The Modified Dynamic Gait Index and Limits of Stability in Myotonic Dystrophy Type 1

INTRODUCTION: The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). METHODS: Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. RESULTS: Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as fallers and those who had been classified as nonfallers. Significant correlations were found between mDGI scores and 10-m walking time. DISCUSSION: Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1

Use of an innovative model to evaluate mobility in seniors with lower-limb amputations of vascular origin: a pilot study

<p>Abstract</p> <p>Background</p> <p>The mobility of older individuals has often been only partially assessed, without considering all important aspects such as potential (available) versus effective (used) mobilities and the physical and psychosocial factors that modulate them. This study proposes a new model for evaluating mobility that considers all important aspects, applied here to lower-limb amputees with vascular origin. This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression). The main objective was to characterize potential and effective mobility as well as mobility modulators in a small sample of people with lower-limb amputations of vascular origin with different characteristics. The second objective of this pilot study was to assess the feasibility of measuring all variables in the model in a residential context.</p> <p>Methods</p> <p>An observational and transversal design was used with a heterogeneous sample of 10 participants with a lower-limb amputation of vascular origin, aged 51 to 83, assessed between eight and 18 months after discharge from an acute care hospital. A questionnaire of participant characteristics and 16 reliable and valid measurements were used.</p> <p>Results</p> <p>The results show that the potential mobility indicators do not accurately predict effective mobility, i.e., participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world. The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors. The evaluations were acceptable in terms of the time taken (three hours) and the overall measurements, with a few exceptions, which were modified to optimize the data collected and the classification of the participants. For the population assessed, the results showed that some of the negative modulators (particularly living alone, no rehabilitation, pain, limited social support, poor muscle strength) played an important role in reducing effective mobility.</p> <p>Conclusion</p> <p>The first use of the model revealed interesting data that add to our understanding of important aspects linked to potential and effective mobility as well as modulators. The feasibility of measuring all variables in the model in a residential context was demonstrated. A study with a large number of participants is now warranted to rigorously characterize mobility levels of lower-limb amputees with vascular origin.</p

The Life-Space Assessment Measure of Functional Mobility has Utility in Community-Based Physical Therapist Practice in the United Kingdom

Background: The Life-Space Assessment (LSA) has demonstrable validity and reliability among people sampled from nonclinical settings. Its properties in clinical settings, especially physical therapy services, are less well established.Objective: The aim of this study was to test the construct/convergent validity, responsiveness, and floor/ceiling effects of the LSA among patients who had musculoskeletal, orthopedic, neurological, or general surgical presentations and were receiving individually tailored, community-based physical therapist interventions to address gait/balance impairments in an urban location in the United Kingdom.Design: A prospective, repeated-measures, comparative cohort design was used.Methods: Two hundred seventy-six community-dwelling, newly referred patients were recruited from 3 cohorts (outpatients; domiciliary, nonhospitalized; and domiciliary, recent hospital discharge). Data were collected from the LSA and the Performance-Oriented Mobility Assessment (POMA1) at initial assessment and discharge. Two hundred twenty-eight participants were retained at follow-up.Results: The median age was 80.5 years, 73.6% were women, and the median number of physical therapist contacts over 53 days was 5. LSA scores at assessment and changes over treatment distinguished between cohorts, even after adjustment for covariates. Weak correlations (0.14–0.41) were found between LSA and POMA1 scores. No LSA floor/ceiling effects were found. Significant improvements in the LSA score after the intervention were found for each cohort and for the sample overall. For the whole sample, the mean change in the LSA score was 10.5 points (95% CI = 8.3–12.8).Limitations: The environmental demands participants faced were not measured. Caregivers answered the LSA questions on behalf of participants when necessary. Assessors were not always masked with regard to the measurement point.Conclusions: The LSA has utility as an outcome measure in routine community-based physical therapist practice. It has satisfactory construct validity and is sensitive to change over a short time frame. The LSA is not a substitute for the POMA1; these measures complement each other, with the LSA bringing the added value of measuring real-life functional mobility

Impact of family structure on long-term survivors of osteosarcoma.

GOALS OF WORK: Long-term outcomes of osteosarcoma have dramatically improved with the use of modern combination therapies. Such aggressive treatments, however, entail chronic complications. In the present study, we assessed the functional, psychological, and familial status of long-term survivors of osteosarcoma treated at our institution. MATERIALS AND METHODS: Fifteen long-term survivors of osteosarcoma were evaluated for functional and psychological sequelae. Functional assessment was based on a method described by Enneking et al. Psychological assessment was based on General Health Questionnaire 28, Inventory Scale for Traumatic Neurosis, and Family System Test. MAIN RESULTS: Ten patients showed mild functional impairments; only five patients were handicapped more seriously. Depressive symptoms were diagnosed in four patients. A total of six patients revealed unbalanced family structures, including three of the four patients with depressive symptoms, all four patients with symptoms of posttraumatic stress disorder, and five of seven patients who showed poor emotional acceptance. CONCLUSIONS: Osteosarcoma survivors will generally recover good functional performance. Only a minority of them remain seriously impaired. One third of the patients present depressive symptoms and posttraumatic stress disorder. Poor coping is closely associated with unbalanced family structures. Therefore, the psychological and familial situation of patients with newly diagnosed osteosarcoma should be carefully assessed

Development of improved balance measures for community-dwelling older adults

Thesis (Sc.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Balance measures used in community-dwelling elderly suffer from important psychometric limitations including limited comprehensiveness in content, ceiling effects, and limited sensitivity to change and responsiveness. This dissertation examines conceptual and methodological reasons underlying psychometric limitations of balance measures, and proposes strategies to overcome these limitations. Conceptually, psychometric limitations of balance measures may be related to gaps in representation of essential task and environmental components within their items. The first study conducted a systematic item-level content analysis of balance measures for community-dwelling elderly to examine the extent to which essential task and environmental components were represented within each measure. One hundred sixty-seven items from 26 measures were coded on seven criteria related to task and environment. Important gaps were noted across measures, with limited comprehensiveness in content areas represented and minimal incorporation of environmental variations. Most measures focused on single-task assessment in quiet, static environments, underrepresenting postural control demands in daily life situations, which involve dynamic changing environments, person-environment interactions, and multi-tasking. Methodologically, most balance measures are traditional fixed-form tests, which require administration of a fixed set of items to every individual. Developing comprehensive and precise fixed-form balance measures is challenging due to the large number of items needed to cover the spectrum of balance ability and components. Item response theory (IRT) and computer-adaptive testing (CAT) offer contemporary methodological approaches to develop comprehensive, tailored, and efficient balance tests with improved psychometric properties across the balance continuum. The second study built a computer-adaptive balance test from three traditional fixed-form balance measures using existing data on 187 community-dwelling older adults. Rasch IRT analysis was applied to compile a 23-item pool from the traditional measures. A 10-item CAT developed from the item pool showed excellent accuracy, acceptable reliability, and superior validity compared with the traditional measures. The CAT was the only measure to discriminate between fallers and non-fallers, and was a stronger predictor of self-reported function compared with the traditional measures. In summary, this dissertation reveals important content gaps in existing balance measures for community-dwelling elderly, highlights content areas that should be incorporated in new measures, and demonstrates advantages of computer-adaptive balance testing over traditional fixed-form measures. Development of new measures that better reflect postural control demands in daily life situations is recommended. Prospective investigation of computer-adaptive balance testing in community-dwelling elderly is also recommended