higher functioning
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Author(s):  
Jacek K Urbanek ◽  
David L Roth ◽  
Marta Karas ◽  
Amal A Wanigatunga ◽  
Christine M Mitchell ◽  
...  

Abstract Background Wearable devices have become widespread in research applications, yet evidence on whether they are superior to structured clinic-based assessments is sparse. In this manuscript, we compare traditional, lab-based metrics of mobility with a novel accelerometry-based measure of free-living gait cadence for predicting fall rates. Methods Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-meter gait speed) with free-living gait cadence from wearable accelerometers in predicting fall rates. Accelerometry data were collected with wrist-worn Actigraphs (GT9X) over 7 days in 432 community-dwelling older adults (aged 77.29±5.46 yrs, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You (STURDY). Falls were ascertained using monthly calendars, quarterly contacts, and ad-hoc telephone reports. Accelerometry-based free-living gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. Results Across all participants, free-living cadence was significantly related to fall rates; every 10 steps/min. higher cadence was associated with a 13.2% lower fall rate (p=0.036). Clinic-based measures of mobility were not related to falls (p>0.05). Among higher-functioning participants (cadence ≥100 steps/min.), every 10 steps/min higher free-living cadence was associated with a 27.7% lower fall rate (p=0.01). In participants with slow baseline gait (gait speed <0.8 m/s), all metrics were significantly associated with fall rates. Conclusion Data collected from biosensors in the free-living environment may provide a more sensitive indicator of fall risk than in-clinic tests, especially among higher functioning older adults who may be more responsive to intervention.


2020 ◽  
Vol 15 (15) ◽  
pp. 104-132
Author(s):  
Steve Taylor

This paper summarises my research into the state of “wakefulness”. I put forward the “essentialist” view that the concepts of a higher-functioning ideal state in various spiritual traditions are conceptualisations of the same essential landscape of expansive human experience. Based on a thematic analysis of transcripts of interviews with 85 individuals who reported an ongoing experience of wakefulness, I describe 18 characteristics of the state. These characteristics can be divided into perceptual, affective, conceptual (or cognitive) and behavioural. I include quotations from my interviews to illustrate the characteristics, and suggest reasons why they are associated with the “wakeful” state. I suggest that there are two “meta characteristics” of wakefulness: fluid or labile self-boundaries (bringing a sense of openness and connection) and inner quietness. The article is written in British English, the author’s Native Language. KEYWORDS Wakefulness, characteristics, sleep.


2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 201-202
Author(s):  
Daniel Liebzeit ◽  
Wan-chin Kuo ◽  
Beverly Carlson ◽  
Kimberly Mueller ◽  
Lisa Bratzke

Abstract Function in older adults includes multiple domains, from basic to “advanced,” but we remain limited in detection of advanced function (engagement in social, leisure, and productive activities). The objective is to describe advanced function and examine relationships with basic function and health outcomes in community-dwelling older adults aged 55-65 years. This is an analysis of existing data from a large, ongoing cohort study, The Wisconsin Registry for Alzheimer’s Prevention (WRAP R01 AG027161). We used a 1:1 prospective case–control design to examine whether older adults with lower advanced function (lower functioning group) at wave 3 showed lower IADLs and poorer health outcomes in wave 4, compared to those with higher advanced function (higher functioning group). The lower functioning group had a mean advanced function score of 74.4 (SD = 10.1), compared to 98.7 (SD = 11.1) in the higher functioning group. The mean IADL scores were similar in the two groups (p = 0.123). The lower functioning group had significantly lower self-rated health (mean = 3.52; SD = .79) than higher functioning group (3.70; 0.79) and a significantly lower proportion of individuals with unimpaired, stable cognition (77%) than the higher functioning group (85%). The lower functioning group had higher rates of comorbidities (4.25 vs. 3.96), mortality (4 vs. 1), and depressive symptoms (CES-D: 7.17 vs. 6.09), although results were not significant at α=0.05. This study provides a foundation for examining advanced function, which may be an early indicator of poor health outcomes in older adults.


2020 ◽  
Vol 22 (4) ◽  
pp. 63-78
Author(s):  
Deborah Orlowski ◽  
Kristen Storey

The self-image and internal functioning of a university student-serving department with a twenty-year history of conflict was shifted using a combination of Appreciative Inquiry and Gallup Strengths.® The resultant higher functioning, more transparent leadership team combined with a more accurate understanding of how the department was viewed by stakeholders was transformative.


2020 ◽  
Author(s):  
Kenneth N. K. Fong ◽  
Y. M. Tang ◽  
Karen Sie ◽  
Andy K. H. YU ◽  
Cherry C. W. Lo ◽  
...  

Abstract Background: Task-specific training has been proven to be effective in promoting recovery of the hemiparetic upper extremities after a stroke. This study was to develop a new and innovative task-specific VR (TS-VR) program using a Leap Motion Controller VR device and the Unity3D program for distal hand function training, and to investigate whether a two-week program of TS-VR training would promote recovery of the hemiparetic upper extremity in patients with chronic stroke.Methods: We designed the TS-VR program based on seven general hand function tasks used in the activities of daily living that require upper limb movement, such as pushing open a door and pouring water. Then, we examined the content validity of the TS-VR according to the views of an expert panel and through field testing on patients with stroke. The final version of the TS-VR was tested on 20 patients suffering from chronic stroke with upper extremity hemiparesis over 2 weeks, 5 sessions per week, 30 minutes per session. Outcomes were assessed using the Fugl-Meyer Assessment-Upper Extremity score (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Data were collected at the first session (week 0), last session (week 2), and follow-up session (week 5). Patients’ arm impairments were stratified into lower- and higher-functioning groups according to the Functional Test for the Hemiplegic Upper Extremity (FTHUE).Results: Significant improvements in upper extremity functions were found after TS-VR training in FMA-UE Total score (χ2=34.219, p=0.000), FMA-UL subscore (χ2=31.2, p=0.000), FMA-Hand subscore (χ2=22.6, p=0.000), and WFMT score (χ2=27.8, p=0.000) among the three time occasions, but no significant effect on grip strength was found. Moreover, the higher-functioning group (levels 5-7 in FTHUE) benefited more from the TS-VR, as indicated in outcome measures of FMA-UL, FMA-Hand, FMA-UE Total, and WMFT respectively, as well as amount of use score in MAL, but this was not the case for those in the lower-functioning group (levels 1-4 in FTHUE).Conclusions: Our findings suggest that our new TS-VR training system was useful for upper extremity recovery in patients with chronic stroke. It has potential to be applied in clinical settings in future.


2020 ◽  
Author(s):  
Kenneth N. K. Fong ◽  
Y. M. TANG ◽  
Karen SIE ◽  
Andy K. H. YU ◽  
Cherry C. W. LO ◽  
...  

Abstract Background: Task-specific training has been proven to be effective in promoting recovery of the hemiparetic upper extremities after a stroke. This study was to develop a new and innovative task-specific VR (TS-VR) program using a Leap Motion Controller VR device and the Unity3D program for distal hand function training, and to investigate whether a two-week program of TS-VR training would promote recovery of the hemiparetic upper extremity in patients with chronic stroke.Methods: We designed the TS-VR program based on seven general hand function tasks used in the activities of daily living that require upper limb movement, such as pushing open a door and pouring water. Then, we examined the content validity of the TS-VR according to the views of an expert panel and through field testing on patients with stroke. The final version of the TS-VR was tested on 20 patients suffering from chronic stroke with upper extremity hemiparesis over 2 weeks, 5 sessions per week, 30 minutes per session. Outcomes were assessed using the Fugl-Meyer Assessment-Upper Extremity score (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Data were collected at the first session (week 0), last session (week 2), and follow-up session (week 5). Patients’ arm impairments were stratified into lower- and higher-functioning groups according to the Functional Test for the Hemiplegic Upper Extremity (FTHUE).Results: Significant improvements in upper extremity functions were found after TS-VR training in FMA-UE Total score (χ2=34.219, p=0.000), FMA-UL subscore (χ2=31.2, p=0.000), FMA-Hand subscore (χ2=22.6, p=0.000), and WFMT score (χ2=27.8, p=0.000) among the three time occasions, but no significant effect on grip strength was found. Moreover, the higher-functioning group (levels 5-7 in FTHUE) benefited more from the TS-VR, as indicated in outcome measures of FMA-UL, FMA-Hand, FMA-UE Total, and WMFT respectively, as well as amount of use score in MAL, but this was not the case for those in the lower-functioning group (levels 1-4 in FTHUE).Conclusions: Our findings suggest that our new TS-VR training system was useful for upper extremity recovery in patients with chronic stroke. It has potential to be applied in clinical settings in future.


2020 ◽  
Vol 7 (2) ◽  
pp. 183-192
Author(s):  
Sally Dunaway Young ◽  
Jacqueline Montes ◽  
Rachel Salazar ◽  
Allan M. Glanzman ◽  
Amy Pasternak ◽  
...  

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S333-S334
Author(s):  
Kiranmayee Muralidhar ◽  
Willy Marcos Valencia ◽  
Kaicheng Wang ◽  
Diana Ruiz ◽  
Carlos Gomez-Orozco ◽  
...  

Abstract Using predictive analytic modelling, the Veterans Affairs has identified Veterans considered to be High Need High Risk (HNHR) requiring increased support. This pilot study sent needs assessment questionnaires to 1112 HNHR Veterans to better understand gaps regarding technology use, access, physical function, and mobility. There were 341(30.7%) respondents: 270(80.4%) Non-Hispanic, 64(18.8%) Hispanic/Latino; 210(61.6%) White, 119(34.9%) Black/African Americans; and 310(90.4%) had ≥high school education. Average Barthel(ADL) score was 81.5±22.8 and Lawton(IADL) score was 5.8±2.2. Younger Veterans (age<70) were more likely able to use Internet ((117(65%) vs 74(46%)),(p≤0.01) and email (106(58.9%) vs 67(41.6%),( p≤0.01). They were also more likely enrolled in MyHealtheVet (87(48.3%) vs 58(36%),(p=0.043). Secure messaging was used by 62(34.3%) younger and 37(23%) older Veterans,(p=0.026). More higher functioning Veterans (140(55.1%)) used email than lower functioning (33(37.9%)),(p=0.018). Among higher functioning Veterans, 148(58.3%) were willing to use videoconference for care coordination and 116(45.7%) owned a smartphone or computer with camera for this; more than lower functioning Veterans (33(37.9%) and 28(32.2%)), (p≤0.01 for both). Less dependent Veterans preferred to be contacted via cellphone (88(62.4%)) or Internet (10(7.1%)) compared to the more dependent (96(48%) and 6(3%)) respectively (p=0.01). Only 71(44.1%) of older Veterans were willing to use videoconference (p≤0.01) and 54(33.5%) owned a smartphone or computer with camera,(p≤0.01). There are significant variations in technology use by age and ethnicity. However, although there are differences by functional ability, a significant number of disabled veterans are willing and able to use technology, and this may provide a way to address access barriers in this population.


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jesse C. Christensen ◽  
Andrew J. Kittelson ◽  
Brian J. Loyd ◽  
Michael A. Himawan ◽  
Charles A. Thigpen ◽  
...  

Abstract Background Rates of total knee arthroplasty (TKA) procedures in younger, more medically complex patients have dramatically increased over the last several decades. No study has examined categorization of lower and higher functioning subgroups within the TKA patient population. Our study aimed to determine preoperative characteristics of younger patients who are lower functioning following TKA. Methods Patients were categorized into higher and lower functioning subgroups defined using a median split of 1) postoperative Timed Up and Go (TUG) test times and 2) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale scores. A split in age (65 years) was used to further classify patients into four categories: younger lower functioning, younger higher functioning, older lower functioning and older higher functioning. Measures from preoperative domains of health, psychological, physical performance and pain severity were examined for between-group differences. Results Comparing mean values, the younger lower functioning subgroup using the TUG had significantly weaker knee extensor, slower gait speed, higher body mass index and greater pain compared to other subgroups. The younger lower functioning subgroup using the WOMAC physical function subscale demonstrated higher pain levels and Coping Strategies Questionnaire-Catastrophizing Subscale scores compared to the older lower functioning subgroup. Conclusions Poorer preoperative physical performance and pain severity appear to have the largest influence on early postoperative TKA recovery in younger lower functioning patients relative to both younger and older higher functioning patients.


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