Effects of Pilates on the risk of falls, gait, balance and functional mobility in healthy older adults: A randomised controlled trial.

OBJECTIVE: To investigate the effects of Pilates on falls risk, fear of falling, postural balance, functional mobility, spatiotemporal gait parameters, mobility and physical activity in older adults. DESIGN: Randomized Controlled Trial (RCT). METHODS: Sixty-one older adults, mean age 70.08 (SD = 5.51) were randomly allocated into a Pilates group (PG, n = 29) or control group (CG, n = 32). Intervention comprised a 12-week Pilates program, with exercises performed twice a week and supplementary exercises at home. The Montreal Cognitive Assessment (MOCA), was used to screen cognition. PRIMARY OUTCOMES: Fear of falling, postural balance (force platform), gait velocity (electronic walkway). SECONDARY OUTCOMES: Functional mobility, mobility, physical activity, and spatiotemporal parameters of gait. Statistical analysis was carried out using Generalized Estimating Equations (GEE). Covariates were adjusted. RESULTS: Positive effects were found for time effects: Time Up and Go (TUG), anteroposterior (AP) and mediolateral (ML) directions of balance, cadence, (stance, step and double support time). The step and double support time showed significant differences between the two groups (p < 0.05). Interaction between time and groups was found for FRT. Age was a significant factor in TUG, FRT, postural balance for AP under open eyes conditions. Health status was significant for ML in eyes open condition. Gait was significant for age, height and health status. CONCLUSION: Effects of 12 weeks of Pilates intervention on functional mobility, mobility, postural balance and spatiotemporal gait parameters were identified. Further trials of a longer duration are warranted to determine the effectiveness of Pilates on falls prevention.

How does ReDO®-10 work? Understanding the mechanisms of action of an intervention focused on daily activities and health from the perspective of participants.

Evaluation of a complex healthcare intervention should include careful exploration of the mechanisms through which it brings about change. This paper describes a qualitative evaluation of the Redesigning Daily Occupations (ReDO®-10) programme as it was implemented for the first time with women with stress-related issues in a primary care setting in Ireland. The ReDO®-10 is a 10-week group intervention designed to support participants make changes to their daily activity patterns to have a more satisfying and balanced daily life. Fourteen women were interviewed after completing the programme. The aim was to explore changes that participants perceived they experienced and to understand how the content of ReDO®-10 was thought to bring about this change (if it did). Directed content analysis was used to analyse the qualitative data using the Behaviour Change Wheel and Theoretical Domains Framework as a coding framework. Overall, four BCW functions of ReDO® -10 were identified: Education, Persuasion, Modelling and Enablement. Participants described improved belief in their own capabilities, knowledge and goals around life changes. Many behaviour changes were also described, particularly in relation to doing more restorative activities in daily life. Behaviour change techniques that were identified as important for change were practicing new, restorative occupations in group sessions and as homework and the use of self-analysis activities to understand the relationship between activities and health for these participants. Modelling, support and other effects of group dynamics were also vital in changes that occurred.

Six weeks of Pilates improved functional mobility, postural balance and spatiotemporal parameters of gait to decrease the risk of falls in healthy older adults.

OBJECTIVE: To determine the effectiveness of Pilates exercises on falls risk factors. DESIGN: Prospective cohort, pre-test post-test study. Participants were selected using convenience and snowballing sampling. Pilates classes were held twice weekly for six weeks (1-h sessions) with a supplementary home programme. METHODS: A test of cognitive function, the Montreal Cognitive Assessment (MOCA), was employed to determine eligibility for inclusion. The following fall-predictor variable measures were employed: the 16 item Falls Efficacy Scale (FES), the short International Physical Activity Questionnaire (IPAQ), the Functional Reach Test (FRT), the Timed Up and Go (TUG), the GAITRite® system, Platform FOOTWORKpro. Multivariate analysis ANOVA with time as within subject factor was used to test for differences between pre and post-test scores adjusted for the factor Pilates. RESULTS: twenty-seven participants completed the study, mean age = 70.4 (SD = 4.5). After adjusting for the effect of the factor Pilates "previous experience or no previous experience of Pilates", statistically significant differences were identified in the following domains: The TUG (p < 0.001), FRT (p < 0.001), velocity, swing and stance time and the Mediolateral sway (p < 0.05). A significant difference was found between pre and post-test for anteroposterior sway in those with experience of Pilates (p < 0.05) and interaction between time and Pilates experience in Physical Activity (p < 0.05). CONCLUSION: Findings suggest that functional mobility, mobility, spatiotemporal parameters of gait, postural balance and physical activity improved in healthy older adults after 6 weeks of Pilates with a supplementary home programme.

A feasibility study of the Redesigning Daily Occupations (ReDOTM-10) programme in an Irish context.

BACKGROUND: Despite high demand, mental health services in primary care in Ireland are underdeveloped. People with mild/moderate anxiety, depression and unspecified psychological distress are frequently seen in primary care settings, mostly by general practitioners (GPs). Occupational therapists have the potential to contribute to service-provision with interventions specially designed for the targeted group e.g. the Redesigning Daily Occupations programme (ReDO-10). AIMS/OBJECTIVES: This study aimed to explore the feasibility of a future RCT of the ReDO-10 programme in Ireland and the contextual factors that would influence future implementation. MATERIAL AND METHODS: Using a multi-phase, mixed-method design, qualitative and quantitative data were gathered from key stakeholders: ReDO-10 participants (n = 10), GPs (n = 9) and occupational therapists (n = 2). Acceptability, satisfaction, cultural fit and demand were explored, as well as methodological issues such as appropriateness of recruitment methods, outcome measures and randomization. RESULTS: ReDO-10 was acceptable to participants who reported improvements in their occupational patterns and valued the group-based format. GPs and occupational therapists welcomed the intervention, but acknowledged the limitations of time and resources in the Irish primary care context. CONCLUSIONS: ReDO-10 is feasible to explore in a future RCT in Ireland and this study provides important context for future implementation and/or research.

Pilates Reducing Falls Risk Factors in Healthy Older Adults: A Systematic Review and Meta-Analysis.

Background: The main theme of this systematic review and meta-analysis is to synthesize the evidence of randomized controlled trial of evidence of Pilates intervention, in comparison to control groups and other forms of exercise, for falls prevention in healthy older adults. Methods: The following electronic databases were searched up to October 2020; EMBASE, Scopus, Google Scholar, MEDLINE (Ovid), Science Direct, Cochrane, and CINAHL. The recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-Analyses were followed. A PICOS approach was adopted as a framework to formulate the research question and set the inclusion and exclusion criteria. Participants were healthy older adults, defined as older adults who have maintained functional ability, including participants of both genders, those with a falls history, non-fallers, and individuals who were considered to be sedentary or active. Randomized controlled trials studies, written in the English language, from the decade, were included if they focused on specific outcome measures to decrease falls risk; functional mobility, mobility, fear of falling, gait, and postural stability. The PEDro scale was used to assess risk of bias. Results: There were included 12 studies. In total, 702 healthy older adults' participants were included. Pilates showed an effect in mediolateral directions in comparison to control groups (MD = -1.77, 95% CI, -2.84 to -0.70, p = 0.001, heterogeneity: I 2 = 3%), mobility (MD = 9.23, 95% CI, 5.74 to 12.73, p < 0.00001, heterogeneity: I 2 = 75%) and fear of falling (MD = -8.61, 95% CI, -10.16 to -7.07, p < 0.00001, heterogeneity: I 2 = 88%). In relation to other exercises group, Pilates showed positive effects in functional mobility (MD = -1.21, 95% CI, -2.30 to -0.11, p = 0.03, heterogeneity: I 2 = 80%), mobility (MD = 3.25, 95% CI, 1.46 to 5.04, p < 0.0004, heterogeneity: I 2 = 0%). No evidence of an improvement was found between the groups for dynamic gait index (MD = 2.26, 95% CI, -0.05 to 4.56, p = 0.06, heterogeneity: I 2 = 86%), anteroposterior directions of balance (MD = -1.58, 95% CI, -3.74 to -0.59, p = 0.15, heterogeneity: I 2 = 51%) and functional mobility when compared to control groups (no exercise) (MD = -1.24, 95% CI, -2.48 to -0.00, p = 0.05, heterogeneity: I 2 = 87%). Discussion: Pilates may be effective in decreasing the risk of falls in older adults. Pilates intervention was found to improve functional mobility, mobility, gait, fear of falling and postural stability and therefore there is some evidence to suggest that Pilates reduces certain risk factors for falls in healthy older adults. However, there is an absence of high-quality evidence in regards to the impact of Pilates on reducing falls and further robust RCTs are needed. Systematic Review Registration: [PROSPERO], identifier [CRD42021206134].

Translation and Transcultural Adaptation of the Wessex Head Injury Matrix, Italian Version: A Preliminary Report.

BACKGROUND: Patients who are in a coma, a vegetative state or a minimally conscious state present a clinical challenge for neurological assessment, which is a prerequisite for establishing a prognosis and planning management. Several scales have been developed to evaluate these patients. The Wessex Head Injury Matrix is a comprehensive tool but is currently available only in the French and English languages. The aim of this study was to translate and evaluate the reliability of the Italian version of the scale. METHODS: The original scale was translated according to a standard protocol: three separate translations were made, and a selected version was back-translated to check for any errors in order to obtain the most accurate Italian translation. A final back translation of the agreed version was made as a further check. The final version was then administered blind to a consecutive series of patients with severe acquired brain injury by two examiners. Inter-rater and test-retest reliability were assessed using a weighted Cohen's kappa (Kw). Concurrent validity of the WHIM was evaluated by ρ Spearman's correlation coefficient using the Glasgow Coma Scale (GCS) and the Coma Recovery Scale Revised (CRS-R) as the available gold standard. RESULTS: Twenty-four patients (12 males and 12 females; mean age 59.9 ± 20.1; mean duration from index event 17.7 ± 20.0 days) with stroke (n = 15), traumatic brain injury (n = 7) and anoxic encephalopathy (n = 2) were included. Inter-rater [Kw 0.80 (95% CI 0.75-0.84)] and test-retest reliability [Kw 0.77 (95% CI 0.72-0.81)] showed good values. WHIM total scores correlated significantly with total scores on the GCS (ρ = 0.776; p < 0.001) and the CRS-R (ρ = 0.881; p < 0.001) demonstrating concurrent validity; Conclusion: The Italian version of the scale is now available for clinical practice and research.

Does a regular Wessex Head Injury Matrix assessment identify early signs of infections in people with Prolonged Disorders of Consciousness?

BACKGROUND & OBJECTIVE: Patients with brain injury are at high risk for infections. Although infection and cognitive deterioration are established for people with dementia, this has not been shown for patients with a prolonged disorder of consciousness (PDOC). This study determines whether regular Wessex Head Injury Matrix (WHIM) assessments can identify early signs of infections in patients with PDOC. METHOD: Retrospective and prospective approaches were used to assess the WHIM scores of patients with a PDOC (N = 21 in the retrospective study and 22 in the prospective study). RESULTS: The WHIM total scores decreased due to infections in 17 of the 21 cases of infection (p < 0.001) in the retrospective study and 15 (p = 0.001) of the 22 prospective cases of infection. Patients in a minimally conscious state (MCS) showed a bigger proportion of change between their baseline score and the scores taken in the pre-infection stage in both the retrospective and prospective studies when compared to patients in a vegetative state (VS). CONCLUSION: The findings suggest the importance of serial WHIM assessments throughout the period of recovery, not only to measure cognitive changes but also to highlight underlying physical changes such as infections that will impact the response to rehabilitation and recovery.

Relationships between Adaptive Behaviours, Personal Factors, and Participation of Young Children.

AIM: To examine the extent to which personal factors (age, socioeconomic grouping, and preterm birth) and adaptive behaviour explain the participation patterns of young children. METHODS: 65 Children 2-5 years old with and without a history of preterm birth and no physical or intellectual disability were selected by convenience sampling from Galway University Hospital, Ireland. Interviews with parents were conducted using the Adaptive Behaviour Assessment System, Second Edition (ABAS-II) and the Assessment of Preschool Children's Participation (APCP). Linear regression models were used to identify associations between the ABAS-II scores, personal factors, and APCP scores for intensity and diversity of participation. RESULTS: Adaptive behaviour explained 21% of variance in intensity of play, 18% in intensity of Skill Development, 7% in intensity of Active Physical Recreation, and 6% in intensity of Social Activities controlling for age, preterm birth, and socioeconomic grouping. Age explained between 1% and 11% of variance in intensity of participation scores. Adapted behaviour (13%), Age (17%), and socioeconomic grouping (5%) explained a significant percentage of variance in diversity of participation controlling for the other variables. CONCLUSIONS: Adaptive behaviour had a unique contribution to children's intensity and diversity of participation, suggesting its importance.

The role of the SMART and WHIM in behavioural assessment of disorders of consciousness: clinical utility and scope for a symbiotic relationship.

As the prevalence and incidence of disorders of consciousness (DoC) increase, researchers and clinicians are tasked with developing best practice assessment techniques. Neurobehavioural assessment remains the most clinically available method of measuring consciousness. Neuroimaging and other physiological measurements are demonstrating promise in supporting this assessment but many of these techniques require further research and are not widely available in sub-acute and long-term care settings. No study to date has explored in-depth complementary use of multiple neurobehavioural assessments in aiding beside assessment of consciousness. This paper describes and proposes complementary use of two commonly used standardised neurobehavioural assessments. The Sensory Modality Assessment and Rehabilitation Technique (SMART) and the Wessex Head Injury Matrix (WHIM) both have specific aims and play an important role in behavioural assessment across the care continuum. This paper proposes that when used together appropriately these two assessments promote best practice and strengthen behavioural assessment of consciousness by providing increased opportunities to capture awareness. Further research into use of more than one neurobehavioural tool is highlighted as an important area of inquiry for this heterogeneous population not only in clinical practice but also in research.

Does Modafinil improve the level of consciousness for people with a prolonged disorder of consciousness? a retrospective pilot study.

BACKGROUND AND AIM: Modafinil is best known as a sleep regulator among healthy individuals, but studies suggest that it reduces excessive daytime sleepiness in patients with brain injury. This retrospective pilot study evaluated the effectiveness of Modafinil for people with a prolonged disorder of consciousness and whether those with a traumatic brain injury did better than those with a non-traumatic brain injury. METHOD: Twenty four prolonged disorder of consciousness patients who were prescribed Modafinil, were assessed at least four times both before and during treatment. The Coma Recovery Scale-Revised was used to determine if patients had a disorder of consciousness and the Wessex Head Injury Matrix was used to monitor behavior during baseline and treatment periods. Patients with a traumatic brain injury (N = 12) were compared with those with non-traumatic brain injury (N = 12). A chi-square test with significance at 0.05 was used and when frequencies were below 5 a Fisher's Exact Test was used. RESULTS: Cognitive improvements were noted in domains of wakefulness, awareness, concentration, tracking and following commands. Significant differences were found for the whole group between baseline and Modafinil (x2 = 9.80; p = 0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head Injury Matrix scores when on Modafinil (x2 = 8.33, p < 0.004). Six non-traumatic brain injury patients had higher scores with Modafinil, two had lower scores and four showed no change. There was no significant difference in the number of patients showing an increase compared to those showing a decrease (Fisher's exact test p = 0.29). CONCLUSION: Modafinil appears to be beneficial for enhancing cognition in prolonged disorder of consciousness patients. Traumatic brain injury patients benefited more than non-traumatic brain injury patients. Implications for Rehabilitation People with prolonged disorders of consciousness are those in coma, a vegetative state or a minimally conscious state. Sensorimotor and neuromodulations (pharmacological and brain stimulation) are the available treatment strategies to this group. Modafinil promotes attention, concentration and maintains wakefulness in a patient with narcolepsy, obstructive sleep apnea and shift work sleep disorders. In a relatively small sample, this retrospective pilot study shows the effectiveness of Modafinil in conjunction with good care, suitable medications and multidisciplinary rehabilitation in enhancing arousal in prolonged disorders of consciousness patients.

The impact of preterm birth on participation in childhood occupation.

UNLABELLED: Outcome studies of premature babies have focused their assessments predominately on neurodevelopmental impairments without relating these deficits to the impact they have on a child's everyday life. This study aims to determine whether very 'preterm birth alone' impacts on a child's ability to participate in and carry out childhood activities. Forty-four former premature infants between 6 months and 5 years 6 months, born in Galway University Hospital, Ireland, without physical or intellectual disability, were compared with 51 age-matched term-born infants. Study infants had an average gestation of 29 weeks and birth weight of 1,145 g. Functional skills were assessed using the Adaptive Behavior Assessment Scale-II and the Assessment of Preschool Children's Participation. Premature infants had significantly lower mean scores in overall adaptive behaviour compared to term infants, regardless of whether chronological (difference = 13.6, 95% (CI) = [8.2, 19.1]) or corrected (difference = 6.6, 95% CI = [1.4, 11.8]) age was used. Premature infants had lower mean scores in conceptual, social and practical skills, but no difference was found between the groups in intensity or diversity of participation. CONCLUSION: Premature infants had significantly lower scores in adaptive behaviour than term infants. This measurable effect of preterm birth on 'childhood occupations' merits further investigation.

Cognitive rehabilitation for mild cognitive impairment: developing and piloting an intervention.

This was an exploratory study, with the purpose of developing and piloting an intervention for people with mild cognitive impairment (MCI) and their family members using cognitive rehabilitation. A case series design was used with pre- and post-intervention and 3-month follow-up outcome measures. Five participants (two males, three females; mean age 75 years) with a diagnosis of MCI attended the memory clinic with a family member. Intervention consisted of six to eight individual sessions of cognitive rehabilitation consisting of personalized interventions to address individually relevant goals delivered weekly. The main rehabilitation strategies utilized were external aids, personal diary, face-name association, relaxation, and encouraging participants to develop habits and routines. The primary outcome measure was goal attainment as assessed by Goal Attainment Scaling. Secondary outcome measures included measures of memory, anxiety, depression, and activities of daily living. Qualitative data were collected post-intervention by interview. Post-intervention 84% of the goals were attained, with 68% maintained at a 3-month follow-up. Mean anxiety and depression scores decreased during the intervention. No significant changes were recorded on a test of memory. The findings suggest that the strongest effect was in relation to compensatory strategies for prospective and episodic memory deficits. Feedback from participants during qualitative interviews indicated that they found strategies useful and implemented them in their daily routines. The findings support the use of a dyadic cognitive rehabilitation intervention for people with MCI and memory difficulties.

What is the locus of the errorless-learning advantage?

In two experiments involving word-stem completion, an advantage was found for errorless over errorful-learning conditions, for both severely and moderately memory-impaired participants. This advantage did not depend on the implicit/explicit nature of the question asked. Additional tests showed that subsequent recognition of target items was good for both groups, but only in the absence of lures derived from participants' prior errors. Source-memory was shown to be virtually absent in the severely impaired group and only weakly present in the moderately impaired group. This combination of results suggests that preserved implicit memory, in the absence of explicit memory, is sufficient for an errorless-learning advantage to accrue.

Can behaviours observed in the early stages of recovery after traumatic brain injury predict poor outcome?

Diagnosis of the vegetative state (VS) or minimally conscious state (MCS) is dependent on the presence or absence of behavioural variables. Diagnosis of the VS in the case of those who have had a severe head injury does not occur for several months after injury. If such outcomes could be predicted it would facilitate appropriate and timely referrals to specialist rehabilitation units. This paper describes a follow up study of patients observed prospectively after severe head injury and followed up four years later. Thirty patients had made a moderate or good recovery and eight met criteria for MCS. Analysis of early observations together with outcome data suggest that the duration of time taken to achieve some early behaviours may be predictive of poorer outcome.