Error Enhancement for Upper Limb Rehabilitation in the Chronic Phase after Stroke: A 5-Day Pre-Post Intervention Study.

A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1-Q3)) in (1) UL Fugl-Meyer assessment (1.0 (0.8-3.0), p < 0.001) and action research arm test (2.0 (0.8-2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0-0.3), p < 0.001) and quality of use (0.1 (0.1-0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (-0.45 (-0.81-0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training.

Identification and reduction of retained primitive reflexes by sensory stimulation in autism spectrum disorder: effects on qEEG networks and cognitive functions.

Several authors have reported finding retained primitive reflexes (RPRs) in individuals with autism spectrum disorders (ASD). This case report describes the reduction of RPRs and changes in cognitive function after transcutaneous electrical nerve stimulation (TENS) of muscle. Three individuals were examined in a study at the Institute for Neurology and Neurosurgery in Havana, Cuba. Two child neurologists, not involved in the study, conducted clinical examinations on each participant and diagnosed each with ASD based on DSM-V criteria and the Autism Diagnostic Interview-Revised (an autism evaluation tool). Each child with ASD possessed a triad of impairments in three domains: social interaction, communication, and repetitive behaviour. Individuals were evaluated by quantitative electroencephalographic measures and tested by standardised cognitive function tests before and after 12 weeks of intervention. These interventions were associated with reduced ASD symptoms in the three domains, significant changes in qEEG network connectivity and significantly improved performance on standardised cognitive tests.

The Relationship between Retained Primitive Reflexes and Hemispheric Connectivity in Autism Spectrum Disorders.

BACKGROUND: Autism Spectrum Disorder (ASD) can be identified by a general tendency toward a reduction in the expression of low-band, widely dispersed integrative activities, which is made up for by an increase in localized, high-frequency, regionally dispersed activity. The study assessed ASD children and adults all possessing retained primitive reflexes (RPRs) compared with a control group that did not attempt to reduce or remove those RPRs and then examined the effects on qEEG and brain network connectivity. METHODS: Analysis of qEEG spectral and functional connectivity was performed, to identify associations with the presence or absence of retained primitive reflexes (RPRs), before and after an intervention based on TENS unilateral stimulation. RESULTS: The results point to abnormal lateralization in ASD, including long-range underconnectivity, a greater left-over-right qEEG functional connectivity ratio, and short-range overconnectivity in ASD. CONCLUSIONS: Clinical improvement and the absence of RPRs may be linked to variations in qEEG frequency bands and more optimized brain networks, resulting in more developmentally appropriate long-range connectivity links, primarily in the right hemisphere.

Reliability, validity and normal ranges of the Zur Balance Scale for detecting mild postural control differences: introducing the modified, short version mZBS.

Introduction: Balance is achieved through interactions between the vestibular, somatosensory, and visual systems. There are several clinical tests to measure postural stability. However, most of them do not assess postural stability with head movements, which is the main function of the vestibular system, and those that do, require the use of sizeable, expensive equipment. Therefore, an applicable, easy-to-perform test that challenges the function of the visual, somatosensory and vestibular systems, using head movements, is needed. The Zur Balance Scale (ZBS) contains ten conditions, which are a combination of surfaces (floor or Styrofoam with subject standing on its width in Romberg position or its length in tandem position), stances (Romberg or tandem), tasks (no head movement with eyes open or closed and horizontal or vertical head movements with eyes open). The purpose of this study was to determine the validity, inter- and intra-examiner reliability, and normal performance values of the ZBS among individuals 29-70-years of age and to introduce the modified version: the mZBS, using kinetic measurements. Methods: Healthy participants ages 29-70 years were evaluated for inter- and intra-tester reliability (n = 65), kinetic measurements on a force plate, and validity compared to the modified clinical test of sensory interaction and balance (mCTSIB) (n = 44) and characterization of normal values (n = 251). Results: Zur Balance Scale head movements, duration of each condition (up to 10 s) and the total ZBS score agreed across examiners (ICC > 0.8). Normal ZBS scores were negatively correlated with age (r = -0.34; P < 0.0001). Older subjects (60-70 years) had a median score of 95.5 compared with younger subjects, where medians ranged from 97.6 to 98.9. Kinetic parameters showed positive correlations between ZBS and the mCTSIB scores, with the highest correlation between the five Romberg tasks (modified ZBS). Conclusion: Zur Balance Scale is a valid and reliable test. Its advantages include using head movements and the ability to detect minimal differences in postural control, even in healthy populations. Kinetic evaluation of the ZBS enables the use of a modified, shorter version of the ZBS (mZBS).

Should inclusion have an expiry date? Older people's attitudes on intellectual disabilities.

BACKGROUND: Older people with intellectual disabilities represent a new and neglected population in need of services, yet it may be problematic to include them in generic services without having a clear idea of how elderly people from the general population feel towards them. To the best of our knowledge, this topic has not been addressed quantitatively. METHOD: Seventy-three participants over 63 years of age (23 females and 50 males) from the general population without an intellectual disability completed two valid measures: the CLAS-MR and the WHOQOL-OLD. RESULTS: Level of education and quality of life were positively associated with attitudes towards people with intellectual disabilities. Age was negatively associated with knowledge regarding intellectual disability. CONCLUSIONS: When preparing for the inclusion of older people with intellectual disabilities in generic services, attention should be given to members' level of education, quality of life, and knowledge regarding intellectual disabilities. Sensitivity should be applied to potential tendencies to shelter people with intellectual disabilities.

Retained Primitive Reflexes and Potential for Intervention in Autistic Spectrum Disorders.

We provide evidence to support the contention that many aspects of Autistic Spectrum Disorder (ASD) are related to interregional brain functional disconnectivity associated with maturational delays in the development of brain networks. We think a delay in brain maturation in some networks may result in an increase in cortical maturation and development in other networks, leading to a developmental asynchrony and an unevenness of functional skills and symptoms. The paper supports the close relationship between retained primitive reflexes and cognitive and motor function in general and in ASD in particular provided to indicate that the inhibition of RPRs can effect positive change in ASD.

Relationship between Occupational Identity Post-Stroke and Outcomes of a Self-Management Participation-Focused Intervention: A Preliminary Investigation.

Self-management programs are used to assist stroke survivors to manage their condition and participation. This study was designed to examine correlations between occupational identity and outcomes of participation-focused self-management program using the Occupational Performance History Interview for the occupational identity and participation and self-efficacy as outcome measures. Spearman's rho correlations were calculated between occupational Identity and the program's outcomes. Results showed moderate significant positive correlations with self-efficacy for self-management and self-efficacy for participation scales at baseline; few were found at post-intervention and follow-up. Non-significant correlations were found between occupational identity and the change in outcome measures from baseline to post-intervention and to follow-up. Findings suggest occupational identity is strongly related to self-efficacy after stroke, and less related to intervention outcomes. However, other factors may possibly affect the effectiveness of self-management programs for a stroke population. Exploration of these factors might help develop programs better tailored to each stroke survivor.

Persistent Childhood Primitive Reflex Reduction Effects on Cognitive, Sensorimotor, and Academic Performance in ADHD.

A study was performed on 2,175 individuals between the ages of 3.2 and 22.04 years diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and drawn from 89 separate locations across the United States in satellite clinics with common practices and common staff training and equipment. The objective was to determine the efficacy of a hemispheric-based training program to reduce extant retained primitive reflexes (RPRs) and examine the relationship to motor function by metronome-based motor, DL, and cognitive tasks measured by subtests of the Wechsler Wide Range Achievement Test. After a 12-week program, RPR's were significantly reduced, as well as performance on all motor and cognitive measures significantly increased. Listening comprehension demonstrated significant increases between pre- and post-testing of 7% (W = 1213000; df = 2094; p < 0.0001) and mathematical problem solving revealed a significant increase of 5% (W = 1331500; df = 2091; p < 0.0001) associated with a significant reduction in primitive reflexes. The study concluded that the incorporation of relatively simple hemispheric-based programming within the educational system worldwide could relatively inexpensively increase academic, cognitive, and motor performance.

Impaired Coordination and Recruitment of Muscle Agonists, But Not Abnormal Synergies or Co-contraction, Have a Significant Effect on Motor Impairments After Stroke.

Movement synergies, muscle co-contraction, and decreased motor drive to muscle agonists were suggested to be major factors in motor impairments after stroke. The purpose of this study was to investigate the major muscle mechanisms contributing to motor impairment after stroke. Twelve healthy and 13 post-stroke patients participated in this observational study. Both groups participated in a single experimental session, performing hand pointing movements in multiple directions, during which EMG was assessed. Additionally, the patients underwent the Fugl-Meyer assessment. A set of features from the electromyography (EMG) signal and co-contraction ratios were used to compare the capacity to modulate the muscle activity between the two groups of participants. A correlation analysis was applied between the Euclidian distances of each target and the Fugl-Meyer scoring assessment in the post-stroke patients. We found that impaired modulation of muscle activity in post-stroke patients was characterized by significantly increased Euclidian distances between the EMG features of different target directions and by a higher variability between muscle activation compared to healthy subjects. Impaired capacity to modulate muscle activity significantly correlated with the impairment status. In conclusion, impaired motor performance post-stroke systematic disturbance in the control signal to limb muscles, which manifests as decreased capacity to modulate muscle activity, rather than co-contraction of muscle antagonists or stereotyped movement patterns.

Examining the feasibility and effectiveness of a culturally adapted participation-focused stroke self-management program in a day-rehabilitation setting: A randomized pilot study.

Background: Stroke survivors find it difficult to participate in daily activities, despite their improvement throughout the rehabilitation process. Thus, it has been questioned whether day-rehabilitation services provide adequate preparation for participation and reintegration into the community. Self-management programs can improve survivors' self-efficacy to manage their condition and participation. Improving Participation After Stroke Self-Management program (IPASS) is an occupational therapy-based group intervention developed in the United States, which has been effective in improving participation outcomes.Objective: To evaluate the feasibility and effectiveness of the IPASS adapted for an Israeli population of individuals admitted to a day-rehabilitation center after stroke.Methods: A single-center, randomized, assessor-blind study was conducted. Eligible participants were randomized to receive the IPASS (intervention group), in addition to standard individual therapy or standard care only (control group). Feasibility was based on attendance rate and a feedback questionnaire. Effectiveness was evaluated with the Functional Independence Measure (FIM), the Reintegration to Normal Living Index (RNLI) and self-efficacy questionnaires.Results: Sixty participants were included, of which 39 completed baseline and post-intervention evaluations. The intervention group improved significantly in the FIM scores (p < .01), as compared to the control group (p > .05). Moderate effect sizes (≥0.35) were found for the FIM and RNLI, and large effect sizes (≥0.65) for two subcategories in the participation self-efficacy questionnaire.Conclusions: The results support the feasibility of the adapted IPASS, and show a trend for positive effects in improving participation and self-efficacy in managing participation in home and community activities, for an Israeli post-stroke population.

Introduction of the Novel Radiographic Line (L5-Kyphosis Apex Line) Intended to Evaluate Scheuermann's Disease and Postural Kyphosis Progression on Standard Lateral X-Rays.

STUDY DESIGN: Cross-sectional and follow-up nested study. PURPOSE: To assess the reliability of the L5-kyphosis apex line (L5-KAL) evaluation and determine the association between changes in L5-KAL, changes in radiological parameters, and changes in clinical symptoms. OVERVIEW OF LITERATURE: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar and thoracic spine during adolescence. Scheuermann's disease patients usually show compensatory hyperlordosis of the lumbar spine, which is usually flexible, and express an anterior translation of the lumbar section. The L5-KAL was developed on the basis of our clinical experience, displaying the horizontal distance between the thoracic and lumbar curves. METHODS: In the cross-sectional segment, 150 initial lateral X-rays of patients with Scheuermann's disease and postural kyphosis were analyzed, and 80 additional X-rays were analyzed in the follow-up segment. The data taken from the X-rays of the whole spinal column included the thoracic kyphosis angle, the C7 plumb line, and the L5-KAL. Clinical data included a numerical rating scale of self-perceived body image, pain, and a Scoliosis Research Society-22 questionnaire (SRS-22). RESULTS: Significant positive associations were observed in a cross-sectional study between the L5-KAL and thoracic kyphosis, lumbar lordosis, C7 line, and self-perceived body image. In the follow-up nested study, in a mixed analysis of variance, the main effect of time was significant for the L5-KAL, kyphotic deformity and SRS-22, which indicated a change in these parameters after treatment of Scheuermann's disease patients. Significant positive associations were observed between the changes in L5-KAL and the changes in thoracic kyphosis. CONCLUSIONS: Our evidence suggests that the L5-KAL can serve as an indicator of the thoracic curve change in Scheuermann's disease and postural kyphosis patients and should be considered in clinical practice.

The Effect of Schroth Therapy on Thoracic Kyphotic Curve and Quality of Life in Scheuermann's Patients: A Randomized Controlled Trial.

STUDY DESIGN: Randomized controlled single-blinded clinical trial. PURPOSE: To evaluate the efficacy of Schroth therapy on thoracic curve angle, pain, and self-perceived body image (SPBI) of the back in Scheuermann's patients in comparison with the efficacy of classic anti-gravitation exercises. OVERVIEW OF LITERATURE: Scheuermann disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence. However, very few studies evaluated the effect of exercises on the progression of kyphosis in Scheuermann patients. Schroth three-dimensional exercise therapy was found in several studies to be effective in the treatment of adolescent scoliosis, however, we found no randomized controlled trials that evaluated the efficacy of this method in Scheuermann patients. METHODS: A total of 50 young adults (males and females) with Scheuermann's disease were randomly divided into either the experimental group (Schroth therapy treatment, n=25) or the control group (classic anti-gravitation exercises, n=25). Participants in both the groups were provided a course of individual treatment sessions during few weeks, with one appointment per week. They were required to perform the exercises daily throughout the study period (12 months) and fill their performance in a research log. We evaluated the thoracic Cobb angle (main outcome measure), pain, SPBI, flexion of the shoulder (supine), flexion of the shoulder (standing), kyphotic deformity measured using inclinometer, and L5 kyphosis apex line (L5-KAL) as well as administered the Scoliosis Research Society-22 Questionnaire for the participants before the treatment, after 6 months, and 1 year postoperatively. These results were then compared. RESULTS: In the mixed analysis of variance, the main effect of time was significant in the thoracic kyphosis (F [1]=5.72, p=0.02), and in the L5-KAL (F [1]=5.76, p=0.02). The main effect of time on the kyphotic deformity, measured using an inclinometer, did not reach the significance level; however, it showed the tendency (F [1]=2.80, p=0.07). In the group-by-time interaction, a significant difference was found in the thoracic kyphosis (F [1]=4.91, p=0.03) and in the kyphotic deformity, measured using an inclinometer (F [1]=4.05, p=0.02). Thus, the Schroth therapy group showed significantly greater improvement than the classic anti-gravitation exercises group. CONCLUSIONS: The present findings indicate that back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptomatic representation in Scheuermann's patients.

Scheuermann's Disease: Radiographic Pathomorphology and Association with Clinical Features.

STUDY DESIGN: Cross-sectional analytical study. PURPOSE: To evaluate the spinal radiological features in patients with Scheuermann's disease and the association between the thoracic kyphosis angle and clinical presentation. Overview of the Literature: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine in adolescents; however, literature is limited in this area. METHODS: Data regarding 150 successive X-ray images of 95 males and 55 females diagnosed with Scheuermann's disease were retrieved from the digital archives of the Maccabi Healthcare Services in Tel Aviv. Data included thoracic kyphosis angle (T3-T12), cervical lordosis (C2-C7), lumbar lordosis (L1-S1), sacral slope (SS), number and location of the anterior wedged vertebrae (AWV, minimum 5°), and C7 plumb line. Other data included age, sex, height, family history, Risser sign, self-perceived body image (rated by the Numeric Rating Scale [NRS]), and back pain during the previous week (rated by the Numeric Pain Rating Scale [NPRS]). RESULTS: Significant positive associations were observed between the Cobb angle of thoracic kyphosis and age (r =0.186, p =0.023), cervical lordosis (r =0.263, p <0.001), lumbar lordosis (r =0.576, p <0.001), SS (r =0.236, p <0.004), T10-T12 Cobb angle (r =0.319, p <0.001), and number of AWV (r =0.519, p <0.001). The highest frequency of vertebral wedging was noted in T7 (68%), followed by T8 (65%) and T9 (44%). The NPRS showed a significant association only with SS (r =0.219, p =0.014). Significant positive associations were observed between the NRS for self-perceived body image, the thoracic kyphosis (r =0.494, p <0.001), and the number of AWV (r =0.361, p <0.001). CONCLUSIONS: Thoracic kyphosis was significantly associated with cervical and lumbar lordosis, SS, T10-T12 Cobb angle, and AWV number. Pain was not substantial; however, self-perceived body image, the most common complaint of patients with Scheuermann's disease, was high and significantly associated with thoracic kyphosis and the number of AWV.

The association between volition and participation in adults with acquired disabilities: A scoping review.

BACKGROUND/OBJECTIVE: Physical, cognitive and psychological factors such as self-efficacy and motivation affect participation in populations with acquired disabilities. Volition is defined as a person's motivation for participating in occupation. The concept of 'volition' expands similar concepts and theories, which focus mostly on cognitive processes that influence motivation. Although volition seems to affect participation, the association between these two concepts has not been examined in populations with acquired disabilities. This scoping review explored this association. METHODS: The literature review used a structured five-stage framework, according to predefined inclusion and exclusion criteria. Seven electronic databases (CINAHL, PsycINFO, PubMed, Web of Science, SCOPUS, The Cochrane Library-Wiley, OTseeker) and Google Scholar were searched for relevant articles, published in English from January 2001 to May 2018. RESULTS: A total of 18 articles, relating to populations with various diagnoses were included. Two directly examined volition and participation and showed a positive association between them. Other articles discussed the effect of participants' chronic condition on their volition and participation, the effect of volition on participation, or the effect on participation of an intervention addressing volition. CONCLUSIONS: An acquired disability affects both volition and participation, and volition seems to affect participation among people with acquired disabilities. Few articles showed positive effects of interventions that addressed clients' volition, on participation. Further research should include additional health conditions and types of literature, to better understand the association between these concepts. This understanding will contribute to the development of occupational therapy interventions that emphasise volition, in order to improve participation outcomes.

Measuring Dynamic Leg Length during Normal Gait.

Dynamic leg length [DLL] is a resultant factor of anatomic leg length and lower limb movement that is measured by the distance from the hip to the heel, ankle, and forefoot during the gait cycle. The aim of this study was to present DLL measurement during normal gait. Forty healthy participants underwent a gait evaluation using a motion analysis system. The average DLLs were compared between sides during the gait cycle using the paired t-test at 51 sample points. Time of maximal and minimal DLLs and the ratio between maximal and minimal DLLs during the gait cycle were calculated. DLLs were found to be consistent, indicated by a within standard deviation of <6.65 mm and by being symmetrical with no significant differences between sides [p > 0.103]. DLL patterns and time of maximal and minimal DLLs were established. The ratio between maximal DLLs during the stance phase and minimal DLLs during the swing phase was also defined and found to be symmetrical. Normative data of DLL measures were set with respect to magnitude and pattern during the gait cycle. These data might serve as a reference for abnormal gait deviation reflected by abnormal DLLs, thus promoting a new perspective in gait analysis.

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly - a preliminary study.

PURPOSE: Unwanted weight loss is one of the established criteria for the diagnosis of frailty. However, the relevance of this criterion to detect frailty in obese older adults has not been assessed. In particular, with the exception of malignancy, unwanted weight loss is not commonly seen in older obese subjects. Therefore, we tested the possibility that some obesity phenotypes and/or diabetes might be more useful in the detection of frailty in this setting. PATIENTS AND METHODS: A preliminary cross-sectional study of 50 consecutive subjects was conducted at The Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center. Inclusion criteria were: young elderly (aged 65-75 years), with general and/or abdominal obesity, without cancer. Frailty was assessed directly using the Fried model, the five-item fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale. Eventually, in the assessment of frailty, the weight loss criterion was replaced by one or several of obesity/diabetes-related variables each time: severity of obesity by body mass index, waist circumference (and their interaction), body fat, and diabetes. The receiver operating characteristic curves for functional impairment indices were plotted to compare the usefulness of the frailty accepted and adjusted models. RESULTS: The prevalence of frailty and pre-frailty in this cohort were 7/50 (14%) and 27/50 (54%), respectively, but unwanted weight loss was seen in three subjects (6%) only. The level of abdominal obesity had the strongest correlation with functional score (r=0.292, P<0.05). Frailty models which included either severe abdominal obesity or diabetes in lieu of unwanted weight loss had good sensitivity rates per each frailty score as compared with the original Fried model. CONCLUSION: For detecting and/or screening for the frailty syndrome in obese young elderly, the level of abdominal obesity or diabetes may provide a useful marker.

Adaptation of the Scoliosis Research Society-22 Questionnaire for the Hebrew Language: Transcultural Adaptation and Reliability Analysis.

STUDY DESIGN: A cross-cultural adaptation and reliability study. OBJECTIVE: To perform cross-cultural adaptation and evaluate the reliability and validity of the Hebrew version of the Scoliosis Research Society-22 (SRS-22) questionnaire. SUMMARY OF BACKGROUND DATA: The SRS-22 validated in different languages is used in assessing health-related quality of life of patients with scoliosis. METHODS: The English SRS-22 was translated/retranslated and a cross-cultural adaptation was performed. The Hebrew SRS-22 was administered twice, a week apart, to 45 patients with idiopathic scoliosis and 15 with Scheuermann kyphosis. The Cobb angle of the thoracic curvature, the numeric rating scale (NRS) of pain and of the self-perceived cosmetic defect, were evaluated. Internal consistency was determined by the Cronbach α coefficient. Intraclass correlation was used for test-retest reliability. Concurrent validity of the SRS-22 domains with the Cobb angle, NRS pain, and NRS cosmetic defect was evaluated by Pearson correlation. RESULTS: The mean age of the subjects was 17.3 ± 7.42 years. The Cobb angle was 39.43 ± 17.52, NRS pain during the last 24 hours was 4.35 ± 3.42, and the NRS cosmetic defect was 3.80 ± 3.57. The mean overall Cronbach α of the Hebrew SRS-22 was 0.75. Two domains, function/activity (α = 0.63) and satisfaction (α = 0.66), showed a questionable internal consistency, self-image (α = 0.72) showed acceptable, pain (α = 0.80) good, and mental health (α = 0.92) excellent internal consistency. The intraclass correlation for five domains ranged from 0.71 to 0.95, demonstrating good test-retest reproducibility. The concurrent validity of the SRS-22 in scoliosis subjects with the Cobb angle was moderate (r = 0.37), and with NRS pain (r = 0.62) and NRS cosmetic defect (r = 0.54) good. In kyphosis subjects, the only significant high correlation was found between the self-image domain of SRS-22 and the NRS cosmetic defect (r = 0.84). CONCLUSION: The Hebrew version of the SRS-22 can be used to assess the outcome of treatment among Hebrew-speaking patients with idiopathic scoliosis and Scheuermann disease. LEVEL OF EVIDENCE: Level 2.

Cognitive impairment and the association between frailty and functional deficits are linked to abdominal obesity in the elderly.

OBJECTIVE: To evaluate whether specific obesity phenotypes in community-dwelling elderly: (a) affect differently the relationship between frailty and functional impairment and (b) are related to cognitive impairment. STUDY DESIGN: A post-hoc cross-sectional analysis of the last Israeli national health and nutrition survey of the elderly (≥ 65 yrs.; n = 1619). MAIN OUTCOME MEASURES: We implemented a previously validated frailty model based on frailty-related variables that were obtained in the survey. Mild cognitive impairment was defined using the Mini-Mental State Examination (a score <24 and >17). The Katz's scale of activities of daily living was used for functional assessment. Data were clustered according to different obesity phenotypes using measured body mass index (BMI) and waist circumference (WC). RESULTS: The link between frailty and disability was most prominent in subjects with abdominal obesity who were non-obese by BMI: compared with non-obese subjects as defined by WC and BMI, the odds ratio (OR) for functional limitations in this phenotype was 8.34 (95 % CI, 2.14-32.48) for pre-frail subjects and 69.26 (10.58-453.55) for frail subjects. The rate of cognitive impairment was 3.3 times higher (p = .023) in women who were obese by WC but not by BMI. CONCLUSIONS: In elderly people with a large WC and BMI < 30 kg/m2, disability is more tightly linked to frailty than for any other form of obesity. Cognitive impairment was more prominent in women with central obesity and BMI < 30 kg/m2 than in the other anthropometric phenotypes. WC should be used for early detection of individuals at risk of progression of frailty to functional incapacity.

Evaluation of Pressure-Applying Accuracy in Multilayer Bandaging Among Physiotherapists Who Treat Lymphedema.

BACKGROUND: Compression therapy is the only conservative treatment that has been shown to be effective for patients with lymphedema in randomized controlled trials. A commonly used classification system divides pressure into four categories ranging from mild to very strong. For lower limb edema, bandages with strong pressure were shown to be most effective. Recent studies indicate that many health care professionals use inadequate pressure. No study thus far has focused on therapists who are trained in lymphatic treatment. METHODS AND RESULTS: Thirty-seven physiotherapists trained in lymphatic treatment were recruited. Each participant received a questionnaire concerning their competence in compression bandaging. The subjects were asked to apply bandages using strong and medium pressure in two practical trials. Using a PicoPress® device, pressure was measured both directly after bandaging and 2 hours later; 75.68% of participants successfully applied the bandaging with moderate pressure, correctly at least once, and 62.16% managed to do so with high pressure. A trend in the results shows that the higher the sub-bandage pressure at the beginning, the more it dropped after 2 hours. There was high consistency in pressure application for strong and moderate pressure. No correlation was found between the parameters of the questionnaire and correct bandaging pressure. CONCLUSIONS: Most of the physiotherapists were successful, at least once, in applying bandages with the proper amount of pressure. It is possible that the nature of the lymphatic treatment contributes to their success. Participants were most accurate in applying moderate pressure; however, it is unclear what impact this pressure has on a leg with lymphedema.

Estimated frailty prevalence among Israeli elderly - results from a cross sectional national survey.

BACKGROUND: Increasing longevity presents new social and medical challenges in developed countries. The prevalence of frailty is of interest because of its association with health prognosis and outcomes, but so far there is no single best diagnostic tool for this entity. Therefore, estimated prevalence of frailty in countries varies considerably and ranges between 5% and 58%. In Israel, the nation-wide prevalence of frailty in the elderly population is presently unknown. The objective of our study was to assess the rate of the frailty in elderly Israelis. METHODS: A post-hoc analysis based on the results of a national Health and Nutrition Survey in Israeli elderly (MABAT Zahav). A non-direct model to estimate frailty was based on five components that were most similar to the common frailty assessment suggested by Morley et al. The frailty state was then reclassified according to different explanatory variables. RESULTS: Data collected from 1619 subjects (F/M = 52.9/47.1%) with an average age of 74.6 years were analyzed. Estimated frailty prevalence in the elderly population was 4.9%. Frail people were more likely to have a lower income, be unemployed and have a lower education level. Frailty rates were higher in women, in Jews and in subjects more prone to low physical function. CONCLUSIONS: The estimated frailty prevalence in the Israeli elderly population, while relatively low, is comparable to some of the rates suggested in the literature. The factors associated with frailty in the Israeli population are in accordance with the existing literature. The suggested model may be helpful in identifying frailty in Israeli elderly.