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Intelangelo L, Elias G, Lassaga I, Bustos C, Jerez-Mayorga D. Reliability of two devices for shoulder strength assessment: Wii Fit Balance Board and hand-held dynamometer. Shoulder Elbow 2024; 16:110-118. [PMID: 38425742 PMCID: PMC10901178 DOI: 10.1177/17585732221145558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 03/02/2024]
Abstract
Background The aim of this study was to compare the reliability and agreement between two devices - Wii Fit Balance Board (WBB) versus Hand-Held Dynamometer (HHD) to measure isometric strength during the athletic shoulder (ASH) test in healthy amateur rugby players. Methods Fifteen males (23.73 ± 2.8 years) completed two testing sessions. Maximal isometric contractions using the dominant arm (D) and non-dominant arm (ND) against a WBB and HHD were assessed at three angles of abduction (180°, 'I'; 135°, 'Y' and 90°, 'T'), in a prone lying position. Results The results indicate a very large correlation between the HHD and the WBB. WBB provides acceptable reliability at I-Test D (CV = 9.97%, ICC = 0.88) and HHD in the I-Test D (CV = 8.90%, ICC = 0.94), I-Test ND (CV = 8.60%, ICC = 0.95) in peak strength values. The HHD is most reliable in D ASH I-Y-T (CV = 10.94%) and WBB (CV = 11.05%). In the ND ASH I-Y-T test, the HHD is the most reliable (CV = 12.5%) compared to the WBB (CV = 14.43%). Conclusions These results suggest that WBB is a reliable device to assess strength in the ASH test with a very large correlation with the HHD. WBB and HHD are two affordable devices to assess isometric shoulder strength.
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Affiliation(s)
- Leonardo Intelangelo
- Musculoskeletal Research Group, University Center for Assistance, Teaching and Research, University of Gran Rosario, Rosario, Argentina
| | - Gonzalo Elias
- Musculoskeletal Research Group, University Center for Assistance, Teaching and Research, University of Gran Rosario, Rosario, Argentina
| | - Ignacio Lassaga
- Musculoskeletal Research Group, University Center for Assistance, Teaching and Research, University of Gran Rosario, Rosario, Argentina
| | - Cristian Bustos
- Department of Innovation & Technology, University Center for Assistance, Teaching and Research, University of Gran Rosario, Rosario, Argentina
| | - Daniel Jerez-Mayorga
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
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Effect of New Zealand Blackcurrant Extract on Force Steadiness of the Quadriceps Femoris Muscle during Sustained Submaximal Isometric Contraction. J Funct Morphol Kinesiol 2022; 7:jfmk7020044. [PMID: 35736015 PMCID: PMC9225559 DOI: 10.3390/jfmk7020044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/15/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
Intake of anthocyanin-rich New Zealand blackcurrant (NZBC) can alter physiological responses that enhance exercise performance. In two studies, we examined the effects of NZBC extract on force steadiness during a sustained submaximal isometric contraction of the quadriceps femoris muscle. With repeated measures designs, male participants in study one (n = 13) and study two (n = 19) performed a 120 s submaximal (30%) isometric contraction of the quadriceps femoris muscle following a 7-day intake of NZBC extract and placebo (study one) and following 0 (control), 1-, 4- and 7-day intake of NZBC extract (study two). Participants for both studies were different. In study one, NZBC extract enhanced isometric force steadiness during the 120 s contraction (placebo: 6.58 ± 2.24%, NZBC extract: 6.05 ± 2.24%, p = 0.003), with differences in the third (60-89 s) and fourth quartile (90-120 s) of the contraction. In study two, isometric force steadiness was not changed following 1 and 4 days but was enhanced following 7-day intake of NZBC extract in comparison to control. In study two, the enhanced isometric force steadiness following 7-day intake did occur in the second (30-59 s), third (60-89 s) and fourth (90-120 s) quartiles. Daily supplementation of anthocyanin-rich NZBC extract can enhance force steadiness of the quadriceps femoris muscle during a sustained submaximal isometric contraction. Our observations may have implications for human tasks that require postural stability.
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Are we missing parameters to early detect risk factors of falling in older adults? Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Test-Retest of a Novel Wii Board-Based Device to Assess Eccentric Knee Flexor Strength During the Nordic Hamstring Exercise. J Sport Rehabil 2022; 31:651-656. [PMID: 35213823 DOI: 10.1123/jsr.2021-0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to assess the test-retest reliability of a Wii board-based device to assess the eccentric knee strength. Healthy participants (n = 20, 22.7 [3.4] y, 1.71 [0.09] m, 69 [13] kg) performed 2 assessments-days 1 and 2-of the Nordic hamstring exercise (3 trials per day, 3 min of rest between trials, and 48 h between trials) on a padded board with an attached Wii Balance Board (WBB). A ratchet inelastic strap made the contact between the participant's distal aspect of both legs and the inverted upper surface of the WBB. The means among 3 trials were used to extract the absolute strength and the left and the right limb strengths. No between-session differences were found (P range = .691-.981). The intraclass correlation coefficient range showed excellent results (.905-.926), as the Cronbach α test (above .94). The correlation was high (r > .91; .820 < r2 < .862). The Bland-Altman analysis returned high levels of agreement. The standard error of measurement ranged from 5.56 to 11.07 N and the minimal detectable change from 15.42 to 30.68 N. The percentage of standard error of measurement values were 2.95%, 3.74%, 2.88%, respectively, for absolute strength, right limb strength, and left limb strength. The adapted system showed an excellent cost-benefit relationship with optimal test-retest reliability. The findings suggest that the adapted system, using the WBB, is a reliable method for measuring the eccentric knee strength.
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Keener MM, Tumlin KI, Heebner NR. Combined driving: task-specific position impacts grip strength of equestrian athletes. Eur Rev Aging Phys Act 2022; 19:2. [PMID: 35012451 PMCID: PMC8903501 DOI: 10.1186/s11556-021-00282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Loss of hand strength is a predictor of mortality in aging populations. Despite reliance on the hands to participate in equestrian driving activity, no existing studies focus on associations of hand strength to athletic performance. Therefore, this study 1) established baseline handgrip of equestrian combined drivers in standing and task-specific positions, 2) determined endurance of task-specific handgrip, 3) compared handgrip strength to normative data, and 4) evaluated associations of handgrip and equestrian-specific variables. Methods There were 51 combined drivers (9 males, 42 females) ages 21–78 who completed a survey, standing handgrip, and grip strength and endurance in a task-specific position. Sixty-three percent of participants were 50 years or older. The dynamometer grip bar was normalized by hand size for standing tests; to duplicate sport-specific tasks, the bar was set to the closest setting. Significances were determined at p < 0.05. Results Drivers with more than 30 years of experience demonstrated highest summed standing (73.1 ± 5.2 kg) and summed sitting (59.9 ± 6.3 kg) grip strength. Females 60-years and older had greater handgrip endurance (Χ2 = 8.323, df = 2, p = .0156) in non-dominant (left) hands. Males (60%) reported more cold weather fatigue than females. Glove wearing was associated with bilateral endurance balance; a higher proportion of endurance balance between dominant and non-dominant (49% high-high and 29% low-low; Χ2 = 11.047, df = 1, p = .0009) was realized. There were no associations of handgrip and prior injury. Conclusions Our results have implications in understanding task-specific and normative grip strengths in aging equestrian populations. Bilateral balance in handgrip strength and endurance is important particularly in maintaining strength in non-dominant hands over time. Equestrian driving sport promotes greater endurance in older females. Strength can be improved by participating in combined driving, and engagement in this sport over several years’ benefits hand strength over time. This cohort of equestrian participants provides evidence that participating in hand-specific activities promotes greater strength, which has been previously shown to improve aging outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-021-00282-w.
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Affiliation(s)
- Michaela M Keener
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA.
| | - Kimberly I Tumlin
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA.,Department of Epidemiology, College of Public Health, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, 720 Sports Center Drive, Lexington, KY, 40506, USA
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Logue RN, Goldenkoff ER, Vesia M, Brown SH. Measuring hand sensory function and force control in older adults: Are current hand assessment tools enough? J Gerontol A Biol Sci Med Sci 2021; 77:1405-1412. [PMID: 34908115 DOI: 10.1093/gerona/glab368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ability to grasp and manipulate objects is essential for performing activities of daily living. However, there is limited information regarding age-related behavioral differences in hand sensorimotor function due, in part, to the lack of assessment tools capable of measuring subtle but important differences in hand function. The purpose of this study was to demonstrate performance differences in submaximal force control and tactile pattern recognition in healthy older adults using two custom-designed sensorimotor assessment tools. METHODS Sensorimotor function was assessed in 13 healthy older adults (mean age 72.2 ±5.5y, range: 65-84y) and 13 young adults (mean age 20 ±1.4y, range: 19-23y). Clinical assessments included the Montreal Cognitive Assessment (MoCA), monofilament testing, maximum voluntary contraction (MVC), and Grooved Pegboard Test. Sensorimotor assessments included submaximal (5, 20% MVC) grip force step-tracking and tactile pattern recognition tasks. RESULTS Clinical assessments revealed no or minimal group differences in MVC, monofilament thresholds, and MoCA. However, sensorimotor assessments showed that older adults took longer to discriminate tactile patterns and had poorer accuracy than young adults. Older adults also produced submaximal forces less smoothly than young adults at the 20% force level while greater variability in force maintenance was seen at 5% but not 20% MVC. CONCLUSIONS These results demonstrate the ability to integrate higher-order tactile information and control low grip forces is impaired in older adults despite no differences in grip strength or cognition. These findings underscore the need for more sensitive evaluation methods that focus on sensorimotor ability reflective of daily activities.
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Affiliation(s)
- Rachel N Logue
- Motor Control Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elana R Goldenkoff
- Brain Behavior Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Vesia
- Brain Behavior Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan H Brown
- Motor Control Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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The Effect of Increasing Blood Flow Restriction Pressure When the Contractions Are Already Occlusive. J Sport Rehabil 2021; 31:152-157. [PMID: 34697249 DOI: 10.1123/jsr.2020-0402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/25/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Blood flow restricted exercise involves the use of external pressure to enhance fatigue and augment exercise adaptations. The mechanisms by which blood flow restricted exercise limits muscular endurance are not well understood. OBJECTIVE To determine how increasing blood flow restriction pressure impacts local muscular endurance, discomfort, and force steadiness when the contractions are already occlusive. DESIGN Within-participant, repeated-measures crossover design. SETTING University laboratory. PATIENTS A total of 22 individuals (13 males and 9 females). INTERVENTION Individuals performed a contraction at 30% of maximal isometric elbow flexion force for as long as possible. One arm completed the contraction with 100% of arterial occlusion pressure applied, while the other arm had 150% of arterial occlusion pressure applied. At the end of the protocol, individuals were asked to rate their perceived discomfort. MAIN OUTCOME MEASURES Time to task failure, discomfort, and force steadiness. RESULTS Individuals had a longer time to task failure when performing the 100% arterial occlusion condition compared with the 150% arterial occlusion pressure condition (time to task failure = 82.4 vs 70.8 s; Bayes factors = 5.77). There were no differences in discomfort between the 100% and 150% conditions (median discomfort = 5.5 vs 6; Bayes factors = 0.375) nor were there differences in force steadiness (SD of force output 3.16 vs 3.31 N; Bayes factors = 0.282). CONCLUSION The results of the present study suggest that, even when contractions are already occlusive, increasing the restriction pressure reduces local muscle endurance but does not impact discomfort or force steadiness. This provides an indication that mechanisms other than the direct alteration of blood flow are contributing to the increased fatigue with added restrictive pressure. Future studies are needed to examine neural mechanisms that may explain this finding.
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Jones CA, Ciucci MR, Abdelhalim SM, McCulloch TM. Swallowing Pressure Variability as a Function of Pharyngeal Region, Bolus Volume, Age, and Sex. Laryngoscope 2020; 131:E52-E58. [PMID: 32304341 DOI: 10.1002/lary.28667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/14/2020] [Accepted: 03/20/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Within-individual movement variability occurs in most motor domains. However, it is unknown how pharyngeal swallowing pressure varies in healthy individuals. We hypothesized that: 1) variability would differ among pharyngeal regions; 2) variability would decrease with increased bolus volume; 3) variability would increase with age; and 4) there would be no sex differences. STUDY DESIGN Case series. METHODS We used pharyngeal high-resolution manometry to measure swallowing pressure in the following regions: velopharynx, tongue base, hypopharynx, and upper esophageal sphincter. Data were collected from 97 healthy adults (41 male) aged 21 to 89 years during thin liquid swallows: 2 mL, 10 mL, and participant-selected comfortable volume. Pressure variability was measured using coefficient of variation. Repeated measures analysis of variance was used to assess impacts of region, bolus volume, age, and sex on pressure variability. RESULTS There was a significant region × volume interaction (P < .001) and significant main effect of age (P = .005). Pressures in the hypopharynx region were more variable than all other regions (P ≤ .028), and pressures in the tongue base region were less variable than all other regions (P ≤ .002) except at 2 mL volumes (P = .065). Swallowing pressure variability was significantly different in the velopharynx and upper esophageal sphincter regions, with comfortable volume and 2 mL swallows having greater variability than 10 mL swallows (P ≤ .026). Pressure variability significantly increased with increasing age (P = .002). There were no effects of sex on pressure variability (P ≥ .15). CONCLUSION Pharyngeal swallowing pressure variability differs according pharyngeal region, volume, and age but not sex. Abnormal swallowing pressure variability may reflect deviations in motor control in persons with swallowing impairment, and results from this study can be used as normative data for future investigations evaluating swallowing pressure generation. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E52-E58, 2021.
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Affiliation(s)
- Corinne A Jones
- Department of Neurology, The University of Texas at Austin, Austin, Texas, U.S.A.,Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Department of Communication Sciences & Disorders, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Suzan M Abdelhalim
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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Norheim KL, Samani A, Bønløkke JH, Omland Ø, Madeleine P. The effects of age and musculoskeletal pain on force variability among manual workers. Hum Mov Sci 2019; 64:19-27. [PMID: 30641456 DOI: 10.1016/j.humov.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Abstract
The present study investigated the influence of age and musculoskeletal pain on force variability during a continuous isometric handgrip force task performed at 30% of maximal voluntary contraction carried out until failure. We recruited 96 male manual workers aged 51-72 years. The participants were stratified according to their age (50-59 and 60+ years) and by pain status (no pain, acute pain and chronic pain). The amplitude and structure of variability expressed as respectively standard deviation (SD) and coefficient of variation (CV), and sample entropy (SaEn) were calculated from the endurance task. The oldest group had an approximately 18% longer endurance time than the youngest group. No between-group differences were found in SD or CV, whereas a significant interaction between age and pain stage was found for SaEn. The youngest group showed lower SaEn than the oldest for both those with chronic pain and those without pain, indicating less force complexity, whereas a tendency for the opposite was found in the acute pain group. Within the pain stage groups, workers with acute pain had higher SaEn compared with both the no pain and chronic pain groups. These findings suggest that age and musculoskeletal pain differentially affects the structure of force variability in manual workers.
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Affiliation(s)
- Kristoffer Larsen Norheim
- Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark.
| | - Afshin Samani
- Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Jakob Hjort Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark.
| | - Øyvind Omland
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark.
| | - Pascal Madeleine
- Sport Sciences, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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Eika F, Blomkvist AW, Rahbek MT, Eikhof KD, Hansen MD, Søndergaard M, Ryg J, Andersen S, Jorgensen MG. Reference data on hand grip and lower limb strength using the Nintendo Wii balance board: a cross-sectional study of 354 subjects from 20 to 99 years of age. BMC Musculoskelet Disord 2019; 20:21. [PMID: 30636625 PMCID: PMC6330568 DOI: 10.1186/s12891-019-2405-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/04/2019] [Indexed: 01/11/2023] Open
Abstract
Background Accurate assessment of isometric hand grip strength (HGS) and isometric lower limb strength (LS) are often limited to specialized clinics due to high costs and need for specialized equipment and personnel. A mobile and user-friendly device would facilitate a wider use of these measures in the clinical setting. The Nintendo Wii Balance Board (WBB) is a novel and pragmatic tool that has been validated for measuring muscle strength and other clinically relevant physiological variables. However, reference data for HGS and LS are lacking. The purpose of the current study is to establish reference data for HGS and LS in individuals ≥20 years of age using the WBB method, and to characterize the effects of age in these measurements. Method Healthy participants were recruited at various locations and their HGS and LS were tested by six assessors using the WBB. Reference data were analysed and presented in age-groups, while the age-related change in HGS and LS was tested and characterized with linear regression models. Results Three hundred and fifty-four participants between 20 and 99 years of age were tested. Data are presented separately according to gender and the following age categories: 20–29, 30–39, 40–49, 50–59, 60–69, 70–79, and 80+, and presented in absolute values as well as percentiles. The main findings were; (1) Significantly higher HGS and LS among males compared to females and for the dominant limb compared to the non-dominant limb, (2) a significant decline in strength with increasing age, and (3) the rate of decline increased significantly (i.e. it was non-linear) with age for HGS, but not for LS. Conclusion This study reported reference data with percentiles for a novel method for assessing HGS and LS. Data were consistent with previously known effects of age and gender on HGS and LS. The presented data may supplement future trials using the WBB in research or in the clinical setting.
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Affiliation(s)
- F Eika
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - A W Blomkvist
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - M T Rahbek
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - K D Eikhof
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - M D Hansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - M Søndergaard
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - J Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - S Andersen
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M G Jorgensen
- Department of Geriatric and Internal Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
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