Standing, Transition, and Walking Ability in Older Adults: The Case for Independently Evaluating Different Domains of Mobility Function

<b><i>Background:</i></b> Independent mobility is a complex behavior that relies on the ability to walk, maintain stability, and transition between postures. However, guidelines for assessment that details <i>what</i> elements of mobility to evaluate and <i>how</i> they should be measured remain unclear. <b><i>Methods:</i></b> Performance on tests of standing, sit-to-stand, and walking were evaluated in a cohort of 135 complex, comorbid, and older adults (mean age 87 ± 5.5 years). Correlational analysis was conducted to examine the degree of association for measures within and between mobility domains on a subset of participants (<i>n</i> = 83) able to complete all tasks unaided. Participants were also grouped by the presence of risk markers for frailty (gait speed and grip strength) to determine if the level of overall impairment impacted performance scores and if among those with risk markers, the degree of association was greater. <b><i>Results:</i></b> Within-domain relationships for sit-to-stand and walking were modest (rho = 0.01–0.60). Associations either did not exist or relationships were weak for measures reflecting different domains (rho = −0.35 to 0.25, <i>p</i> &#x3e; 0.05). As expected, gait speed differed between those with and without frailty risk markers (<i>p</i> &#x3c; 0.001); however, balance and sit-to-stand measures did not (<i>p</i> ≥ 0.05). <b><i>Conclusions:</i></b> This study highlights the need to independently evaluate different mobility domains within an individual as a standard assessment approach. Modest within-domain relationships emphasize the need to account for multiple, unique control challenges within more complex domains. These findings have important implications for standardized mobility assessment and targeted rehabilitation strategies for older adults.

Validation of a Multimodal EEG-Based Index to Aid in Diagnosing and Tracking Concussion Among Athletes

ObjectiveThe goal of this study was to validate an EEG based multimodal index to aid in the assessment of concussion at time of injury, severity of concussion, and aid in evaluating readiness to return to play/activity.BackgroundThe absence of a gold standard for diagnosis of concussion results in reliance on subjective self-report of symptoms. EEG has been demonstrated to be sensitive to changes in brain function following head injury, especially in connectivity. Using machine learning with inputs primarily from EEG measures, and including multimodal inputs, an objective marker of the likelihood of concussion (Concussion Index, CI) was derived.Design/MethodsMale and female concussed athletes and controls ages of 13–25 years, represented a convenience sample (n = 580), enrolled from US High School, Colleges, and Concussion Clinics. Concussed subjects had a witnessed head impact and were removed from play by site guidelines. Assessments were performed within 72 hours of injury, at clinically determined return to play (RTP), 45 days following RTP, and included EEG (frontal and frontotemporal regions), neurocognitive performance, and standard concussion assessments.ResultsSensitivity = 85.99%, Specificity = 70.78%, NPV = 90.10% and PPV = 62.02, were obtained. Results demonstrated significance: (1) between CI at injury compared to RTP (p < 0.0001); (2) between CI in patients with rapid (<14 days) compared with those with prolonged recovery (=14 days), (p = 0.0038); (3) stability over time in controls (p < 0.0001); and (4) between CI and total symptom burden (correlation coefficient 0.8031, p < 0.0001).ConclusionsThis study independently validated a multimodal, EEG-based, objective index of concussion (CI). The neurotechnology platform incorporating this capability is handheld, rapid to use, and lends itself to incorporation into the standard assessment of concussion to aid in clinical diagnosis and assessment of readiness to RTP. This data supported the FDA clearance for the Concussion Index (embedded in the BrainScope medical device).

Language Screening in 3-Year-Olds: Development and Validation of a Feasible and Effective Instrument for Pediatric Primary Care

Objective: The study was aimed at evaluating the validity and feasibility of SPES-3 (Sprachentwicklungsscreening), a language screening in 3-year-old children within the constraints of regular preventive medical check-ups.Methods: A four-component screening measure including parental reports on the child's expressive vocabulary and grammar based on the MacArthur Communicative Development Inventory and pediatrician-administered standardized assessments of noun plurals and sentence comprehension was used in a sample of 2,044 consecutively seen children in 30 pediatric offices. One-hundred forty-four children (70 who failed and 74 who passed the screener) comprised the validation sample and also underwent follow-up gold standard assessment. To avoid verification and spectrum bias multiple imputation of missing diagnosis for children who did not undergo gold standard assessment was used. Independent diagnoses by two experts blinded to the screening results were considered gold standard for diagnosing language disorder. Screening accuracy of each of the four subscales was analyzed using receiver operator characteristic (ROC) curves. Feasibility was assessed by use of a questionnaire completed by the pediatricians.Results: The two parental screening subscales demonstrated excellent accuracy with area under the curve (AUC) scores of 0.910 and 0.908 whereas AUC scores were significantly lower for the subscales directly administered by the pediatricians (0.816 and 0.705). A composite score based on both parental screening scales (AUC = 0.946) outperformed single subscales. A cut off of 41.69 on a T-scale resulted in about 20% positive screens and showed good sensitivity (0.878) and specificity (0.876). Practicability, acceptability and sustainability of the screening measure were mostly rated as high.Conclusion: The parent-reported subscales of the SPES-3 language screener are a promising screening tool for use in primary pediatric care settings.

A Collaborative Exploration of Ako Māori and its Impact on Māori Learners in Legal Studies

<p>How can Māori culturally preferred pedagogies be implemented in a secondary classroom in a unit standard assessment context? What impact does this implementation have on the emotional engagement, intellectual reasoning and intrinsic growth of the learners? This research was undertaken by way of “interviews as chat” and journal recording, followed by a collaborative storying session which occurred around emerging themes. Formative data collection occurred from a question/suggestion box, work samples, attendance data and my journal. Lastly summative data was collected through a second round of interviews. This research concludes that a collaborative exploration of ako Māori is of significant benefit to Māori learners, although the Pākehā-centric assessment system restricts a teacher's ability to fully embrace a kaupapa Māori educational paradigm.</p>

A Collaborative Exploration of Ako Māori and its Impact on Māori Learners in Legal Studies

<p>How can Māori culturally preferred pedagogies be implemented in a secondary classroom in a unit standard assessment context? What impact does this implementation have on the emotional engagement, intellectual reasoning and intrinsic growth of the learners? This research was undertaken by way of “interviews as chat” and journal recording, followed by a collaborative storying session which occurred around emerging themes. Formative data collection occurred from a question/suggestion box, work samples, attendance data and my journal. Lastly summative data was collected through a second round of interviews. This research concludes that a collaborative exploration of ako Māori is of significant benefit to Māori learners, although the Pākehā-centric assessment system restricts a teacher's ability to fully embrace a kaupapa Māori educational paradigm.</p>

The Theory and Measurement of Expertise-Based Problem Solving in Organizational Teams: Revisiting Demonstrability

The current paper revisits and builds upon task demonstrability, which defines the criteria necessary for groups to choose a correct response if any member prefers that response. We identify boundary conditions of the current conceptualization of task demonstrability with respect to its use in understanding modern organizational teams. Specifically, we argue that, in its current form, task demonstrability is not optimally suited to studying ongoing teams in which member expertise varies and teams work to complete complex multifaceted tasks. To address this issue, we provide a revisited perspective on demonstrability. We specify the nomological network of revisited demonstrability and recast each of its criteria in a form that preserves the original intent of the construct, but has broader applicability, particularly to organizational contexts. We then discuss theoretical implications and managerial applications of the construct. Finally, noting that there is no standard assessment tool for demonstrability (original or revisited), we develop and validate a measure to facilitate future research.

The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury

Introduction: Assessments during rehabilitation of spinal cord injury (SCI) align with the World Health Organization's classifications and national quality requirements. This paper aims to report on the development and first implementation experiences of an institutional standard of assessments performed after newly acquired SCI.Setting: Specialized SCI acute care and post-acute rehabilitation clinic in Switzerland.Methods: A situation analysis of an interdisciplinary post-acute SCI rehabilitation program was performed. The results informed a subsequent consensus-based selection of assessments, and an information and implementation strategy. Linking to the ICF Core Set for SCI in post-acute settings and ICF Generic-30 Set was performed. The Nottwil Standard was piloted for 18 months.Results: Situation analysis: A battery of 41 assessments were irregularly performed during initial rehabilitation after newly aquired SCI. Selection of assessments: A multidisciplinary group of clinicians agreed on 10 examinations, 23 assessments and two questionnaires that make up the Nottwil Standard. In total, 55 ICF categories are covered, including most of the ICF Generic-30 Set categories. The implementation strategy included Executive Board commitment, a structured improvement project, guidelines for documentation and assessments, a manual controlling system, and staff training on the Nottwil Standard. Pilot phase: 54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female) were included. Twenty-seven assessments out of 33 assessments were performed in more than 80% of all observed patients' rehabilitation.Conclusion: Implementation of a standard assessment schedule was feasible but required a well-structured process with good communication strategy and controlling mechanism, and full engagement of involved professions.

Identification of Risk Factors for Delirium, Cognitive Decline, And Dementia After Cardiac Surgery (FINDERI - Find Delirium Risk Factors): A Study Protocol of A Prospective Monocentric Observational Pilot Trial

BACKGROUND: Postoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing a postoperative delirium. A gold standard assessment or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available. METHODS: The FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational pilot study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aims are to validate a delirium screening questionnaire and to identify specific preoperative risk factors and perioperative exposition factors for postoperative delirium, cognitive decline, and accelerated dementia after cardiac surgery. Our secondary aim is to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in the context of cardiac surgery. CONCLUSION: This prospective, observational pilot trial might help to identify pre- and perioperative risk factors and biomarkers for postoperative delirium, cognitive decline, and dementia. The predictive value of a delirium screening questionnaire in cardiac surgery might also be revealed.TRIAL REGISTRATION: Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in German Clinical Trials Register (DRKS) (DRKS00025095) on April, 19th 2021 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025095.

The measurement of proprioceptive accuracy. A systematic literature review

Proprioceptive accuracy refers to the individual’s ability to perceive proprioceptive information, i.e., the information referring to the actual state of the locomotor system, that originates from mechanoreceptors located in various parts of the locomotor system and from tactile receptors of the skin. Proprioceptive accuracy appears an important aspect in the evaluation of sensorimotor functioning; however, no widely accepted standard assessment exists. In this systematic review, our goal was to identify and categorize different methods that are used to assess different aspects of proprioceptive accuracy. A literature search was conducted in five different databases (PubMed, SPORTDiscus, PsycINFO, ScienceDirect and SpringerLink). Overall, 1139 articles reporting 1346 methods were included in this review. The methods measure eight different aspects of proprioception, i.e., the perception of joint position, movement, trajectory, velocity and the sense of force, muscle tension, weight and size. They apply various paradigms of psychophysics (i.e. the method of adjustment, constant stimuli and limits). The appropriate measurement method should be chosen based on theoretical considerations or ecological validity.