Capability of 2 gait measures for detecting response to gait training in stroke survivors: Gait Assessment and Intervention Tool and the Tinetti Gait Scale.

OBJECTIVE: To characterize the performance of 2 observational gait measures, the Tinetti Gait Scale (TGS) and the Gait Assessment and Intervention Tool (G.A.I.T.), in identifying improvement in gait in response to gait training. DESIGN: In secondary analysis from a larger study of multimodal gait training for stroke survivors, we measured gait at pre-, mid-, and posttreatment according to G.A.I.T. and TGS, assessing their capability to capture recovery of coordinated gait components. SETTING: Large medical center. PARTICIPANTS: Cohort of stroke survivors (N=44) greater than 6 months after stroke. INTERVENTIONS: All subjects received 48 sessions of a multimodal gait-training protocol. Treatment consisted of 1.5 hours per session, 4 sessions per week for 12 weeks, receiving these 3 treatment aspects: (1) coordination exercise, (2) body weight-supported treadmill training, and (3) overground gait training, with 46% of subjects receiving functional electrical stimulation. MAIN OUTCOME MEASURES: All subjects were evaluated with the G.A.I.T. and TGS before and after completing the 48-session intervention. An additional evaluation was performed at midtreatment (after session 24). RESULTS: For the total subject sample, there were significant pre-/post-, pre-/mid-, and mid-/posttreatment gains for both the G.A.I.T. and the TGS. According to the G.A.I.T., 40 subjects (91%) showed improved scores, 2 (4%) no change, and 2 (4%) a worsening score. According to the TGS, only 26 subjects (59%) showed improved scores, 16 (36%) no change, and 1 (2%) a worsening score. For 1 treatment group of chronic stroke survivors, the TGS failed to identify a significant treatment response to gait training, whereas the G.A.I.T. measure was successful. CONCLUSIONS: The G.A.I.T. is more sensitive than the TGS for individual patients and group treatment response in identifying recovery of volitional control of gait components in response to gait training.

Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training.

BACKGROUND: No single intervention restores the coordinated components of gait after stroke. OBJECTIVE: The authors tested the multimodal Gait Training Protocol, with or without functional electrical stimulation (FES), to improve volitional walking (without FES) in patients with persistent (>6 months) dyscoordinated gait. METHODS: A total of 53 subjects were stratified and randomly allocated to either FES with intramuscular (IM) electrodes (FES-IM) or No-FES. Both groups received 1.5-hour training sessions 4 times a week for 12 weeks of coordination exercises, body weight-supported treadmill training (BWSTT), and over-ground walking, provided with FES-IM or No-FES. The primary outcome was the Gait Assessment and Intervention Tool (G.A.I.T.) of coordinated movement components, with secondary measures, including manual muscle testing, isolated leg movements (Fugl-Meyer scale), 6-Minute Walk Test, and Locomotion/Mobility subscale of the Functional Independence Measure (FIM). RESULTS: No baseline differences in subject characteristics and measures were found. The G.A.I.T. showed an additive advantage with FES-IM versus No-FES (parameter statistic 1.10; P = .045, 95% CI = 0.023-2.179) at the end of training. For both FES-IM and No-FES, a within-group, pre/posttreatment gain was present for all measures (P < .05), and a continued benefit from mid- to posttreatment (P < .05) was present. For FES-IM, recovered coordinated gait persisted at 6-month follow-up but not for No-FES. CONCLUSION: Improved gait coordination and function were produced by the multimodal Gait Training Protocol. FES-IM added significant gains that were maintained for 6 months after the completion of training.

Food security status and produce intake and behaviors of Special Supplemental Nutrition Program for Women, Infants, and Children and Farmers' Market Nutrition Program participants.

OBJECTIVE: This study identified differences between women from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)- and WIC/Farmers' Market Nutrition Program-participating households regarding household food security status, fruit and vegetable intake and behaviors, perceived diet quality, and education level; and assessed the relationship between household food security status and perceived diet quality and perceived health. DESIGN, SUBJECTS/SETTING: Cross-sectional survey of women from Athens County, Ohio (WIC, n=829; Farmers' Market Nutrition Program, n=246) living in WIC households. RESULTS: Of 228 participants completing the food security portion of the survey, 61 (26.8%) were living in food secure households, while 47 (20.6%), 75 (32.9%), and 45 (19.7%) were living in households at risk for (marginal) food insecurity, with low food security, and with very low food security, respectively. For the entire sample, food insecurity was associated with poorer diet quality (r=-0.248, P<0.001). Food security status (chi(2)=2.117, P=0.548) did not differ between groups. Farmers' Market Nutrition Program reported higher education levels (P=0.027). Unlike fruit intake (t test, P=0.769), vegetable intake servings were greater among Farmers' Market Nutrition Program (2.2+/-1.2), compared to WIC (1.9+/-1.0) (t test, P=0.040). Both perceived benefit (chi(2)=4.574, P=0.032) and perceived diet quality (chi(2)=7.219, P=0.027) were greater for Farmers' Market Nutrition Program. CONCLUSIONS: Farmers' Market Nutrition Program participants exhibit more indicators of a healthful diet, but appear not to be more food secure. Nutrition education regarding the benefits of fresh produce intake can help to improve diet quality and increase Farmers' Market Nutrition Program participation.

Household food insecurity is inversely associated with social capital and health in females from special supplemental nutrition program for women, infants, and children households in Appalachian Ohio.

Food insecurity has been negatively associated with social capital (a measure of perceived social trust and community reciprocity) and health status. Yet, these factors have not been studied extensively among women from households participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or the WIC Farmers' Market Nutrition Program. A cross-sectional, self-administered, mailed survey was conducted in Athens County, Ohio, to examine the household food security status, social capital, and self-rated health status of women from households receiving WIC benefits alone (n=170) and those from households receiving both WIC and Farmers' Market Nutrition Program benefits (n=65), as well as the relationship of food security, social capital, and self-rated health status. Household food security and perceived health status were not significantly different between groups; however, high social capital was greater (chi(2)=8.156, P=0.004) among WIC, compared to WIC/Farmers' Market Nutrition Program group respondents. Overall, household food insecurity was inversely associated with perceived health status (r=-0.229, P=0.001) and social capital (r=0.337, P<0.001). Enabling networking among clients, leading to client-facilitated programs and projects, and developing programs that strengthen social capital, including community-based mentoring programs and nutrition education programs that are linked to community-based activities, are needed, as is additional research to verify these findings.

Self-identified knowledge and practices of family physicians in Appalachian Ohio regarding food acquisition of patients.

This study assessed the self-identified food security knowledge and practices of family physicians practicing in Appalachian Ohio, along with related factors, using a 17-item survey. Respondents (n=189, 42.2%) were primarily male (n=151, 79.9%), white (n=172, 91%), US citizens (n=182, 96.8%), rural inhabitants (n=137, 72.5%), and doctors of medicine (n=19, 63.3%). Only 29 (16.0%) of the family physicians strongly agreed (n=2, 1.1%) or agreed (n=27, 14.9%) that they were knowledgeable about food security. A food security practice score (n=189, 3.4+/-2.4) was computed using a multi-item question (Cronbach's alpha=0.76). Food security knowledge was related to (Kendall's tau) age (0.137, P =.028), years as a physician (0.162, P =.004), and food security practice score (0.161, P =.007). Family physicians involved in improving community food security had greater food security practice scores (n=43, 4.9+/-2.9), compared with those who did not (n=138, 2.9+/-2.0) ( P <.001). Education of family physicians about food insecurity and considering food security in practice is warranted.

Food security status of households in Appalachian Ohio with children in Head Start.

This study measured food security and hunger of households involved in Head Start in a rural Appalachian county and assessed factors that could affect food security and hunger. A convenience sample of households with children enrolled in the Head Start program in Athens County, Ohio, were sampled (n=710), with adults from 297 (42%) households responding. The survey instrument included the 18-question US Household Food Security Survey Module for measuring hunger and food insecurity. Of those responding, 152 households (51.2%) were food secure and 145 (48.8%) were food insecure. Ninety (30.3%) had experienced hunger in the previous 12 months, and 41 (13.8%) households were classified as food insecure with childhood hunger. Hunger was related to a variety of household characteristics and associated with several factors, including participation in food banks, dependence on family members and friends outside of the household for food, lacking reliable transportation, and not having a garden.

Selenium intakes, absorption, retention, and status in adolescent girls.

OBJECTIVES: To assess selenium intakes, absorption, retention, and status in healthy adolescent girls and the effect of calcium supplementation on selenium parameters. DESIGN: Annual 2-week study conducted each year for 3 consecutive years in which yearly selenium intakes, absorption, and retention and blood selenium status were measured. SETTING: A metabolic unit in a large metropolitan hospital located in Columbus, Ohio--a low selenium region of the United States. SUBJECTS: Healthy white girls aged 11 to 14 years (n=16) enrolled in a calcium balance study and randomly assigned to receive a placebo of methylcellulose (n=9) or a calcium supplement containing 1,000 mg supplemental calcium as calcium citrate malate (n=7). INTERVENTIONS: Each subject consumed a diet with approximately 100 microg selenium/day during the yearly 2-week balance studies. RESULTS: Selenium status measurements (serum and erythrocyte selenium and glutathione peroxidase activity) were all within normal ranges for adults during the study. Apparent selenium absorption averaged 71%, 76%, and 74% for years 1, 2, and 3 of the study, respectively, and did not vary significantly (P>.05). Average daily selenium retention did not differ among the years of the study (P>.05) and indicated that the usual selenium intake was approximately 100 microg daily. Measurements of selenium status and retention did not differ between calcium-supplemented and placebo groups. CONCLUSIONS: An intake of approximately 100 microg selenium/day is the typical intake of the mineral among the subjects and appeared adequate to maintain selenium status in these healthy adolescent girls; in addition, calcium supplementation of 1,000 mg daily does not have a negative impact on selenium parameters.

Physician treatment of osteoporosis in response to heel ultrasound bone mineral density reports.

Optimal information that should be included in ultrasound (US) heel bone mineral density (BMD) reports is not known. If additional information about further evaluation of patients with low heel BMD were included in reports, would responses for treatment improve? We screened people at health fairs using the Sahara heel US machine. For those with a T-score of