A Three Month Home Exercise Programme Augmented with Nordic Poles for Patients with Intermittent Claudication Enhances Quality of Life and Continues to Improve Walking Distance and Compliance After One Year.

OBJECTIVE/BACKGROUND: The objective of this study was to collect 1 year follow-up information on walking distance, speed, compliance, and cost in patients with intermittent claudication who took part in a previously reported 12 week randomised clinical trial of a home exercise programme augmented with Nordic pole walking versus controls who walked normally. A second objective was to look at quality of life and ankle brachial pressure indices (ABPIs) after a 12 week augmented home exercise programme. METHODS: Thirty-two of the 38 patients who completed the original trial were followed-up after 6 and 12 months. Frequency, duration, speed, and distance of walking were recorded using diaries and pedometers. A new observational cohort of 29 patients was recruited to the same augmented home exercise programme. ABPIs, walking improvement, and quality of life questionnaire were recorded at baseline and 12 weeks (end of the programme). RESULTS: Both groups in the follow-up study continued to improve their walking distance and speed over the following year. Compliance was excellent: 98% of the augmented group were still walking with poles at both 6 and 12 months, while 74% of the control group were still walking at the same point. The augmented group increased their mean walking distance to 17.5 km by 12 months, with a mean speed of 4.2 km/hour. The control group only increased their mean walking distance from 4.2 km to 5.6 km, and speed to 3.3 km/hour. Repeated ANOVA showed the results to be highly significant (p = .002). The 21/29 patients who completed the observational study showed a statistically significant increase in resting ABPIs from baseline (mean ± SD 0.75 ± 0.12) to week 12 (mean ± SD 0.85 ± 0.12) (t = (20) -8.89, p = .000 [two-tailed]). All their walking improvement and quality of life parameters improved significantly (p = .002 or less in the six categories) over the same period and their mean health scores improved by 79%. CONCLUSIONS: Following a 12 week augmented home exercise programme, most patients with intermittent claudication continued to significantly improve their walking distance and walking speed at 1 year compared with normal walking. Quality of life and ABPIs improved significantly after only 12 weeks and it is postulated that the improvement in ABPI was due to collateral development. These results justify the belief that an augmented home exercise programme will be as clinically effective as existing supervised exercise programmes, with the added benefits of lower cost and better compliance. Funding for a multicentre trial comparing an augmented home exercise programme with existing supervised exercise programme is now urgently required.

Randomized clinical trial comparing Nordic pole walking and a standard home exercise programme in patients with intermittent claudication.

BACKGROUND: This was a randomized clinical trial to determine whether Nordic pole walking (NPW) is more effective in improving walking distance than a standard home exercise programme (HEP) in patients with intermittent claudication. METHODS: Fifty-two patients with stable claudication were allocated randomly to a standard HEP or NPW group, and asked to complete three 30-min walks per week for 12 weeks. Claudication distance (CD) and maximum walking distance (MWD) were measured at 0 (baseline), 4, 8 and 12 weeks. Patients in the NPW group were tested with (NPW+) and without (NPW-) poles. RESULTS: For NPW+, CD increased immediately from a median (range) of 124 (71-248) m to 148 (116-426) m, and MWD from 248 (149-900) to 389 (194-1099) m (P = 0.004 and P < 0.001 respectively). By 12 weeks, CD had further increased to 199 (118-550) m and MWD had more than doubled to 538 (250-1750) m (P < 0.001 and P = 0.001). For NPW-, CD at 12 weeks had increased significantly to 151 (100-328) m and MWD to 400 (200-900) m (P < 0.001 and P = 0.006 respectively). At 12 weeks the changes in the standard HEP group were not significant, despite excellent compliance: CD from 107 (56-332) to 153 (59-321) m and MWD from 355 (92-600) to 334 (149-874) m (P = 0.030 and P = 0.260 respectively). CONCLUSION: A 12-week exercise programme using Nordic poles significantly improved walking distance in claudicants compared with a standard HEP. REGISTRATION NUMBER: ISRCTN78168304 (http://www.controlled-trials.com).

The social misperception syndrome in children with learning disabilities: social causes versus neurological variables.

Family shortcomings or other intrinsic psychological deficits are frequently viewed as contributing factors to the social misperceptiveness frequently seen in children with learning disabilities. This article attempts to synthesize research defining the social problems of some children with learning disabilities. Particularly emphasized is the role of communication skills deficits. Breakthroughs in neurophysiology negate, to a large extent, traditional emphases on family dysfunction, school failure, or personality distrubances as primary causes of the social problems of some children with LD. Advances in vision and language research allow departure from the social paradigm of the "misperceptive syndrome" to consider constitutionally based hypotheses of neural dysfunction. Neural aberrations are viewed as triggering deficient language processing, which in turn may lead to unsatisfactory social interactions. Several correlates and characteristics of family, school, and environmental systems are discussed in the context of their impact on personality development and on changes in the life adjustments of both children and adults with learning disabilities.

Contrast sensitivity differences between proficient and disabled readers using colored lenses.

Colored overlays or lenses (e.g., Irlen lenses) have been used in attempts to remediate reading difficulties. The present study included four middle-socioeconomic status (SES) adults and four middle-SES children with reading disabilities as well as an equal number of nondisabled readers of the same age groups and SES. Examined were (a) the relationship of wavelength (lens color) to visual grating performance, (b) the effect of reading disability on performance with each lens-color/luminosity-grating combination, (c) group performances on a visual detection task with the clear and chromatic lenses, and (d) peripheral retinal brightness thresholds. The spatial frequency of the gratings (and not the lens color) permitted subjects with reading disabilities to be differentiated from the proficient readers. Subjects with reading disabilities displayed significantly lower contrast sensitivity when tested with sine-wave gratings, as well as displaying higher brightness thresholds in the peripheral retina.

Wechsler Digit Span subtest: diagnostic usefulness with dyslexic children.

The current study supports Levinson's contention (1988) that the diagnosis of dyslexia cannot be based solely on neurophysiological evidence but must be made in conjunction with reading and educational test scores. Contrary to much current research, in the present study specific WISC-R profiles are identified within a stringently defined subgroup of 57 9- to 12-yr-old dyslexic children. Well-defined subtest scatter can differentiate dyslexics from proficient readers. In particular, the Digit Span subtest, which is not routinely administered by psychologists or included in computing Verbal IQ, can be considered an important component of a diagnostic battery. Unexpectedly, Coding emerged with Digit Span as a third factor in a principal component analysis; statistically significant sex differences appeared on the Coding task. Findings appear to confirm the phonological encoding deficiencies displayed by dyslexics on the Digit Span subtest. This study strongly supports consideration of WISC-R subtest differences, along with correlated factors, neurophysiological and perceptual evidence, when diagnosing dyslexic children. Cross-validation is planned.

Light sensitivity in peripheral retinal fields of dyslexic and proficient readers.

This present study furthers research on perceptual differences between dyslexics and normal readers which is contrary to the current linguistic approaches to this problem. Specifically, thresholds of light intensity for small retinal areas were examined. As hypothesized, the peripheral retinas of proficient readers evidenced lower thresholds than the peripheral retinas of dyslexic readers. These results are consistent with Grosser and Spafford's previous research which showed that dyslexics were better able to detect colors with their peripheral retinas than proficient readers. This research lends support to the premise that dyslexics' retinas have unusually high cone density in the periphery. Additional research is warranted to improve both diagnosis and treatment of dyslexia.

Perceptual evidence for an anomalous distribution of rods and cones in the retinas of dyslexics: a new hypothesis.

The present study tested the hypothesis that from the ability of dyslexics to read peripheral letters one may infer the presence of cones, those visual receptors specialized for acuity, in the peripheral retina. The cones are also the receptors for color discriminations. The method of retinal perimetry was used to map color-sensitive zones of the retina for 14 dyslexic and 14 control subjects. A statistically significant difference showed that the 14 dyslexics reported colors at more peripheral positions than did the 14 normal readers. These data are consistent with the premise that dyslexics have an anomalous distribution of retinal receptors. These findings perhaps may help to explain the erratic eye movements of some dyslexics. It is suggested that retinal perimetry might be one component of a diagnostic battery for the differential diagnosis of dyslexics.

Reply to Stuart and Lovegrove's question, "visual processing deficits in dyslexia: receptors or neural mechanisms?".

Recently Stuart and Lovegrove questioned the receptor hypothesis of Grosser and Spafford which these authors used to account for the findings that dyslexic individuals have superior peripheral color discrimination to normal readers but also have poorer peripheral brightness discrimination than normal readers. Stuart and Lovegrove hypothesized that dyslexics instead have an impaired transient visual system. The receptor hypothesis is an attempt by Grosser and Spafford to link the functioning of the rods and cones to transient and sustained visual system functioning in a more specific manner than has been tried heretofore by suggesting that, while the parvocellular system is almost entirely fed by cones, both kinds of receptors drive magnocellular cells (but with the rapid onset of early transient system responding being due to the highly light sensitive rods). The rods are proposed to be the receptors initiating the rapid onset of responding in the magnocellular, transient pathway. In dyslexic individuals, they maintain, there are relatively fewer rods to provide for the rapid onset of transient system responses, resulting in a diminished capacity of the transient system to inhibit sustained system activity (as occurs with normal readers). Their receptor hypothesis supplements the concept of transient-vs-sustained system differences.

Digit span and other WISC-R scores in the diagnosis of dyslexia in children.

The examination of subtest scores on the Wechsler Intelligence Scale is needed to provide confirmatory evidence for various subtest categorizations as there is no consensus about what patterns might be diagnostically useful. The present study supports the use of the ACID/AVID profiles (Arithmetic, Coding or Vocabulary, Information, and Digit Span) as elements in the diagnosis of dyslexia. WISC-R scores from 44 subjects were analyzed for specific subtest patterns of scores which might separate dyslexic individuals from the WISC-R standardization group. Perhaps some WISC-R ACID/AVID profile pattern analyses may be valid in the diagnosis of a stringently defined population of learning disabled individuals such as dyslexic children.

Retinal differences in light sensitivity between dyslexic and proficient reading children: new prospects for optometric input in diagnosing dyslexia.

The role of visual processes in dyslexia has been overlooked in the recent past as linguistic explanations for this problem dominated educational thought. It is the intent of this paper to relate new information about visual functions with dyslexia. Static perimetry was used to assess brightness thresholds of dyslexic and proficient-reading children. The dyslexic subjects obtained significantly lower sensitivity scores (higher thresholds) than proficient readers for the upper hemifields. Visual field screening tests may be useful in the differential diagnosis of dyslexia.