Exercise intervention for individuals with chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) is recommended to improve function of the calf muscle pump (CMP). A systematic review with meta-analysis was conducted to measure the effects of exercise (including function of the CMP, ankle strength, range of motion [ROM], and healing rates) for VLUs. Four (4) databases (Cumulative Index to Nursing and Applied Health Literature, 1981; MEDLINE, 1964; Scopus, 1966; and EMBASE, 1947) were searched for relevant articles from the date of index inception to January 2016. All study types that evaluated the effect of exercise on the function of the CMP in patients with CVI were included; narrative and systematic studies were excluded. All data were extracted by 1 reviewer onto a predetermined form and verified by a second reviewer. Data extracted included number of patients, primary diagnosis, patient demographics, study location, wound characteristics, inclusion/exclusion criteria, exercise group details, control group details, co-interventions, primary outcome measures, secondary outcome measures, wound healing measures, blinding, intention to treat, and study design. A total of 1325 articles was screened; 14 met the inclusion criteria (total study participants = 519). CMP hemodynamics were assessed using air plethysmography measurement results from the included studies. A meta-analysis of 8 articles was distilled to 3 with relevant data (83 participants) that found a significant increase on CMP ejection fraction in favor of the exercise group (Hedge's g = 0.83; 95% CI 0.35-1.30, P < .001) compared to control. CMP residual venous fraction also favored the exercise group (Hedge's g = 0.42; 95% CI -0.03-0.862, P = .066). Ankle ROM was higher in the exercise group (116 participants; Hedge's g = 0.62; 95% CI -0.15-1.39, P = .116); however, these differences were not significantly different from controls. Exercise directed at improving calf muscle strength and ankle ROM for individuals with or at risk for VLUs improves CMP hemodynamics and function. Additional research using larger sample sizes to confirm the role of exercise in healing VLUs is warranted.

Objectives Individuals living with young-onset Parkinson's disease compose a rare subtype of a disease typically associated with older age. Situated within a large grounded theory study exploring information behavior, this paper describes the core category of the theory, i.e. uncertainty. Methods Data were collected with 39 individuals living with young-onset Parkinson's disease who took part in in-depth interviews, focus groups and/or an online discussion board. Fourteen autobiographies written by individuals living with young-onset Parkinson's disease were also used as data sources. Results Through experiencing young-onset Parkinson's disease, participants were confronted with uncertainty along two main lines. First, they experienced uncertainty with respect to their identities as young- and middle-aged adults, deviating from the idealized age-graded life path marked out within their socio-cultural context. Second, they experienced uncertainty with respect to their functioning, as the heterogeneous nature of Parkinson's progression meant that it would not be possible to chart how their disease would change over time. This uncertainty was associated with feelings of lost control over their lives and increased grief. Discussion With a deeper appreciation for how uncertainty is experienced in the lives of those with young-onset Parkinson's disease, health professionals may be better prepared to discuss these issues with patients and provide support and resources.

To conduct a systematic review and meta‐analysis on the effects of electrical stimulation therapy ( EST ) on healing pressure ulcers in individuals with spinal cord injury ( SCI ). CINAHL , The Cochrane Library, PubMed , SCOPUS , EMBASE , Nursing & Allied Health and Dissertation & Theses databases were searched for relevant English language articles from the date of inception to 31 January 2014. Separate searches were conducted in Google Scholar and academic journals specialised in wound care. Two reviewers independently assessed study eligibility. Studies were included if EST was used to treat pressure ulcers in individuals with SCI . A total of 599 articles were screened, and 15 studies met the inclusion criteria. A meta‐analysis with five studies demonstrated that EST significantly decreased the ulcer size by 1·32%/day [95% confidence interval ( CI ): 0·58–2·05, P < 0·001] compared to standard wound care (SWC) or sham EST. Another meta‐analysis conducted with four studies showed that EST increased the risk of wound healing by 1·55 times compared with standard wound care or sham EST (95% CI : 1·12 to 2·15, P < 0·0001). Because of the wide array of outcome measures across studies, a single meta‐analysis could not be conducted. EST appears to be an effective adjunctive therapy to accelerate and increase pressure ulcer closure in individuals with SCI .

Objectives: Typical rehabilitation programs following total hip arthroplasty and total knee arthroplasty include joint range of motion and muscle-strengthening exercises. Balance and balance exercises following total hip arthroplasty and total knee arthroplasty have not received much attention. The purpose of this study was to determine whether an intervention of balance exercises added to a typical rehabilitation program positively affects patients’ balance. Methods: A total of 63 patients were provided with outpatient physical therapy at their home. Patients were randomly assigned to either typical (n = 33) or balance (n = 30) exercise group. The typical group completed seven typical surgery-specific joint range of motion and muscle-strengthening exercises, while the balance group completed the typical exercises plus three balance exercises. After 5 weeks of administering the rehabilitation program, patients’ balance was assessed on a force plate using 95% ellipse area of the center of pressure amplitude. Results: Patients in the balance group demonstrated significant reduction in the 95% ellipse area for the anterior and posterior lean standing conditions (p < 0.01). Conclusion: Balance exercises added to the typical outpatient physical therapy program resulted in significantly greater improvements in balance for participants with total hip arthroplasty or total knee arthroplasty, compared to the typical exercise program alone. Physical therapists might consider the use of balance exercises to improve balance in individuals in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty.

Based on society's expectations of what defines the norms for what is deemed "masculine" and "feminine", and a propensity for society's members to adhere to these expectations, women may face a unique set of circumstances and pressures following surgical treatment for laryngeal cancer. This is primarily due to the changes that occur to women's physical, psychological, and social functioning when dealing with cancer diagnosis and treatment outcomes. Because of concerns related to physical disfigurement, acoustic and perceptual changes to one's voice, and threat of the psychological sequelae associated with total laryngectomy (TL) (or, the surgical removal of one's voicebox and surrounding structures), there is an increased potential for violation of social expectations that cross these areas of functioning. As such, efforts that seek to better understand the potentially differential impact of TL on women and identify the specific needs they may have leading up to and after such treatment pursuant to contemporary societal expectations are warranted. Thus, this paper provides an examination of the potentially differential impact of TL on women. In addressing this position, this paper examines the unique challenges women may face postlaryngectomy through the framework of the International Classification of Functioning, Disability, and Health (ICF). Through the use of the ICF, this paper will provide an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as facilitators or barriers to women's societal reintegration secondary to TL.Learning outcomes: Readers will be able to describe the multiple factors that may contribute to the differential impact of total laryngectomy (TL) on women. More specifically, readers will gain an understanding about women's physical, psychological, and social functioning secondary to TL This paper also provides readers with exposure to the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework. This framework provides readers with an expanded perspective related to the interactions between body functioning, active participation in daily activities, and contextual factors that may act as either facilitators or barriers to the societal reintegration of women secondary to TL. (C) 2015 Elsevier Inc. All rights reserved.

Interactions between dogs and humans, including participating in physical activities and dog-sport events, are beneficial for both parties. Self-Determination Theory was used as a framework to explore dog-sport competitors' motivation to participate in dog-sport events. Eighty-five competitors completed surveys including demographic questions, a measure of frequency of engagement in dog-sport competitions, open-ended questions regarding motivators, and the Sports Motivation Scale, adapted to dog-sport participation. Seventy-eight percent of participants were aged 45 to 74 years, and the majority were female. Seventy-seven percent of participants reported participation at >= 12 competitions per year, while 23% reported attending <= 6 competitions. The logistic regression model was significant (chi(2)((6)) =16.68, n = 84, p < 0.05) and explained 18% (Cox and Snell R Square) to 27.4% (Nagelkerke R Square) of the variance in number of competitions selected. Intrinsic motivation (IM-to experience) and self-determined extrinsic motivation (EM-identified) were the two predictors that contributed significantly to the model. Data from open-ended survey questions indicated that participants valued and enjoyed dog sports and reported similar benefits for themselves and their dogs. Participants perceived the benefits associated with participation in dog sports as motivators for continued engagement. Self-determined motivation appeared to differentiate between people who competed more frequently at dog-sport competitions and those who competed less frequently. Understanding motivation to participate could help when promoting dog-sport competition to dog owners who do not participate or participate less frequently, including younger men and women. The Sports Motivation Scale adapted to dog sports is a good survey tool to elucidate information regarding motivation to participate in dog sports.

Background: Parkinson’s disease (PD) impairs gait performance, which can lead to falls and decreased quality of life. This study examined the feasibility of implementing a novel home-based intervention designed to elicit gait improvement in individuals with PD. Methods: Five participants with PD completed a two-week home-based gait retraining intervention designed around guided video feedback. Semi-structured interviews were conducted postintervention and two months postintervention to acquire feedback from the participants about their experience with the intervention. Spatiotemporal parameters of gait and functional mobility were assessed pre and postintervention and at two months postintervention. Results: Participants reported high levels of usability and expressed they believed that the intervention improved their gait and led to a fortified sense of ability and revived sense of empowerment. Comparisons of spatiotemporal and mobility parameters of gait identified that improvements occurred between preintervention and postintervention—step length (x̄ = 10.7%), gait velocity (x̄ = 15.1%), and TUG scores (x̄ = 9.8%)—and between preintervention and two months postintervention—step length (x̄ = 3.9%), gait velocity (x̄ = 9.9%), and TUG scores (x̄ = 4.2%). Conclusions: Guided home-based video training has potential to be an effective treatment strategy for improving gait impairment among individuals with PD.

Background/Objectives: Dog ownership in older adulthood has been connected with increased likelihood of meeting the physical activity guidelines. There are older dog owners, however, who do not walk their dogs. Investigation utilizing the Self-Determination Theory was used to identify differences in motivation between regular and infrequent dog-walkers, while qualitative investigation helped identify and explore factors that influence motivation (basic psychological needs). Method: Ninety-four dog owners, aged 55 years and older, participated in the study. Participants completed the Behavioural Regulations in Exercise Questionnaire 2, a measure of motivation, a questionnaire to measure dog-walking behaviour,

Objective: To compare the relative efficacy of visual versus auditory cueing on gait among individuals with Parkinson's disease (PD).Data Sources: A systematic search was completed up to September 2011, using the following databases: EMBASE, Scopus, Medline, CINAHL, and PubMed.Study Selection: Four authors searched the databases using the following terms: Parkinson's disease (including abbreviations), gait, cadence, step, pace, cueing, cues, and prompt. All studies that evaluated the effect of cueing on gait in PD were selected by consensus of 2 pairs of authors who reviewed the titles and abstracts. Each pair of authors then applied the inclusion and exclusion criteria to each study, and 25 articles were chosen. Inclusion criteria were cueing studies that reported pre- and postoutcome measures of gait parameters. Exclusion criteria were lack of data and studies that evaluated gait aids.Data Extraction: Gait measures of cadence, stride length, and velocity, before and after cueing, were collected from each study. If data were represented in graphs, a pair of authors extracted the data points individually, then compared and averaged values.Data Synthesis: The data were synthesized using a meta-analysis based on cue type. Auditory cueing demonstrated significant improvement of cadence (Hedge g = .556; 95% confidence interval [CI], .291-.893), stride length (Hedge g = .497; 95% CI, .289-.696), and velocity (Hedge g=.544; 95% CI, .294-.795). In contrast, visual cueing significantly improved stride length only (Hedge g = .554; 95% CI, .072-1.036).Conclusions: The findings suggest that auditory cueing is more effective for treating gait disorders in PD. Further research is needed to determine the optimum auditory cueing strategy for gait improvements. Archives of Physical Medicine and Rehabilitation 2013;94:562-70 (C) 2013 by the American Congress of Rehabilitation Medicine

Background and Purpose: The purpose of this study was to evaluate the effect of visuospatial neglect on functional outcome and discharge destination in individuals with right brain damage. Methods: Sixteen subjects agreed to participate in the study and 6 of these subjects demonstrated visuospatial neglect. During two different data collection periods, participants were evaluated with the Rivermead Behavioral Inattention Test, the Functional Independence Measure (FIM), the Mini-Mental State Examination, the Berg Balance Scale, and the Chedoke-McMaster Impairment Inventory. Results: Admission and discharge FIM scores were significantly lower for subjects with visuospatial neglect. The discharge destination for the group with visuospatial neglect demonstrated a trend toward supported living (i.e., long-term care). The groups did not differ significantly in onset to rehabilitation admission interval or length of rehabilitation stay. Conclusions: The presence of visuospatial neglect may predict the need for greater amounts of caregiver assistance at discharge.

Purpose: To present a new graphic representation of the international classification of functioning, disability and health (ICF), entitled the ICF-conceptual revision (ICF-CR). The ICF-CR aims to be clearer and more usable tool than the ICF graphic currently used by starting to address criticisms of the ICF raised in the literature, with a focus on positioning quality of life (QoL) in relation to the ICF's other components. Method: This is a conceptual paper based on a review of criticisms of the ICF and related literature published on human functioning. Results: In addition to criticisms of the current graphic, four criticisms of the ICF are discussed in relation to the development of the ICF-CR, including: the lack of development of biopsychosocial theory, the lack of clarity between activities and participation, the language used, and the absence of QoL. General systems theory is used to help construct the new graphic in addressing these criticisms and to position QoL. Conclusions: The ICF-CR is designed to be a more responsive graphic of human functioning; one which enhances the clarity of principles integral to the ICF, including biopsychosocial theory and universalism. It is hoped the ICF-CR will promote continued discussion toward the goal of enhancing the ICF, both visually and conceptually.

Motor learning has been found to occur in the rehabilitation of individuals with Parkinson's disease (PD). Through repetitive structured practice of motor tasks, individuals show improved performance, confirming that motor learning has probably taken place. Although a number of studies have been completed evaluating motor learning in people with PD, the sample sizes were small and the improvements were variable. The purpose of this meta-analysis was to determine the ability of people with PD to learn motor tasks. Studies which measured movement time in upper extremity reaching tasks and met the inclusion criteria were included in the analysis. Results of the meta-analysis indicated that people with PD and neurologically healthy controls both demonstrated motor learning, characterized by a decrease in movement time during upper extremity movements. Movement time improvements were greater in the control group than in individuals with PD. These results support the findings that the practice of upper extremity reaching tasks is beneficial in reducing movement time in persons with PD and has important implications for rehabilitation.

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Balance problems and falls are a common concern among individuals with Parkinson's disease (PD). Falls frequently occur during daily activities such as reaching into cupboards in the kitchen or bathroom. This study compared the correlation among two standard postural stability tests - the postural stability score on the Unified Parkinson's Disease Rating Scale (UPDRS) and the Functional Reach Test (FRT) - and ecologically valid reaching tasks that correspond to reaching at different cupboard heights among 20 individuals with PD and 20 age-matched controls. Both the FRT and the UPDRS postural stability tests are quick measures that can be performed during the clinical examination. The FRT, but not the postural stability score, demonstrated a significant correlation with the ecologically valid reaching tasks, among individuals with PD. Furthermore the FRT scores did not correlate with the UPDRS postural stability scores, indicating that these are measuring different aspects of balance. This study suggests that the FRT score may better predict the risk of postural instability encountered during daily activities among individuals with PD.

Although dual-task interference has previously been demonstrated to have a significant effect on postural control among individuals with Parkinson's disease, the impact of speech complexity on postural control has not been demonstrated using quantitative biomechanical measures. The postural stability of twelve participants with idiopathic Parkinson's disease and twelve healthy age-matched controls was evaluated under three conditions: (1) without a secondary task, (2) performing a rote repetition task and (3) generating a monologue. Results suggested a significant effect of cognitive load on biomechanical parameters of postural stability. Although both groups increased their postural excursion, individuals with Parkinson's disease demonstrated significantly reduced excursion as compared with that of healthy age-matched controls. This suggests that participants with Parkinson's disease may be overconstraining their postural adjustments in order to focus attention on the cognitive tasks without losing their balance. Ironically, this overconstraint may place the participant at greater risk for a fall.

PURPOSE:To compare the original and reduced versions of the Berg Balance Scale (BBS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as completed by patients following total hip arthroplasty (THA) or total knee arthroplasty (TKA), with respect to their potential utility in clinical and research settings.METHOD:Patients with THA (n=26) or TKA (n=28) were evaluated before and after 5 to 7 weeks' participation in a home-based exercise programme. They were assessed using the original versions of the BBS and the WOMAC; scores for the reduced versions of the BBS and the WOMAC were extracted from the original versions.RESULTS:Good to excellent correlations (r≥0.80) were observed between the original and the reduced versions of the BBS and the WOMAC. The index of responsiveness, evaluated using standardized response means (SRM), was similar for the original and the reduced versions of the BBS and the WOMAC function sub-scale.CONCLUSIONS:The reduced versions of the BBS and the WOMAC provided similar information to the original versions and were equally responsive. These reduced versions comprise fewer questions and may be completed in considerably less time, which suggests that they may be advantageous for clinical and research use.

Parkinson's disease is a chronic neurological disorder that results in gait and posture impairment. There is increasing evidence that these motor impairments may be partially due to deficits within the sensory system. In this study, the effects of a facilitatory insole that provides increased plantar sensory stimulation, was evaluated during gait, in a group of individuals with Parkinson's disease in comparison with healthy age-matched controls. Spatial-temporal parameters of gait were evaluated using an instrumented carpet, and muscle activation patterns were evaluated using surface EMG. All participants were tested with both a facilitatory (ribbed) insole and a conventional (flat) insole while walking 20 feet. Results indicated that the use of the facilitatory insole produced a significant increase in single-limb support time. Additionally, the muscle activation sequence of the tibialis anterior was normalized by the facilitatory insole, at the time of initial ground contact. These changes may lead to an overall improvement in gait pattern and stability, and suggest that the use of this type of facilitatory insole may be a useful treatment strategy for improving the gait of individuals with Parkinson's disease. This also provides support for the role of facilitation of the sensory system in improving motor output in individuals with Parkinson's disease.