Quantitative Assessment of the Stops Walking While Talking Test in the Elderly
|
|
- Paulina Gregory
- 6 years ago
- Views:
Transcription
1 838 Quantitative Assessment of the Stops Walking While Talking Test in the Elderly Esther W. de Hoon, MD, John H. Allum, DSc, PD, Mark G. Carpenter, PhD, Christian Salis, Bastiaan R. Bloem, PhD, MD, Martin Conzelmann, MD, Heike A. Bischoff, MD ABSTRACT. de Hoon EW, Allum JH, Carpenter MG, Salis C, Bloem BR, Conzelmann M, Bischoff HA. Quantitative assessment of the stops walking while talking test in the elderly. Arch Phys Med Rehabil 2003;84: Objective: To examine whether trunk sway and walking speed differ between elderly stoppers and nonstoppers during a shorter version of the stops walking while talking (SWWT) test an observational assessment of impaired dualtask performance and during a normal walking trial. Design: The original SWWT test was administered on the way to the test room (over a distance of 150m). Then, subjects were asked to walk 2 trials of 8m while wearing a trunk sway measuring device strapped firmly to their lower back. For the first 8-m trial, no questions were asked (control trial). During the second 8-m trial, subjects were asked an easy question (What is your age?) after walking 2m. Setting: Long-stay geriatric care unit in Switzerland. Participants: Seventeen institutionalized elderly (16 women, 1 man; mean age, 86.3y; range, 79 93y). Subjects had to be able to walk at least 150m and to understand simple questions. Interventions: Not applicable. Main Outcome Measures: The amplitude of trunk sway angle and angular velocity in the forward-backward (pitch) and side-to-side (roll) directions and the duration of each trial were compared between the two 8-m walking trials with and without a question among subjects who did and did not come to a complete stop. Results: In the original SWWT test, 4 persons stopped walking while talking, compared with 8 persons who stopped in the short (8-m) walking trial when a question was asked. Persons who stopped during the 8-m trial when a question was asked had significantly longer walking durations (by 19s) and larger trunk roll angular displacements (by 5.5 ) during trials, both with and without a question. For both stoppers and nonstoppers, duration was longer during the trial when a question was asked. From the Department of Otorhinolaryngology, University Hospital, Basel, Switzerland (de Hoon, Allum, Carpenter); Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands (de Hoon); Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada (Carpenter); Department of Orthopaedics, University of Basel, Basel, Switzerland (Salis, Bischoff); Department of Neurology, University Medical Centre St Radboud, Nijmegen, The Netherlands (Bloem); and Department of Geriatrics, Felix-Platter Spital, Basel, Switzerland (Conzelmann, Bischoff). Supported by grants from the Fundatie van de Vrijvrouwe van Renswoude te s-gravenhage, Glaxo-Welcome, a NDIT/FPIT StudEx subsidy, and by the Free Academic Society of Basel. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. Reprint requests to John H. Allum, DSc, PD, University HNO-Klinik, Petersgraben 4, CH-4031 Basel, Switzerland, jallum@uhbs.ch /03/ $30.00/0 doi: /s (02) Conclusion: A fixed and brief walking distance, coupled with a single sudden question, provided an effective method of identifying subjects who stop walking while talking. These subjects are those who have slower walking speeds and more unstable trunk control in the roll plane even under normal walking conditions. Our findings support the predictive capabilities of a brief SWWT test for the unstable and fall-prone elderly, as well as the usefulness of objective trunk sway measures to identify gait instabilities. Key Words: Accidental falls; Balance; Elderly; Rehabilitation; Walking by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation A MAJOR FOCUS OF THOSE caring for the elderly is to prevent falls, primarily by reducing the factors that contribute to fall risk. Predicting a tendency to fall in the elderly is, however, difficult when based on single physiologic measures. Generally, it is an accumulation of deficits, such as low muscle strength, decreased reaction times, deficits in sensory inputs contributing to balance control, and mobility impairments that lead to deficits in the functional tasks of daily living. 1-8 Eventually, such impairments may lead to falls in the elderly In view of the complex and multifactorial pathophysiology underlying falls, it is understandable that the assessment of isolated components of postural control does not predict falls well. Accumulated evidence does, however, suggest that fall risks can be estimated effectively by measuring dual-task performance, that is, by a person s ability to execute a secondary task while standing or walking For example, Lundin-Olsson et al 15 found that the timed up and go test 16 is a good predictor of fall risk if combined with a manual task, such as carrying a tray on which there is a glass of water. The stops walking when talking (SWWT) test appears to be an even better predictor of fall risk. 1 The test is a functional one of impaired dual-task performance that is related to fall risk in the elderly. 1 To perform the test, the examiner starts a routine conversation with the person being tested during a walk of 100 to 200m and documents whether that person completely stops walking during the conversation. This inability to walk and talk at the same time appeared to be an excellent predictor of falls in cognitively impaired elderly persons. 1 Nonetheless, the test has several shortcomings. One shortcoming is that the test requires mobility skills (eg, the ability to walk more than 100m) that may be beyond the capabilities of frail institutionalized elderly persons. Another drawback is that the conversation content is not defined. A third shortcoming is that classification is limited to visual inspection of complete stops. It could be argued that the SWWT test is not objective enough to detect more subtle changes in balance or gait control during dual-task conditions 17 (ie, the test is not graded enough to recognize borderline fallers). Quantitative assessment of balance control by using static or dynamic posturography can reveal subtle changes in postural control during dual-task per-
2 ASSESSMENT OF THE STOPS WALKING WHILE TALKING TEST, de Hoon 839 formance ,18 However, such assessments are based only on balance control during stance and not on the gait activities of daily living; thus, they are possibly less relevant in predicting falls. We had 2 objectives in this study. First, we wanted to know whether subjects also stop walking when talking if the walking distance is shorter and is paired with a simple question. Second, we studied whether measures of trunk sway might provide objective measures with which to identify persons with impaired dual-task performance, and therefore at risk to fall. We measured dynamic balance control (in the form of trunk sway) during an abbreviated version of the SWWT test, based on an 8-m walking distance. The trunk sway measuring device we used 19,20 permitted an accurate, observer-independent, assessment of balance control during a natural walking task and was well tolerated by the elderly. We also recorded the duration of the trial (as an estimate of walking velocity). METHODS Similar to Lundin-Olsson et al, 1 we asked frail elderly people with weakness and an increased risk of falling 9 to participate in this study. Seventeen institutionalized elderly subjects (16 women, 1 man; mean age, 86.3y; range, 79 93y) agreed to participate. They were recruited from 2 long-stay geriatric care units within the Felix-Platter Hospital, Basel University, Basel, Switzerland. Inclusion criteria were 70 years of age or older and the ability to walk 150m with or without a walking aid. Exclusion criteria were a score below 10 on the Mini-Mental State Examination 21 (MMSE), decreased corrected or uncorrected vision (sufficiently severe to interfere with gait and balance), a hearing impairment, Parkinson s disease, spasticity, or amputation. Medical comorbidities were documented with the Charlson Comorbidity Index. 22 Witnessed, oral informed consent was obtained from all participants, as required by the local ethics committee. In the study s first phase, the original SWWT test as described by Lundin-Olsson, 1 was performed. Subjects were asked to walk from their room to the examination room (distance, 150m) while engaged in a routine conversation throughout the walk. Complete stops in walking were noted by the examiner. In part 2 of the study, subjects were instructed to walk a distance of 8m twice at their own speed with their normal walking aid (if needed) without stopping. One examiner walked at the same speed next to the subject. During the first 8m walk, no question was asked. At 2m into the second walk, the examiner posed a simple question (What is your age?), which all subjects answered. During each trial, trunk sway and trial duration were measured. To measure trunk sway, we used a device a that has 2 angular-velocity transducers, which were mounted on a converted motorcycle kidney belt. The transducers were oriented on the belt so that trunk angular velocity was measured in the pitch (fore-aft) and roll (lateral) directions at the level of L1-3. Measurement samples were collected every 10ms. The transducers were connected to a personal computer by a 10-m cable. The examiner walking next to the subject carried the cable, thereby allowing the subjects to move freely over distance of the short walk. Offline, angular velocity first was integrated to yield angular displacement. From the stream of angular displacement and velocity samples, maximum excursions in the positive and negative directions were calculated for the roll and pitch measurements to yield 4 outcome variables, in addition to trial duration: peak-to-peak pitch angle and angular velocity, and peak-to-peak roll angle and angular velocity (fig 1). Statistical Analysis We reasoned that subtle balance changes would be apparent in subjects who stopped during the 8-m question trial. We therefore placed subjects into 2 groups 1 group that stopped while walking (stoppers) and 1 group that did not stop (nonstoppers). The measurement variables were analyzed after log transformation to ensure a normal distribution. 19 We used a between- and within-subjects analysis of variance (ANOVA) to examine effects between stoppers and nonstoppers, or between question and no-question trials, as well as any interactions. Significant ANOVA effects were then investigated using t tests with Bonferroni adjustments for the number of variables measured. Significance was set at P less than.05. RESULTS During the 150-m walk of the original SWWT test, 1 4of17 subjects (24%) stopped walking while talking. During the trials over the 8-m walking distance, 1 subject (6%) stopped walking with no question, whereas 8 (47%) subjects (stoppers) stopped during the question trial. The 4 subjects who stopped walking in the 150-m walk were among the 8 subjects who stopped during the 8-m question trial. No significant differences were found between the stopper and nonstopper groups in age (P.66) or scores on the MMSE (P.79). One person from each group (n 2, 14%) had reported previous falls. Figure 1 provides examples of the original trunk sway data for 2 subjects, one a stopper and the other a nonstopper. The data were recorded during the 8-m trial without a question. Apart from the obviously longer duration of the trial for the stopper, it is also apparent in the time histories and x-y plots (of pitch vs roll) that roll sway angle and angular velocities oscillations were larger for the stopper. The distinct differences in trial durations and roll sway angular deviations between individual stoppers and nonstoppers were present across the complete populations (fig 2) for both of the 8-m trials, that is, independent of whether a question was asked. Thus, walking duration was significantly longer (35.1s vs 16.2s; F 1, , P.0023) in the stoppers compared with nonstoppers, independent of whether a question was asked. Similarly, roll angle of the trunk was significantly larger in the stoppers (13.4 vs 7.9 ; F 1, , P.0121) for the no-question 8-m walking trial, as well as for the 8-m walking trials with a question, compared with the nonstoppers (fig 2). There was also a trend for larger pitch angle of the trunk in the stoppers (12.0 vs 10.3 ). However, this trend was not statistically significant. For all subjects, walking time was significantly longer (F 1, , P.029) during the 8-m trial with a single question (mean standard deviation, s), compared with the 8-m trial without a question ( s). DISCUSSION Our first finding was that a shorter version of the original SWWT test (asking a single question during an 8-m walk) provided a faster and perhaps more effective method of identifying subjects with impaired dual-task performance (classified as stoppers) with less space requirements (a walking path of 150m was not needed). In this study, 29% of subjects stopped walking when talking during the original SWWT test, a finding similar to the 21% reported by Lundin-Olsson. 1 However, when subjects were required to answer a simple question during the 8-m walking distance, 47% stopped while answering the question. We suspect that the brief test had a higher diagnostic yield in identifying subjects who are prone to fall because we asked a sudden question, rather than engaging
3 840 ASSESSMENT OF THE STOPS WALKING WHILE TALKING TEST, de Hoon Fig 1. Time history and x-y (roll-pitch) plots of trunk sway for a stopper subject (upper set of traces) and a nonstopper (lower set of traces) walking 8m during the no-question trial. Underneath each plot of pitch and roll time histories, samples of roll and pitch angle are plotted against one another to create an x-y plot. Similarly, the x-y plots of pitch and roll angular velocity are plotted to the right of the angle x-y plots. The envelop of the x-y plots is marked. The scales for all plots are the same for the 2 subjects. Note the differences in the durations of the time histories (14.3s vs 38.0s) and the large roll (x direction) extent of the stopper s x-y plots (4.6 vs 15.9 /s and 29.2 vs 61.6 /s). The measurement variables used for this study were the peak-to-peak extent of the x-y plots in the roll and pitch direction and trial duration (ie, the values for time and roll amplitude listed here). in a more predictable routine conversation. It is possible that the higher proportion of stoppers we identified was confounded by the inclusion of false-positive results (ie, subjects who stop during the brief SWWT test, but who do not fall in daily life). Elderly persons do, however, have more problems with sudden and unexpected events than with more predictable routines (eg, falls typically occur under sudden and unexpected circumstances 7 ). Thus, our asking a question abruptly on average 6 seconds into the 8-m walking trial may mimic an event leading to a fall more effectively than a predictable conversation during a longer walk. To verify this statement, it may prove interesting to examine the dynamics of body motion related to the question event in future studies and to compare the motion with that occurring during actual falls. In addition, our question was clearly defined in its content and timing, whereas the routine conversation in the original SWWT 1 was not. For these reasons, our abbreviated version of the original SWWT test might be used more easily in a clinical setting and may help to expand the application of this test to other patient populations that are unable to walk the long distances of the original SWWT test, with or without a walking aid. The abbreviated version of the SWWT test permits easier quantification of trial duration and body movements, such as trunk sway measured in a controlled environment. In agreement with previous reports of slowed performance during dual tasking, 15,19 we found that the overall trial duration was longer during the dual-task question trial compared with the noquestion trial. The increased duration for the dual-task question
4 ASSESSMENT OF THE STOPS WALKING WHILE TALKING TEST, de Hoon 841 trial can be partially explained by the fact that some subjects completely stopped for a few seconds. However, it is worth noting that stoppers also walked slower than nonstoppers during the no-question trial. More interestingly, differences were observed in trunk roll sway amplitude between subjects classified as stoppers when compared with nonstoppers. Thus, stoppers had a significantly larger trunk roll angular displacement during both the no-question and the question walking trials, indicating more lateral instability and a tendency to fall sideways. Stoppers and nonstoppers could not be separated by other variables, including cognitive ability, that we measured. The validity of our findings is substantiated by our identification of similar changes in subjects with balance deficits compared with their age-matched controls. These subjects also had longer gait trial times and larger trunk roll angle deviations. 20 Furthermore, trunk sway during gait trials is generally reduced with age. 19 Thus, the measures of trunk sway (peakto-peak trunk roll angle during gait) we observed in the stoppers that exceed those of younger (about 55y) acute vestibularloss subjects during gait 20 appear to provide a quantitative measure of gait instability during the single- and dual-task circumstances. In contrast, during normal stance, trunk sway is generally increased with age and also with vestibular loss. 19,20 Thus, increases in trunk sway deviations in people prone to fall during stance may not be related to deviations occurring during gait. CONCLUSION Our results add explanatory power to the findings of Lundin- Olsson et al, 1 showing that persons with impaired dual-task performance have a decreased overall walking speed and poorer dynamic control of trunk roll. A prospective study with long-term follow-up of falls is needed to validate the clinical significance in terms of fall risk prediction of our short version of the SWWT test. Furthermore, future research with this short version of the SWWT test should establish thresholds of performance (both for trial duration and trunk sway) in relation to fall risks to identify subjects with an increased risk for falling at an early stage. Fig 2. Differences in gait measures for stoppers and nonstoppers. The height of the columns represents the mean values of durations and the peak-to-peak amplitude of trunk roll and pitch angular deviations measured during each of the 8-m walking trials, one with a question and one without. NOTE. Error bars indicate the standard error of the mean. *Significantly different means of the stoppers versus nonstoppers. References 1. Lundin-Olsson L, Nyberg L, Gustafson Y. Stops walking when talking as a predictor of falls in elderly people [letter]. Lancet 1997;349: Tinetti ME, Baker DI, Garrett PA, Gottschalk M, Koch ML, Horwitz RI. Yale FICSIT: risk factor abatement strategy for fall prevention. J Am Geriatr Soc 1993;41: Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among the elderly people living in the community. N Engl J Med 1994;331: Tinetti ME, McAvay G, Claus E. Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT Trial? Frailty and Injuries: Cooperative Studies of Intervention Techniques. Am J Epidemiol 1996;144: Fiatarone MA, O Neill EF, Doyle N, et al. The Boston FICSIT Study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. J Am Geriatr Soc 1993;41: Province MA, Hadley EC, Hornbrook MC, et al. The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques. JAMA 1995;273: Connel BR, Wolf SL. Environmental and behavioral circumstances associated with falls at home among healthy elderly individuals. Atlanta FICSIT Group. Arch Phys Med Rehabil 1997;78: Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther 1997;77: Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319: Tinetti ME, Powell L. Fear of falling and low self-efficacy: a case of dependence in elderly persons. J Gerontol 1993;48 Spec No: Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997;337: Lajoie Y, Teasdale N, Bard C, Fleury M. Attentional demands for static and dynamic equilibrium. Exp Brain Res 1993;97: Maki BE, McIlroy WE. Influence of arousal and attention on the control of postural sway. J Vest Res 1996;6: Andersson G, Yardley L, Luxon L. A dual-task study of interference between mental activity and control of balance. Am J Otol 1998;19: Lundin-Olsson L, Nyberg L, Gustafson Y. Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc 1998;46:
5 842 ASSESSMENT OF THE STOPS WALKING WHILE TALKING TEST, de Hoon 16. Podsiadlo D, Richardson S. The timed up&go : a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39: Bloem BR, Grimbergen YA, Cramer M, Valkenburg VV. Stops walking when talking does not predict falls in Parkinson s disease [letter]. Ann Neurol 2000;48: Thapa PB, Gideon P, Fought RL, Kormicki M, Ray WA. Comparison of clinical and biomechanical measures of balance and mobility in elderly nursing home residents. J Am Geriatr Soc 1994;42: Gill J, Allum JH, Carpenter MG, et al. Trunk sway measurements of postural stability during clinical balance tests: effects of age. J Gerontol A Biol Sci Med Sci 2001,56:M Allum JH, Held-Ziolkowska M, Adkin AL, Carpenter MG, Honegger F. Trunk sway measures of postural stability during clinical balance tests: effects of a unilateral vestibular deficit. Posture Gait 2001;14: Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12: Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40: Supplier a. SwayStar ; Balance Int Innovations, CH-3807 Iseltwald, Switzerland.
Research Report. Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test
Research Report Predicting the Probability for Falls in Community-Dwelling Older Adults Using the Timed Up & Go Test Background and Purpose. This study examined the sensitivity and specificity of the Timed
More informationFunctional Ability Screening Tools for the Clinic
Functional Ability Screening Tools for the Clinic Shelley Hockensmith,, P.T., NCS Objectives Review screening tools for physical or functional ability including Five Times Sit to Stand, Walking Speed,
More informationUniversity of Groningen. Maintaining balance in elderly fallers Swanenburg, Jaap
University of Groningen Maintaining balance in elderly fallers Swanenburg, Jaap IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please
More informationTHERE IS A GROWING body of literature that suggests
99 ORIGINAL ARTICLE The Reliability and Validity of the Four Square Step Test for People With Balance Deficits Secondary to a Vestibular Disorder Susan L. Whitney, PhD, PT, NCS, ATC, Gregory F. Marchetti,
More informationAs many as one-third of community-living older individuals
Validity of Divided Attention Tasks In Predicting Falls in Older Individuals: A Preliminary Study Joe Verghese, MD, MS,* Herman Buschke, MD,* Lisa Viola, DO,* Mindy Katz, MPH,* Charles Hall, PhD, Gail
More informationGait Assessment & Implications in Geriatric Rehabilitation
Gait Assessment & Implications in Geriatric Rehabilitation Therapy Network Seminars, Inc. Nicole Dawson, PT, PhD, GCS Learning Objectives Following completion of this webinar, participants will be able
More informationSusan W. Muir PT PhD. Post-Doctoral Fellow Division of Geriatric Medicine Schulich School of Medicine & Dentistry University of Western Ontario
Susan W. Muir PT PhD Post-Doctoral Fellow Division of Geriatric Medicine Schulich School of Medicine & Dentistry University of Western Ontario University of Toronto Rehabilitation Rounds June 14, 2012
More informationFall Prevention for Community Dwelling Older Adults: An Update on Assessment and Intervention Strategies
Fall Prevention for Community Dwelling Older Adults: An Update on Assessment and Intervention Strategies Erica A. Pitsch, PT, MPT, DPT, NCS UCSF/SFSU Graduate Program in Physical Therapy Objectives Be
More informationDoes Fear of Falling Relate to Low Physical Function in Frail Elderly Persons?: Associations of Fear of Falling, Balance, and Gait
REPORT Does Fear of Falling Relate to Low Physical Function in Frail Elderly Persons?: Associations of Fear of Falling, Balance, and Gait Yumi HIGUCHI 1, Hiroaki SUDO 2, Noriko TANAKA 1, Satoshi FUCHIOKA
More informationIdentifying a cut-off point for normal mobility: a comparison of the timed up and go test in community-dwelling and institutionalised elderly women
Age and Ageing 2003; 32: 315 320 # Age and Ageing Vol. 32 No. 3 # 2003, British Geriatrics Society. All rights reserved. Identifying a cut-off point for normal mobility: a comparison of the timed up and
More informationCORE MEASURE: CORE MEASURE: BERG BALANCE SCALE (BBS)
OVERVIEW NUMBER OF TEST ITEMS SCORING EQUIPMENT TIME (NEW CLINICIAN) TIME (EXPERIENCED CLINICIAN) COST o The BBS is a widely-used, clinician-rated scale used to assess sitting and standing, static and
More informationWilliam C Miller, PhD, FCAOT Professor Occupational Science & Occupational Therapy University of British Columbia Vancouver, BC, Canada
William C Miller, PhD, FCAOT Professor Occupational Science & Occupational Therapy University of British Columbia Vancouver, BC, Canada THE L TEST MANUAL Version: November 2014 Table of Contents Introduction...
More informationDoes the type of concurrent task affect preferred and cued gait in people with Parkinson s disease?
Does the type of concurrent task affect preferred and cued gait in people with Parkinson s disease? Robyn Galletly 1 and Sandra G Brauer 1, 2 1 Division of Physiotherapy, University of Queensland 2 Department
More informationCreated in January 2005 Duration: approx. 20 minutes
1 1 The Timed Up and Go Test Created in January 2005 Duration: approx. 20 minutes 2 Credits 2005 Stein Gerontological Institute. All rights reserved. Principal medical contributors: Alan Katz, MD Francois
More informationUpdate on Falls Prevention Research
Update on Falls Prevention Research Professor Stephen Lord Coffs Harbour Falls Prevention Network Rural Forum 28 th February 2014 Acknowledgments: Dr Jasmine Menant, Mr. Daniel Schoene Recent falls risk
More informationOverview The BBS is a widely-used, clinician-rated scale used to assess sitting and standing, static and dynamic balance.
Core Measure: Berg Balance Scale (BBS) Overview The BBS is a widely-used, clinician-rated scale used to assess sitting and standing, static and dynamic balance. Number of Test Items The BBS consists of
More informationBuilding Better Balance
Building Better Balance The Effects of MS on Balance Individuals with MS experience a decline in their balance due to various MS related impairments. Some of these impairments can be improved with exercise
More informationFundamental motion outcomes - Steps / Strides
Fundamental motion outcomes - Steps / Strides We describe the close relationship between stride, cadence and velocity, as fundamental motion outcomes, in particular for the elderly. Stride (Length, Time,
More informationEFFECTIVENESS OF VIRTUAL REALITY FOR BALANCE AND COORDINATION TRAINING OF ELDERLY PATIENTS
EFFECTIVENESS OF VIRTUAL REALITY FOR BALANCE AND COORDINATION TRAINING OF ELDERLY PATIENTS Kristina Žukienė 1, Živilė Barasaitė 1,2, Asta Markauskienė 1 Vilniaus kolegija/ University of Applied Sciences
More informationContinence, falls and the frailty syndrome. Anne Foley - BGS Bladders and Bowel Health 2012
Continence, falls and the frailty syndrome Outline Frailty Geriatric syndromes and giants Aetiology What can be done? The future Frailty Frailty Frailty (noun): The state of being weak in health or body
More informationIJPMR 12, April 2001; 25-30
IJPMR 12, April 2001; 25-30 An Objective Approach for Assessment of Balance Disorders and Role of Visual Biofeedback Training in the Treatment of Balance Disorders : A Preliminary Study Dr. Rajendra Sharma,
More informationSignificance of Walking Speed. Maggie Benson Virginia Commonwealth University Department of Physical Therapy
Significance of Walking Speed Maggie Benson Virginia Commonwealth University Department of Physical Therapy The 6 th Vital Sign Walking speed is considered the 6 th vital sign A valid and reliable measure
More informationDavid R Howell, Louis R Osternig, Li-Shan Chou Department of Human Physiology, University of Oregon, Eugene, OR, USA
B1-2 ID69 COMPLEXITY OF COGNITIVE TASK AFFECTS GAIT BALANCE CONTROL IN CONCUSSED ADOLESCENTS David R Howell, Louis R Osternig, Li-Shan Chou Department of Human Physiology, University of Oregon, Eugene,
More informationLateral Stability and Falls in Older People
ARTICLE Lateral Stability and Falls in Older People Mark W. Rogers and Marie-Laure Mille Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University,
More informationBalance and Falls in PD: Effective Interventions and Assistive Devices
Balance and Falls in PD: Effective Interventions and Assistive Devices Hanan Khalil, PhD Department of Rehabilitation Sciences Jordan University of Science and Technology Irbid, Jordan hwkhalil8@just.edu.jo
More informationCleveland Clinic Mellen Center for Multiple Sclerosis. Mellen Center Approaches: Falls and Fall Prevention in MS. Q: What is a fall?
Mellen Center Approaches: Falls and Fall Prevention in MS Q: What is a fall? A: A fall can be defined as an unplanned change in position resulting in the individual resting on the ground or a lower level.
More informationClinical Perspective. Interpreting Validity Indexes for Diagnostic Tests: An Illustration Using the Berg Balance Test
Clinical Perspective Interpreting Validity Indexes for Diagnostic Tests: An Illustration Using the Berg Balance Test Physical therapists routinely make diagnostic and prognostic decisions in the course
More informationCase Report. Training of Balance Under Singleand Dual-Task Conditions in Older Adults With Balance Impairment. Key Words:
Case Report of Balance Under Singleand Dual-Task Conditions in Older Adults With Balance Impairment Background and Purpose. Traditionally, rehabilitation programs emphasize training balance under single-task
More informationNatus Medical Incorporated is the sole designer, manufacturer, and seller of the following systems:
Natus Medical Incorporated 9570 SE Lawnfield Road Clackamas, OR 97015 Phone: (800) 767-6744 www.onbalance.com SOLE SOURCE NeuroCom Balance Manager systems consist of hardware and software that provide
More informationFall and fracture prevention - research update. Professor Stephen Lord Neuroscience Research Australia University of NSW
Fall and fracture prevention - research update Professor Stephen Lord Neuroscience Research Australia University of NSW Overview Risk factors for indoor and outdoor falls Multiple Profile Assessment for
More informationObjectives_ Series II
Interaction Between the Development of Posture Control and Executive Function of Attention (Reilly et. al 2008) Journal of Motor Behavior, Vol. 40, No. 2, 90 102 Objectives_ Series II Gain an understanding
More informationMargaret Schenkman, PT, PhD, FAPTA University of Colorado, Denver Colorado
Margaret Schenkman, PT, PhD, FAPTA University of Colorado, Denver Colorado Present a framework for clinical reasoning with emphasis on Patient centered care Application of enablement and disablement frameworks
More information17 th WORKSHOP ON NEUROOTOLOGY. Dementia & Imbalance. DR. ATRI CHATTERJEE Assistant Professor. Neurology VMMC & SafdarJung Hospital New Delhi
17 th WORKSHOP ON NEUROOTOLOGY Dementia & Imbalance DR. ATRI CHATTERJEE Assistant Professor. Neurology VMMC & SafdarJung Hospital New Delhi ?Association Dementia Imbalance?Causation balance: An even distribution
More informationExercise Assessment and Program Design for Preventing Falls
Exercise Assessment and Program Design for Preventing Falls Christian J. Thompson, Ph.D. Thompson Fitness Solutions, LLC Department of Kinesiology, University of San Francisco Objectives Describe the prevalence
More informationTHE FUNCTIONAL REACH TEST (FRT) is a valuable
538 Is the Functional Reach Test Useful for Identifying Falls Risk Among Individuals With Parkinson s Disease? Andrea L. Behrman, PhD, PT, Kathye E. Light, PhD, PT, Sheryl M. Flynn, PhD, PT, Mary T. Thigpen,
More informationSomatosensory Impairment and Balance Dysfunction in Multiple Sclerosis
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2014 UMass Center for Clinical and Translational Science Research Retreat
More informationEFFECT OF POSTURAL SWAY SCALE AS A PROGNOSTIC TOOL IN LOW BACK PAIN MANAGEMENT.
Original Research Article Allied Science International Journal of Pharma and Bio Sciences ISSN 0975-6299 EFFECT OF POSTURAL SWAY SCALE AS A PROGNOSTIC TOOL IN LOW BACK PAIN MANAGEMENT. 1 MANJULADEVI.NB.P.T,
More informationAge-related effect of visual biofeedback on human balance control
Activitas Nervosa Superior Rediviva Volume 53 No. 2 2011 ORIGINAL ARTICLE Age-related effect of visual biofeedback on human balance control Zuzana Halická, Jana Lobotková, Kristína Bučková, Diana Bzdúšková,
More informationKinematic analysis of slipping when stepping
102 Japanese Journal of Comprehensive Rehabilitation Science (2016) Original Article Kinematic analysis of slipping when stepping Takayuki Tamura, RPT, 1 Yohei Otaka, MD, PhD, 2,3 Jun Nakamoto, MD, 1 Keisuke
More informationTest-Retest Reliability of The Sensory Organization Test in Noninstitutionalized Older Adults
77 Test-Retest Reliability of The Sensory Organization Test in Noninstitutionalized Older Adults Cheryl D. Ford-Smith, MS, PT, Jean F. Wyman, PhD, RN, R.K. Elswick, Jr., PhD, Theresa Fernandez, MS, RN,
More informationComputerized Functional Reach Test to Measure Balance Stability in Elderly Patients With Neurological Disorders
Elmer ress Original Article J Clin Med Res. 2016;8(10):715-720 Computerized Functional Reach Test to Measure Balance Stability in Elderly Patients With Neurological Disorders Silvio Scena a, Roberto Steindler
More informationOne hundred and ten individuals participated in this study
Purpose The purpose of this study was to compare gait characteristics in an asymptomatic population of younger and older adults to older OA patients of different severities Hypothesis(es) The following
More informationii. Reduction of tone in upper limb Lycra arm splints improve movement fluency in children with cerebral palsy.
Guidelines for the Provision of Dynamic Compression for people diagnosed with Multiple Sclerosis The use of Lycra garments in patients with the diagnosis of Multiple Sclerosis has been initiated with very
More informationFalls and Mobility. Katherine Berg, PhD, PT and Arielle Berger, MD. Presented by: Ontario s Geriatric Steering Committee
Falls and Mobility Katherine Berg, PhD, PT and Arielle Berger, MD Key Learnings Arielle Berger, MD Key Learnings Learn approaches to falls assessment Understand inter-relationship between promoting safe
More informationSMART EquiTest. Physical Dimensions. Electrical Characteristics. Components. Performance Characteristics. Accessories Included
Balance Manager Systems Technical Specifications SMART EquiTest Physical Dimensions (W x D x H) in cm Assembled dimensions 53 x 61* x 94 135 x 155* x 239 Base 53 x 61 x 6 135 x 155 x 15 System cart 25
More informationUniversity of Manitoba - MPT: Neurological Clinical Skills Checklist
Name: Site: Assessment Skills Observed Performed Becoming A. Gross motor function i. Describe movement strategies (quality, devices, timeliness, independence): supine sidelying sit stand supine long sitting
More informationALTHOUGH THE IDEA of directed rehabilitative therapy
26 Reduced Hip Extension During Walking: Healthy Elderly and Fallers Versus Young Adults D. Casey Kerrigan, MD, MS, Laura W. Lee, MD, James J. Collins, PhD, Patrick O. Riley, PhD, Lewis A. Lipsitz, MD
More informationBody balance evaluation in osteoporotic elderly women
Arch Osteoporos (2009) 4:25 29 DOI 10.1007/s11657-009-0023-y ORIGINAL ARTICLE Body balance evaluation in osteoporotic elderly women Daniela Cristina Carvalho de Abreu & Deborah Collucci Trevisan & Júlia
More informationBiological theory for the construct of intrinsic capacity to be used in clinical settings Matteo Cesari, MD, PhD
Biological theory for the construct of intrinsic capacity to be used in clinical settings Matteo Cesari, MD, PhD World Health Organization Geneva (Switzerland) December 1, 2016 World Health Organization.
More informationBecause there is some evidence that falls in hospital can
BRIEF METHODOLOGICAL REPORTS A Comparative Study of the Use of Four Fall Assessment Tools on Acute Medical Wards Michael Vassallo, FRCP, PhD, Rachel Stockdale, MRCP (UK), w Jagdish C. Sharma, FRCP, Roger
More informationEquipment Stopwatch A clear pathway of at least 10 m (32.8 ft) in length in a designated area over solid flooring 2,3.
Core Measure: 10 Meter Walk Test (10mWT) Overview The 10mWT is used to assess walking speed in meters/second (m/s) over a short distance. Number of Test Items 1 item Scoring The total time taken to ambulate
More informationAmerican Council on Exercise
American Council on Exercise February 23, 2015 Fitnovatives Blog Exercise Progressions for Clients Who Are Overweight or Are Affected by Obesity While there is no single right way to train clients who
More informationThe prognosis of falls in elderly people living at home
Age and Ageing 1999; 28: 121 125 The prognosis of falls in elderly people living at home IAN P. D ONALD, CHRISTOPHER J. BULPITT 1 Elderly Care Unit, Gloucestershire Royal Hospital, Great Western Road,
More informationMary Fitzpatrick, ANP, MSCN Michelle Cameron, MD, PT
Mary Fitzpatrick, ANP, MSCN Michelle Cameron, MD, PT This continuing education activity is managed and accredited by Professional Education Service Group. The material presented in this activity represents
More information914. Application of accelerometry in the research of human body balance
914. Application of accelerometry in the research of human body balance A. Kilikevičius 1, D. Malaiškaitė 2, P. Tamošauskas 3, V. Morkūnienė 4, D. Višinskienė 5, R. Kuktaitė 6 1 Vilnius Gediminas Technical
More informationB alance impairment and falls are important features of
PAPER Postural abnormalities to multidirectional stance perturbations in Parkinson s disease M G Carpenter, J H J Allum, F Honegger, A L Adkin, B R Bloem... See end of article for authors affiliations...
More informationFall Risk Reduction in the Elderly. Disequilibrium of Aging. CDP results that identified impairments and provided focused patient management.
A CASE STUDY Fall Risk Reduction in the Elderly NeuroCom International, Inc. A 70 year-old woman is referred to physical therapy by her primary care physician. She reports a seven month history of dizziness
More informationInteractions between Hearing and Mobility during Realistic, Everyday Challenges
Interactions between Hearing and Mobility during Realistic, Everyday Challenges Jennifer Campos CEAL Chief Scientist Toronto Rehabilitation Institute, UHN Associate Professor, University of Toronto, Psychology
More informationFrailty: Challenges and Possible Solutions
Frailty: Challenges and Possible Solutions EMA Workshop: Ensuring safe and effective medicines for an ageing population Niccolò Marchionni Professor of Geriatrics University of Florence, Italy 22-23 March
More informationCharacteristics of early fallers on elderly patient rehabilitation wards
Age and Ageing 2003; 32: 338 342 # Age and Ageing Vol. 32 No. 3 # 2003, British Geriatrics Society. All rights reserved. Characteristics of early fallers on elderly patient rehabilitation wards MICHAEL
More informationMovement Science Lab. Computerized Dynamic Posturography (CDP) a. Sensory Organization Test (SOT)
Computerized Dynamic Posturography (CDP) a. Sensory Organization Test (SOT) The SOT determines the ability to use the three sensory systems that contribute to postural control: somatosensory, visual and
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationPredicting Survival in Oldest Old People
GERIATRICS AND GERONTOLOGY SPECIAL SECTION CLINICAL RESEARCH STUDY Michael W. Rich, MD, Section Editor Diana G. Taekema, MD, PhD, a,b J. Gussekloo, MD, PhD, c Rudi G. J. Westendorp, MD, PhD, a,d Anton
More informationEngaging Residents to Become Research Pioneers in Fall Risk Management
Engaging Residents to Become Research Pioneers in Fall Risk Management Kim Eichinger Executive Director of Fitness Country Meadows Retirement Communities keichinger@countrymeadows.com Research Pioneers
More informationPostural instability Hypokinesia Rigidity Tremor Forward flexed posture. pain million people 50+ years old 10 most populated countries
4.1-4.6 million people 50+ years old 10 most populated countries Cyndi Robinson, PT, PhD University of Washington Seattle, Washington, USA Progressive neurodegenerative disorder Selective neuronal loss
More informationGait abnormalities as early signs of MCI
Demensfondens forskningsstipendier Anna Nordström Gait abnormalities as early signs of MCI With aim To evaluate spatiotemporal gait parameters as predictor of mild cognitive impairment (MCI) in A population
More informationObjectives. Definition: Screen. Definition: Assessment 10/30/2013. Falls: Screens vs. Assessments vs. Outcome Measures
Objectives Falls: Screens vs. Balance and Falls SIG: Neurology & Health Policy and Administration Sections of the APTA Jacqueline Osborne PT, DPT, GCS, CEEAA Geriatric Residency Coordinator Brooks Institute
More informationFALLS ARE A MAJOR HEALTH care problem for older
ORIGINAL ARTICLE Older Fallers With Poor Working Memory Overestimate Their Postural Limits Teresa Liu-Ambrose, PhD, PT, Yasmin Ahamed, BSc, Peter Graf, PhD, Fabio Feldman, MSc, Stephen N. Robinovitch,
More informationT he prevention of falls in the older population is a
421 ORIGINAL ARTICLE Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET) J C T Close, R Hooper, E Glucksman, SHDJackson, C G Swift... See end
More informationThe Relationship of Postural Sway to Sensorimotor Function, Functional Performance, and Disability in the Elderly
567 The Relationship of Postural Sway to Sensorimotor Function, Functional Performance, and Disability in the Elderly Michael A. Hughes, MS, Pamela W. Duncan, PhD, PT, Dorian K. Rose, MS, PT, Julie M.
More informationFalls in the Elderly. Causes and solutions.
Falls in the Elderly. Causes and solutions. Brent Tipping Sub-specialist Geriatrician and Specialist Physician Division of Geriatric Medicine University of the Witwatersrand 6 th Annual congress of the
More informationExternal validation of abbreviated versions of the activities-specific balance confidence scale in Parkinson's disease
Washington University School of Medicine Digital Commons@Becker Physical Therapy Faculty Publications Program in Physical Therapy 2010 External validation of abbreviated versions of the activities-specific
More informationReliability, Construct Validity, and Clinical Feasibility of the Activities-Specific Fall Caution Scale for Residential Living Seniors
732 ORIGINAL ARTICLE Reliability, Construct Validity, and Clinical Feasibility of the Activities-Specific Fall Caution Scale for Residential Living Seniors Robin A. Blanchard, MSc, Anita M. Myers, PhD,
More informationSoteria Strains. Safe Patient Handling and Mobility Program Guide
Soteria Strains Safe Patient Handling and Mobility Program Guide Section 4 Special Considerations Section 4.3 - Orthopedics V1.0 edited July 28, 2015 A provincial strategy for healthcare workplace musculoskeletal
More informationImproving balance control and self-reported lower extremity function in community-dwelling older adults: a randomized control trial
450295CRE27310.1177/0269215512450295Clinical RehabilitationMelzer and Oddsson 2012 Article CLINICAL REHABILITATION Improving balance control and self-reported lower extremity function in community-dwelling
More informationSensitivity and Specificity of the Minimal Chair Height Standing Ability Test: A Simple and Affordable Fall-Risk Screening Instrument
Sensitivity and Specificity of the Minimal Chair Height Standing Ability Test: A Simple and Affordable Fall-Risk Screening Instrument By: Nadia C. Reider, MSc ; Patti-Jean Naylor, PhD ; Catherine Gaul,
More informationThe following instruments were used to assess gait speed, balance, and aerobic capacity by the physiotherapist.
Supplementary File S1. Measurement of physical indices. Gait, Balance, & Aerobic Capacity Measurement The following instruments were used to assess gait speed, balance, and aerobic capacity by the physiotherapist.
More informationDoes Multiple Risk Factor Reduction Explain the Reduction in Fall Rate in the Yale FICSIT Trial?
American Journal of Epidemiology Copyright O 1996 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol. 144, 4 Printed In U.SJL Does Multiple Risk Factor Reduction
More informationPREVIOUS PHYSICAL ACTIVITY AND BODY BALANCE IN ELDERLY PEOPLE
Original Previous Paper physical activity and body balance in elderly people DOI: 10.5604/20831862.1077558 Biol. Sport 2013;30:311-315 PREVIOUS PHYSICAL ACTIVITY AND BODY BALANCE IN ELDERLY PEOPLE Accepted
More informationC-MILL PRE-TRAINING MATERIAL
4 C-MILL PRE-TRAINING MATERIAL 1 Background information The ability to adjust gait to the requirements of the environment is related to fall risk. Someone must be able to avoid a doorstep, puddle of water
More informationlntertester and lntratester Reliability of a Dynamic Balance Protocol Using the Biodex Stability System
Journal of Sport Rehabilitation, 1998, 7, 95-101 0 1998 Human Kinetics Publishers, Inc. lntertester and lntratester Reliability of a Dynamic Balance Protocol Using the Biodex Stability System Randy Schmitz
More informationBerg Balance Scale. CVA, Parkinson Disease, Pediatrics
CVA, Parkinson Disease, Pediatrics CVA Highly recommended for inpatient and outpatient rehabilitation Recommended for acute care Parkinson s Disease Recommended for H and Y stages 2 and 3 G code-changing
More informationPre- Cardiac intervention. Dr. Victor Sim 26 th Sept 2014
Pre- Cardiac intervention Frailty assessment Dr. Victor Sim 26 th Sept 2014 Defining frailty Lacks consensus (Rockwood CMAJ 2005;173(5):489-95 Introduction) Some consider symptoms, signs, diseases and
More informationSlide 1. Slide 2 Overview of Course. Slide 3 Overview of Course. Gait and Balance Standardized Assessment in Geriatric Fallers
Slide 1 Gait and Balance Standardized Assessment in Geriatric Fallers Dianna Saunders, MS, PT Nicole Prieto, MSPT NF/SG Veterans Health System Gait and Balance Clinic Gainesville, FL Lenni Jo Yarchin,
More informationAgings and the parameters in static postural way
Proceeding 8th INSHS International Christmas Sport Scientific Conference, 5-7 December 2013. International Network of Sport and Health Science. Szombathely, Hungary Agings and the parameters in static
More informationSara Combilizer. Multifunctional aid for early mobilization and ICU rehabilitation. with people in mind
Sara Combilizer Multifunctional aid for early mobilization and ICU rehabilitation with people in mind Importance of mobilization Enhancing the functionality of body mechanics from the beginning of a structured
More informationWhat goes wrong with balance in Parkinson s Disease? Fay B Horak, PhD, PT Professor of Neurology Oregon Health and Science. CoM
What goes wrong with balance in Parkinson s Disease? Fay B Horak, PhD, PT Professor of Neurology Oregon Health and Science CoM CoM Course Objectives Understand different types of balance systems affected
More information2018 ABG QCDR Measure Specifications. (changes to old measures from 2017 in red font)
2018 ABG QCDR Measure Specifications (changes to old measures from 2017 in red font) Calculations Reporting Rate = Performance Met + Performance Not Met + Denominator Exceptions + Denominator Exclusions
More informationThe Effects of Two Types of Cognitive Tasks on Postural Stability in Older Adults With and Without a History of Falls
Journal of Gerontology: MEDICAL SCIENCES 1997, Vol. 52A, No. 4, M232-M240 Copyright 1997 by The Gemntological Society of America The Effects of Two Types of Cognitive Tasks on Postural Stability in Older
More informationImproving Balance and Mobility in People with Multiple Sclerosis
University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2014 UMass Center for Clinical and Translational Science Research Retreat
More informationFrailty in Older Adults
Frailty in Older Adults John Puxty puxtyj@providencecare Geriatrics 20/20: Bringing Current Issues into Perspective Session Overview Definition of Frailty Strategies for identifying frail older adults
More informationEXERCISE programs can decrease falls (1 3), improve
Journal of Gerontology: MEDICAL SCIENCES 2006, Vol. 61A, No. 2, 184 189 Copyright 2006 by The Gerontological Society of America The Influence of Intense Tai Chi Training on Physical Performance and Hemodynamic
More informationFalls. Key Points. The highest proportions of community-dwelling older adults who fall are in the 80+ age cohort (de Negreiros Carbral et al., 2013).
Falls Key Points Reducing falls and fall-associated deaths and serious injuries is one of the major goals of Healthy People 2020 (U.S. Department of Health and Human Services, 2010). Twenty-eight to thirty-five
More informationPhysical, mental, and social functioning in women age 65 and above with and without a falls history: An observational case-control study
Journal of Frailty, Sarcopenia and Falls Original Article Physical, mental, and social functioning in women age 65 and above with and without a falls history: An observational case-control study Lisbeth
More informationParkinson s Disease Foundation. Parkinson s Disease Foundation. PD ExpertBriefing: Led By: Ronald F. Pfeiffer, M.D. To hear the session live on:
Parkinson s Disease Foundation Parkinson s Disease Foundation PD ExpertBriefing: Gait, Balance PD and ExpertBriefing: Falls in Parkinson s Disease Understanding Led By: the Terry Progression Ellis, Ph.D.,
More informationBalance Matters. Dan Mathers, MSPT. Balance Program Coordinator St. Vincent Rehabilitation.
Balance Matters Dan Mathers, MSPT Balance Program Coordinator St. Vincent Rehabilitation dpmather@stvincent.org Who I am Dan Mathers, MSPT Graduated with Master of Science in Physical Therapy in 1999 from
More informationFALL PREVENTION. Looking At Falls From The Inside Out
FALL PREVENTION Looking At Falls From The Inside Out Objectives 1.The learner will demonstrate an understanding of the basis of underlying impairments that lead to the falls, and understand how to choose
More informationEvaluation of Preventive Care Program for Cognitive Function Decline among Community-dwelling Frail Elderly People A Pilot Study
Journal of Japan Academy of Community Health Nursing Vol. 9, No. 2, pp. 87 92, 2007 Evaluation of Preventive Care Program for Cognitive Function Decline among Community-dwelling Frail Elderly People A
More informationSystem for Evaluation of the Static Posturography Based on Wii Balance Board
System for Evaluation of the Static Posturography Based on Wii Balance Board PIVNICKOVA L., DOLINAY V., VASEK V. Faculty of Applied Informatics Tomas Bata University in Zlin nam. T.G.Masaryka 5555, 760
More informationJournal of Biomechanics
Journal of Biomechanics 43 (2010) 2648 2652 Contents lists available at ScienceDirect Journal of Biomechanics journal homepage: www.elsevier.com/locate/jbiomech www.jbiomech.com Short communication All
More information