaching from a crouched posture is preceded by bimanual anticipatory postural adjustments (APAs) that shift the body weight to the stance limb. Weight-shift APAs are more robust in an unstable body posture (knees together) and involve the shoulder and elbow extensors of the reach arm and shoulder flexor of the stance arm. This pattern mirrors the forelimb coordination of cats reaching and humans initiating a step.

Survey with content analysis to explore nurses' satisfaction with opportunities to undertake continuing professional education in relation to aseptic technique.

BACKGROUND: Aseptic technique is a key skill undertaken every day by large numbers of nurses. However, there is relatively little empirical evidence to underpin practice. Furthermore, it is not clear to what extent it should be considered a single task or a set of principles to be applied differentially depending upon the situation and how individual nurses make this decision. OBJECTIVE: This study explored nurses' experiences of continuing professional education (CPE) in relation to aseptic technique. DESIGN: A national survey was undertaken throughout the United Kingdom. Responses were subjected to inductive quantitative content analysis. PARTICIPANTS: Participants were recruited via an electronic link placed on the website of a major nursing organisation. RESULTS: 941 nurses responded. 253 (26.9%) were satisfied with arrangements for continuing professional education. Satisfaction was associated with a perception of good support from employers, sound preparation before qualifying and practising aseptic technique regularly. 311 (33%) were dissatisfied. Reasons included witnessing unwarranted variations in practice (n = 55, 5.8%), witnessing suboptimal practice requiring correction (65, 6.9%), a perception that standards had fallen through a decline in pre-registration preparation (n = 109, 11.6%) and opportunities for updating (n = 124, 13.2%). Some employers had introduced training in conjunction with organisation-wide change in practice. In other cases participants reported receiving updates when required to perform a new procedure, when moving between clinical specialities or changing employer. Train-the-trainer (cascade) teaching was used in formal and informal arrangements for updating. CONCLUSION: This study provides a springboard for exploring arrangements for updating and assessing nurses' competence to undertake aseptic technique. Health providers need to evaluate what is currently provided and address gaps in provision. There is clear evidence that the current system does not meet the needs of many nurses.

Transition and Sustainability of an Online Care Model for People With Parkinson's Disease in Response to the COVID-19 Pandemic.

INTRODUCTION: CoronaVirus Disease-2019 (COVID-19) led to social distancing and the need for alternative care models. Telehealth programs for people with Parkinson's (PWP) disease may ensure continuity of care. The goal of this observational survey study was to determine the practicability, satisfaction, and barriers to online programs, their relationship to perceived symptoms, mood, and quality of life, and program sustainability beyond the immediate pandemic. METHODS: In-person Parkinson's programs at New York Institute of Technology College of Osteopathic Medicine transitioned online at the start of the pandemic to include Rock Steady Boxing, Support Groups, and Rock Steady Buddies. A custom online survey sent to 150 participants investigated PD history, symptomatology, level of exercise before and during the pandemic, depression (PHQ-9), quality of life (PDQ-39), and practicability and perceived satisfaction related to these online programs. Descriptive statistics were reported. RESULTS: Of 69 respondents [mean age of 70.2y (SD 8.4 yrs)], >75% were satisfied with the transition to online programs. Consistent attendance and minimal barriers to programs indicated practicability, with increased adherence to exercise. Of 66 completed PHQ-9s, 22.7% had scores ≥9 (moderate to severe depression); of 61 completed PDQ-39s, scores averaged 21.4; better quality of life than national averages for PWP. Self-perceived physical and mental wellbeing were positively affected. CONCLUSIONS: Results suggest the transition to online programs met the needs of the Parkinson's community in a practicable and sustainable manner during the pandemic. With COVID-19 still prevalent, the current model of blending synchronous online and in-person classes provides a more flexible, sustainable format compared to in-person alone. Institutions may consider including online components to existing programs to promote continuity of care for aging populations as part of best practices.

Auditory and visual cueing modulate cycling speed of older adults and persons with Parkinson's disease in a Virtual Cycling (V-Cycle) system.

BACKGROUND: Evidence based virtual environments (VEs) that incorporate compensatory strategies such as cueing may change motor behavior and increase exercise intensity while also being engaging and motivating. The purpose of this study was to determine if persons with Parkinson's disease and aged matched healthy adults responded to auditory and visual cueing embedded in a bicycling VE as a method to increase exercise intensity. METHODS: We tested two groups of participants, persons with Parkinson's disease (PD) (n = 15) and age-matched healthy adults (n = 13) as they cycled on a stationary bicycle while interacting with a VE. Participants cycled under two conditions: auditory cueing (provided by a metronome) and visual cueing (represented as central road markers in the VE). The auditory condition had four trials in which auditory cues or the VE were presented alone or in combination. The visual condition had five trials in which the VE and visual cue rate presentation was manipulated. Data were analyzed by condition using factorial RMANOVAs with planned t-tests corrected for multiple comparisons. RESULTS: There were no differences in pedaling rates between groups for both the auditory and visual cueing conditions. Persons with PD increased their pedaling rate in the auditory (F 4.78, p = 0.029) and visual cueing (F 26.48, p < 0.000) conditions. Age-matched healthy adults also increased their pedaling rate in the auditory (F = 24.72, p < 0.000) and visual cueing (F = 40.69, p < 0.000) conditions. Trial-to-trial comparisons in the visual condition in age-matched healthy adults showed a step-wise increase in pedaling rate (p = 0.003 to p < 0.000). In contrast, persons with PD increased their pedaling rate only when explicitly instructed to attend to the visual cues (p < 0.000). CONCLUSIONS: An evidenced based cycling VE can modify pedaling rate in persons with PD and age-matched healthy adults. Persons with PD required attention directed to the visual cues in order to obtain an increase in cycling intensity. The combination of the VE and auditory cues was neither additive nor interfering. These data serve as preliminary evidence that embedding auditory and visual cues to alter cycling speed in a VE as method to increase exercise intensity that may promote fitness.

The 6MWT: will different methods of instruction and measurement affect performance of healthy aging and older adults?

BACKGROUND AND PURPOSE: The Six-Minute Walk Test (6MWT) is commonly used to assess the fitness level of healthy adults and of older adults with disabilities. It can also be used as an intervention to increase walking endurance. However, its use may be limited in certain rehabilitation settings due to space requirements. If it can be shown that the measured linear distance walked in the 6-minute walk is comparable to the distance walked as measured by a pedometer, the test may be more widely used in a variety of rehabilitation settings. In addition, questions exist as to whether the method of instruction ("walk as far as you can" vs "walk as fast as you can") can impact the rate of perceived exertion of the person performing the test. The purposes of this study were to assess for differences in the measured linear distance and from the gender-based predicted value when compared to the pedometer measurement. In addition, we assessed the difference, if any, in the rate of perceived exertion (RPE) using the 2 different methods of administration. Furthermore, the distance in meters walked using the 2 different methods of instruction was compared; likewise, comparisons were made of these values to predicted values. METHODS: A group of 26 older adults participated in this descriptive study. After a practice trial, each person completed 2 linear trials using different methods of instruction, ("walk as fast as you can" or "walk as far as you can") of the 6MWT while wearing a DIGI-WALKER SW-651 pedometer. Vital signs were taken before and after each trial. Linear distance, pedometer distance, and numeric value RPE were recorded. RESULTS: Paired t tests demonstrated no gender differences. An intraclass correlation coefficient (2,1) of 0.822 was calculated between all dependent variables. A repeated measures MANOVA was conducted to assess for differences between all variables resulting in no differences (F = 1.98; P = .13). Pairwise comparisons were also insignificant for the distance measurements except predicted value and pedometer fast P = .024. Paired t tests also demonstrated differences between RPE between trials (t = 2.15; P = .041). CONCLUSION: There was good agreement between these distance measures for the 6MWT. The use of a pedometer was found to be a valid measure of walking distance during the 6MWT. It was also found that the method of instruction made no differences in walking distance. Although the change was minimal on the Borg scale, the RPE was found to be significantly different between far and fast trials in healthy adults. From this study, it appears that that either mode of instruction is valid in healthy community-dwelling populations. Future studies should include populations with impairments.