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Kim IJ, Hegazy F. Enhancing Footwear Safety for Fall Prevention in Older Adults: A Comprehensive Review of Design Features. Ann Geriatr Med Res 2024; 28:121-133. [PMID: 38246912 DOI: 10.4235/agmr.23.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Falls are a global concern affecting people of all ages; however, older adults are particularly vulnerable to age-related factors and foot-related issues. Footwear is critical for preventing falls, as it provides stability and protection against slips, trips, and falls (STFs). However, a significant gap exists in the systematic exploration of the safety aspects of footwear design for fall prevention in older adults. METHODS This comprehensive review applied a meticulous search strategy encompassing prominent databases, including Google Scholar, ScienceDirect, SCOPUS, MEDLINE, ResearchGate, and PubMed. This review synthesized and analyzed existing research to bridge knowledge gaps and provide insights into optimal footwear choices for older adults in terms of design features such as fit, fixation, heel height, collar height, slip resistance, and sole/insole hardness. RESULTS The results underscore the importance of specific design features for preventing falls among older adults. A proper fit, secure fixation, appropriate heel and collar heights, slip resistance, and sole/insole hardness significantly contributed to fall prevention. These findings offer valuable guidance for optimizing footwear designs to enhance comfort, stability, and safety in the daily lives of older individuals. CONCLUSION This comprehensive review fills a critical knowledge gap regarding the safety of footwear designs for fall prevention in older adults. The identified design features play a vital role in reducing the risk of falls and offer practical recommendations for the development of safer footwear. Ultimately, this study contributes to the existing knowledge base and supports efforts to prevent STFs in older adults through improved footwear design.
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Affiliation(s)
- In-Ju Kim
- Department of Industrial Engineering and Engineering Management, College of Engineering, University of Sharjah, Sharjah, United Arab Emirates
| | - Fatma Hegazy
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Hazari A, Mishra V, Kumar P, Maiya A. The accuracy of 10 g monofilament use for clinical screening of diabetes peripheral neuropathy among Indian population. PLoS One 2024; 19:e0297110. [PMID: 38394307 PMCID: PMC10890773 DOI: 10.1371/journal.pone.0297110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The purpose of this study was to test the diagnostic accuracy of the 10g monofilament to screen for diabetic peripheral neuropathy (DPN) in India. The study further assessed the effect of physical activity, footwear use, and occupation on the outcome. METHODS Non-probabilistic purposive sampling was used to recruit patients with T2DM to assess the diagnostic utility of the 10 g monofilament. 160 participants were recruited divided into 4 groups. Each group consisted of 40 participants with 20 under each category described as "Physical Worker Vs Non- physical worker" (n = 40), "Barefoot Vs Footwear" (n = 40), "Use of Slipper at Home Vs No-slippers use at home" (n = 40), "Agriculture Vs Non- agriculture" (n = 40). 10 g monofilament was used to detect the presence of protective sensation towards screening of DPN against biothesiometer (Vibration Pressure Threshold). RESULTS The area under the ROC (receiver operating characteristic) curve was 0.6 for identifying DPN using the 10 g monofilament. Physical work (p = 0.04), footwear (p = 0.04), slipper use at home (p = 0.02) and occupation (p = 0.02) impacted on the diagnostic utility of the 10g monofilament. CONCLUSIONS This study shows that the 10 g monofilament has limited accuracy for detecting DPN in the Indian population and this is further affected by occupation, socioeconomic and religious practice.
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Affiliation(s)
| | | | - Praveen Kumar
- Gulf Medical University, Ajman, United Arab Emirates
| | - Arun Maiya
- Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sato SD, Schlechter M, Price M, Hoogkamer W. Asymmetric shoe height induces reactive changes in gait kinematics but not kinetics in healthy young adults. Gait Posture 2023; 104:70-76. [PMID: 37327557 DOI: 10.1016/j.gaitpost.2023.05.027] [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: 08/23/2022] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Footwear interventions are a potential avenue to correct walking asymmetry in neurologic populations, such as stroke. However, the motor learning mechanisms that underlie the changes in walking imposed by asymmetric footwear are unclear. RESEARCH QUESTION The objectives of this study were to examine symmetry changes during and after an asymmetric shoe height intervention in (1) vertical impulse and (2) spatiotemporal gait parameters and (3) joint kinematics, in healthy young adults METHODS: Eleven healthy young adults (3 males, 8 females; 21.2 ± 3.1 years old) participated in this study. Participants walked on an instrumented treadmill at 1.3 m/s for four conditions: (1) a 5-minute familiarization with equal shoe height, (2) a 5-minute baseline with equal shoe height, (3) a 10-minute intervention, where participants walked with asymmetric shoe height with a 10 mm shoe insert in one shoe, and (4) a 10-minute post-intervention, where participants walked with equal shoe height. Asymmetry in kinetics and kinematics were used to identify changes during intervention and aftereffects, a hallmark of feedforward adaptation RESULTS: Participants did not alter vertical impulse asymmetry (p = 0.667) nor stance time asymmetry (p = 0.228). During the intervention, step time asymmetry (p = 0.003) and double support asymmetry (p < 0.001) were greater compared to baseline. Leg joint asymmetry during stance (Ankle plantarflexion: p < 0.001; Knee flexion: p < 0.001; Hip extension: p = 0.011) was greater during the intervention compared to baseline. However, changes in spatiotemporal gait variables and joint mechanics did not demonstrate aftereffects. SIGNIFICANCE Our results show that healthy human adults change gait kinematics, but not weight-bearing symmetry with asymmetrical footwear. This suggests that healthy humans prioritize maintaining vertical impulse by changing their kinematics. Further, the changes in gait kinematics are short-lived, suggesting feedback-based control, and a lack of feedforward motor adaptations.
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Affiliation(s)
- Sumire D Sato
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA; Neuroscience and Behavior Program, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Maia Schlechter
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA; Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Mark Price
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA; Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Wouter Hoogkamer
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA
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Becker S, Simon S, Mühlen J, Dindorf C, Fröhlich M. Assessing the Subjective Effectiveness of Sensorimotor Insoles (SMIs) in Reducing Pain: A Descriptive Multicenter Pilot Study. J Funct Morphol Kinesiol 2023; 8:jfmk8020066. [PMID: 37218862 DOI: 10.3390/jfmk8020066] [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: 04/05/2023] [Revised: 04/30/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
This pilot study aimed to investigate the use of sensorimotor insoles in pain reduction, different orthopedic indications, and the wearing duration effects on the development of pain. Three hundred and forty patients were asked about their pain perception using a visual analog scale (VAS) in a pre-post analysis. Three main intervention durations were defined: VAS_post: up to 3 months, 3 to 6 months, and more than 6 months. The results show significant differences for the within-subject factor "time of measurement", as well as for the between-subject factor indication (p < 0.001) and worn duration (p < 0.001). No interaction was found between indication and time of measurements (model A) or between worn duration and time of measurements (model B). The results of this pilot study must be cautiously and critically interpreted, but may support the hypothesis that sensorimotor insoles could be a helpful tool for subjective pain reduction. The missing control group and the lack of confounding variables such as methodological weaknesses, natural healing processes, and complementary therapies must be taken into account. Based on these experiences and findings, a RCT and systematic review will follow.
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Affiliation(s)
- Stephan Becker
- Department of Sport Science, RPTU Kaiserslautern-Landau, 67663 Kaiserslautern, Germany
| | - Steven Simon
- Department of Sport Science, RPTU Kaiserslautern-Landau, 67663 Kaiserslautern, Germany
| | - Jan Mühlen
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, 50933 Cologne, Germany
| | - Carlo Dindorf
- Department of Sport Science, RPTU Kaiserslautern-Landau, 67663 Kaiserslautern, Germany
| | - Michael Fröhlich
- Department of Sport Science, RPTU Kaiserslautern-Landau, 67663 Kaiserslautern, Germany
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Effects of Footwear on Anterior Cruciate Ligament Forces during Landing in Young Adult Females. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081119. [PMID: 35892920 PMCID: PMC9332041 DOI: 10.3390/life12081119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/23/2022]
Abstract
Rates of anterior cruciate ligament (ACL) rupture in young people have increased markedly over the past two decades, with females experiencing greater growth in their risk compared to males. In this study, we determined the effects of low- and high-support athletic footwear on ACL loads during a standardized drop–land–lateral jump in 23 late-/post-pubertal females. Each participant performed the task unshod, wearing low- (Zaraca, ASICS) or high- (Kayano, ASICS) support shoes (in random order), and three-dimensional body motions, ground-reaction forces, and surface electromyograms were synchronously acquired. These data were then used in a validated computational model of ACL loading. One-dimensional statistical parametric mapping paired t-tests were used to compare ACL loads between footwear conditions during the stance phase of the task. Participants generated lower ACL forces during push-off when shod (Kayano: 624 N at 71–84% of stance; Zaraca: 616 N at 68–86% of stance) compared to barefoot (770 N and 740 N, respectively). No significant differences in ACL force were observed between the task performed wearing low- compared to high-support shoes. Compared to barefoot, both shoe types significantly lowered push-off phase peak ACL forces, potentially lowering risk of ACL injury during performance of similar tasks in sport and recreation.
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Relationships between the Perception of Footwear Comfort and the Fear of Falls in People at the Early Period of Old Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106267. [PMID: 35627804 PMCID: PMC9141443 DOI: 10.3390/ijerph19106267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022]
Abstract
Objective: The present study aimed to analyze the relationships between the perceptions of footwear comfort with fear of falls in younger-old women and men. Participants: the population sample involved 100 free-living community dwellers aged 65−74. Design: the Falls Efficacy Scale-International and a visual analogue scale to assess perception of footwear comfort were used as research tools. Results: there were statistically significant differences in the FES-I results in people who suffered a fall in the last year compared to those who did not experience a fall (p < 0.001), as well as in the subjective assessment of mediolateral control in people who have suffered and have not suffered a fall in the last year (p = 0.033). In women, statistically significant relationships were found in the subjective assessment of shoe comfort in terms of arch height (p = 0.025) and material properties of the footwear (p = 0.036) with the results of FES-I. Conclusions: People who have fallen show a higher level of fear of falling. The assessment of footwear comfort in terms of mediolateral control was lower in the younger-old who had experienced a fall in the last year. In women, a worse assessment of arch height and material properties of the footwear is accompanied by greater fear of falling.
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Asgari N, Yeowell G, Sadeghi-Demneh E. A comparison of the efficacy of textured insoles on balance performance in older people with versus without plantar callosities. Gait Posture 2022; 94:217-221. [PMID: 35367850 DOI: 10.1016/j.gaitpost.2022.03.022] [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: 02/03/2021] [Revised: 03/08/2022] [Accepted: 03/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Textured insoles have been suggested to enhance foot sensation, which contributes to controlling upright balance. However, the interaction between plantar callosity and the textured surface has not been studied. RESEARCH QUESTION Firstly, to compare the efficacy of textured insoles on balance performance and foot position sense between two groups of older people: one group had plantar callosity, and the other did not. Secondly, to investigate the efficacy of textured insoles within each study group. METHODS Thirty older people with a history of falls (15 with plantar callosity and 15 without callosity) participated in this study. All participants underwent assessments of postural sway on a force plate, joint position sensation of the ankle with a slope box, and mobility using the "Timed Up and Go" test under three insole surface conditions: 1) smooth (control), 2) placebo and 3) textured surface. Two-way analyses of variance were used to compare the outcomes of the two groups and three conditions. RESULTS Older people with plantar callosity had worse ankle joint position sense and slower antero-posterior and mediolateral postural sway velocity than their peers who did not have plantar callosity. The textured insoles improved ankle joint position sense and mobility regardless of callus status in the plantar surface of older peoples' feet. The insole-callosity interaction was not significant for any study outcome. SIGNIFICANCE Textured insoles could be beneficial to older people with and without callosity as they have shown immediate improvements in ankle joint position sense and mobility.
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Affiliation(s)
- Narjes Asgari
- Student Research Committee, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gillian Yeowell
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Ebrahim Sadeghi-Demneh
- Musculoskeletal Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
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Puszczalowska-Lizis E, Koziol K, Omorczyk J. Perception of footwear comfort and its relationship with the foot structure among youngest-old women and men. PeerJ 2021; 9:e12385. [PMID: 34722004 PMCID: PMC8532988 DOI: 10.7717/peerj.12385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Adequate footwear comfort and functionality are important regardless of age, but they become particularly important in the youngest-old women and men, mainly due to the fact that this age range is the initial period of old age with changes in shoe preferences. The aim of this study was to assess the perception of footwear comfort and its relationship with the feet structure in youngest-old women and men. Methods The cross-sectional study covered community dwellers living on their own aged 65–74 years (50 women; 50 men). The feet characteristics were measured using the CQ-ST podoscope (Electronic System, Ltd, EU), and the perception of footwear comfort was assessed with a visual analogue scale. The assessment took into account gender-specific footwear of a certain brand (Befado Dr orto). Results Statistically significant intergender differences were observed in the perception of footwear comfort with respect to the shoe heel width (p = 0.022), the arch height (p = 0.013), the overall comfort (p = 0.049) and the material properties of the footwear (p = 0.017). In women, there were statistically significant positive relationships among the heel angle (γ) and the perception of footwear comfort in terms of heel cushioning (p = 0.021), forefoot cushioning (p = 0.015), arch height (p = 0.029). In men, there was a statistically significant negative relationship of the left foot Clarke’s angle with the heel height (p = 0.043), and a positive relationship between the right foot width and the arch height (p = 0.044). Conclusions Youngest-old women, compared to men of the same age range, have a higher perception of shoe comfort in terms of the shoe heel width, the arch height, the overall comfort of the footwear and the material properties of the footwear. The appropriate profile and construction of the shoe allows for an increase in the contact surface of the foot with the shoe, hence the improvement in the perception of footwear comfort in people with lowered arch or widened forefoot.
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Affiliation(s)
| | | | - Jaroslaw Omorczyk
- Faculty of Physical Education and Sport, Institute of Sport, University of Physical Education in Krakow, Krakow, Poland
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Immediate effect of insoles on balance in older adults. Foot (Edinb) 2021; 47:101768. [PMID: 33946001 DOI: 10.1016/j.foot.2020.101768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In recent years, fall prevention in older adults has received considerable attention in healthcare. Among many interventions, insoles are considered cost-effective and easily adopted tools to improve balance in older people. Numerous studies have verified the immediate effects of insoles on balance in older adults. However, there is still lack of consensus regarding the immediate benefits of using insoles on balance improvement. RESEARCH QUESTION Given this, a meta-analysis was conducted to provide more conclusive evidence about the immediate effect of insoles on balance in older adults and answer the question: "Do insoles influence balance in older people?" METHODS PubMed, NDSL, Medline, Google Scholar, and Web of Science were searched from March to August 2018. The key terms were "insole", "elderly", "gait", "balance", "shoe", "foot", and "postural". Finally, seven primary studies were selected for this meta-analysis. The balance related outcomes were coded to compute effect sizes and the overall effect size of the standardized mean differences was analyzed. Moderating variables included kinematic variables of balance, static and dynamic balance, and type of insole. RESULTS The overall effect size of insoles was medium (d = 0.618), which suggests that insoles are beneficial for older adults for improving balance. More specifically, this study revealed that textured and vibration insoles were the most effective types of insoles. SIGNIFICANCE This finding supports the idea that augmented tactile and mechanical sensory input from insoles can enhance the postural control mechanisms in older adults with age-related deterioration of sensory mechanisms. The use of insoles may lead to a reduction in the rate of falls which are related to decreased quality of life in older adults.
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Gaino JZ, Bértolo MB, Nunes CS, Barbosa CDM, Landim SF, Sachetto Z, Magalhães EDP. The effect of foot orthoses on balance, foot function, and mobility in rheumatoid arthritis: A randomized controlled clinical trial. Clin Rehabil 2021; 35:1011-1020. [PMID: 33586475 DOI: 10.1177/0269215521993316] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare balance, foot function and mobility in patients with rheumatoid arthritis with and without foot orthoses. DESIGN Randomized controlled trial. SETTING Outpatient rheumatology clinic. SUBJECTS A total of 94 subjects with rheumatoid arthritis were randomized; of these, 81 were included in the analyses (Intervention group: 40; Control group: 41). INTERVENTION The Intervention Group received custom-made foot orthoses while the Control Group received none intervention. MAIN MEASURE The "Foot Function Index," the "Berg Balance Scale," and the "Timed-up-and-go Test" were assessed at baseline an after four weeks. The chosen level of significance was P < 0.05. RESULTS Average (standard deviation) participant age was 56.7 (±10.6) years old and average disease duration (standard deviation) was 11.4 (± 7.2) years. Groups were similar at baseline, except for comorbidity index and race. After four weeks, significant interaction group versus time was observed for Foot Function Index (change: Intervention group: -1.23 ± 1.58; Control group: -0.12 ± 1.16 - P = 0.0012) and for Berg Balance Scale (change: Intervention group: 2 ± 3; Control group: 0 ± 3 - P = 0.0110), but not for the Timed-up-and-go Test (change: Intervention group: -1.34 ± 1.99; Control group: -0.84 ± 2.29 - P = 0.0799). CONCLUSION Foot orthoses improved foot function and balance in patients with rheumatoid arthritis.
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Affiliation(s)
- Juliana Zonzini Gaino
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Manoel Barros Bértolo
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Caroline Silva Nunes
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Cecília de Morais Barbosa
- Department of Internal Medicine, Gerontology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Síbila Floriano Landim
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Zoraida Sachetto
- Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
| | - Eduardo de Paiva Magalhães
- Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas-Unicamp, Campinas, São Paulo, Brazil
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Effects of Balance Shoes on Balance and Postural Stability in the Elderly: A Crossover, Controlled, Randomized Single-Blind Study. Healthcare (Basel) 2021; 9:healthcare9020179. [PMID: 33567648 PMCID: PMC7915041 DOI: 10.3390/healthcare9020179] [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: 01/08/2021] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
The risk of falling increases with age. Individuals wearing unadapted shoes present an aggravating risk factor. The objective of this study was to determine the effectiveness of specifically designed balance shoes on balance and postural stability in healthy elderly people compared to that of their usual shoes. In total, 21 healthy individuals aged 65–84 years (76.0 ± 8.0 years) performed balance tests (bipedal with open or closed eyes, unipedal with open eyes, limits of stability, and step cadence) while wearing their (i) personal shoes or (ii) balance shoes (Axis Comfort Development©). Three test sessions were conducted with personal and balance shoes. The first served as the baseline, and the other two were performed after a familiarization period of several days with the personal or balance shoes. The perception of balance shoe efficiency was documented using a questionnaire. The balance shoes significantly improved bipedal balance with closed eyes. Moreover, the familiarization period significantly improved unipedal balance with open eyes. Most subjects felt safer and stabler using balance shoes. The investigated specifically designed balance shoes were effective in elderly individuals in improving postural balance compared to personal shoes. The balance shoes could, therefore, reduce the falling risk in healthy elderly people.
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Peng HT, Lin CH, Kuo YC, Song CY. Effects of Arch Support Insoles on Single- and Dual-Task Gait Performance Among Community-Dwelling Older Adults. Clin Interv Aging 2020; 15:1325-1332. [PMID: 32848373 PMCID: PMC7428319 DOI: 10.2147/cia.s254474] [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: 03/18/2020] [Accepted: 07/12/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the immediate and prolonged effects of arch support insoles on single- and dual-task gait performance among community-dwelling older adults. Methods Twenty women performed single- and dual-task walking for 10 m at self-selected comfortable and fast paces while performing serial subtractions (cognitive interference) or carrying a tray (motor interference). Spatiotemporal gait parameters were measured and compared with measurements without arch support immediately after the insertion of the insoles and at 1-week follow-up. Results Some effects were noted, with small-to-medium effect sizes. During comfortable-paced single-task walking, stride length and walk ratio (step length/cadence) increased after arch support use. During comfortable-paced motor dual-task walking, arch support use increased cadence, stride length, and speed and decreased dual-task costs (DTCs) on cadence and speed. During fast-paced motor dual-task walking, cadence increased and the DTC on cadence decreased after arch support use at the 1-week follow-up. During comfortable-paced cognitive dual-task walking, cadence increased and the walk ratio decreased following arch support use. At the 1-week follow-up, DTCs on cadence reduced, but those on stride length and speed increased. During fast-paced cognitive dual-task walking, the speed and stride length demonstrated immediate decreases followed by increases at the 1-week follow-up. Conclusion The study results indicate that the use of arch support improves single- and motor dual-task gait performance, which may contribute to gait and balance training in older adults.
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Affiliation(s)
- Hsien-Te Peng
- Department of Physical Education, Chinese Culture University, Taipei, Taiwan
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chi Kuo
- Department of Exercise and Health Science, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Shoes and Insoles: The Influence on Motor Tasks Related to Walking Gait Variability and Stability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124569. [PMID: 32630373 PMCID: PMC7345333 DOI: 10.3390/ijerph17124569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022]
Abstract
The rhythmic control of the lower limb muscles influences the cycle-to-cycle variability during a walking task. The benefits of insoles, commonly used to improve the walking gait, have been little studied. Therefore, the aim of this study was to assess the walking gait variability and stability on different walking conditions (without shoes, WTS, with shoes, WS, with shoes and insoles, WSI) related to brain activity. Twelve participants randomly (WTS/WS/WSI) walked on a treadmill at 4 km/h for 10 min. Kinematic analysis (i.e., footstep and gait variability), brain activation (beta wave signal), rating of perceived exertion (RPE, CR-10 scale), and time domain measures of walking variability were assessed. The maximum Lyapunov exponent (LyE) on the stride cycle period's datasets was also calculated. Stride length and cycle calculated for all walking conditions were 61.59 ± 2.53/63.38 ± 1.43/64.09 ± 2.40 cm and 1.11 ± 0.03/1.14 ± 0.03/1.15 ± 0.04 s (F1,10 = 4.941/p = 0.01, F1,10 = 4.938/p = 0.012) for WTS, WS, WSI, respectively. Beta wave (F1,10 = 564.201/p = 0.0001) was higher in WTS compared to WS and WSI. Analysis of variance's (ANOVA) LyE showed a F1,10 = 3.209/p = 0.056, while post hoc analysis showed a significant effect between WS and WSI with p = 0.023, and nonsignificant effects between WTS and WS/WSI (p = 0.070/0.607), respectively. Small perturbations of the foot can influence the control of gait rhythmicity by increasing the variability in a dissipative deterministic regimen.
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Huang M, Yick KL, Ng SP, Yip J, Cheung RTH. The effect of support surface and footwear condition on postural sway and lower limb muscle action of the older women. PLoS One 2020; 15:e0234140. [PMID: 32492058 PMCID: PMC7269262 DOI: 10.1371/journal.pone.0234140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diminished somatosensory function is a critical age-related change which is related to postural instability in the older population. Footwear is a cost-effective way to modulate the postural stability by altering sensorimotor inputs via mechanoreceptors on the plantar surface of the feet. Compared to insoles with indentions in the entire surface, we innovatively developed a textured insole with site-specific nodulous protrudous. This study thus aimed to investigate the immediate effect of the nodulous insole and supporting surface condition on static postural stability and lower limb muscle activation for healthy older women. METHODS This is a single-session study with repeated measurements. Twenty-three healthy older women stood on the firm (i.e., concrete floor) and foam surfaces with their eyes open in the three footwear conditions, namely barefoot, plain shoes and shoes with an innovative textured insole, for 30 seconds. Static postural sway and muscle activation of biceps femoris (BF), vastus lateralis (VL), tibialis anterior (TA), and lateral gastrocnemius (LG) of the dominant leg were measured during each testing condition. RESULTS Compared to a firm surface, standing on the foam could significantly increase the body sway and lower limb muscle activation (p<0.05). When standing on the foam, compared to barefoot, wearing footwear significantly decreased the VL and TA muscle activation and minimize the postural sway in medial-lateral and anterior-posterior direction, while the influence is larger for the shoes with nodulous insloe compared to the plain shoes. No significant differences between the footwear conditions for static stability and muscle activation were observed on firm surface condition. CONCLUSIONS For older women, footwear could improve the postural stability in the unstable surface, particularly the footwear with nodulous insole, with the underlying mechanism as enhancing the mechanoreceptors on the plantar surface of the feet.
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Affiliation(s)
- Meizhen Huang
- Department of Rehabilitation Sciences, Gait & Motion Analysis Lab, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Kit-lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- * E-mail:
| | - Sun-pui Ng
- College of Professional and Continuing Education, The Hong Kong Polytechnic University, Hong Kong
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Roy Tsz-hei Cheung
- Department of Rehabilitation Sciences, Gait & Motion Analysis Lab, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
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15
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Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg 2020; 37:327-369. [PMID: 32146988 DOI: 10.1016/j.cpm.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.
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Affiliation(s)
- Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Christopher Girgis
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Marco Avalos
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Adam E Fleischer
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
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16
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Kenny RPW, Eaves DL, Martin D, Behmer LP, Dixon J. The Effects of Textured Insoles on Cortical Activity and Quiet Bipedal Standing With and Without Vision: An EEG Study. J Mot Behav 2019; 52:489-501. [PMID: 31379265 DOI: 10.1080/00222895.2019.1648237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Wearing textured insoles (TIs) can reduce static postural sway, but the neurophysiological mechanisms by which these changes occur are not well understood. To address this issue, cortical activity was investigated in this study using electroencephalography (EEG) recordings from 19 scalp locations, in 15 healthy young adults (5 females; mean age = 27 ± 4.09 years) during quiet bipedal standing, under different insole conditions (textured versus smooth), with and without vision. Compared to smooth insoles (SIs), TIs significantly reduced postural sway in two measures; anterior-posterior range and standard deviation. In the EEG data, whole-head analyses showed cortical activity in the upper alpha power band was significantly reduced for textured compared to SIs. Exploratory analyses revealed this effect was significant both with and without vision, and was more pronounced over the parietal, compared to central regions, and over central compared to frontal regions. This trend was observed in low alpha and theta bands, but the effect of insole type was not significant. Textured insoles thus appear to affect not only balance outcomes but also cortical activity. The cortical activity adaptation may represent greater information becoming readily available at the cortical level, enhancing the representation of the body in space.
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Affiliation(s)
- Ryan P W Kenny
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Daniel L Eaves
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | | | - John Dixon
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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17
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Wylie G, Torrens C, Campbell P, Frost H, Gordon AL, Menz HB, Skelton DA, Sullivan F, Witham MD, Morris J. Podiatry interventions to prevent falls in older people: a systematic review and meta-analysis. Age Ageing 2019; 48:327-336. [PMID: 30615052 PMCID: PMC6503946 DOI: 10.1093/ageing/afy189] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/16/2018] [Accepted: 11/14/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND foot problems are independent risk factors for falls in older people. Podiatrists diagnose and treat a wide range of problems affecting the feet, ankles and lower limbs. However, the effectiveness of podiatry interventions to prevent falls in older people is unknown. This systematic review examined podiatry interventions for falls prevention delivered in the community and in care homes. METHODS systematic review and meta-analysis. We searched multiple electronic databases with no language restrictions. Randomised or quasi-randomised-controlled trials documenting podiatry interventions in older people (aged 60+) were included. Two reviewers independently applied selection criteria and assessed methodological quality using the Cochrane Risk of Bias tool. TiDieR guidelines guided data extraction and where suitable statistical summary data were available, we combined the selected outcome data in pooled meta-analyses. RESULTS from 35,857 titles and 5,201 screened abstracts, nine studies involving 6,502 participants (range 40-3,727) met the inclusion criteria. Interventions were single component podiatry (two studies), multifaceted podiatry (three studies), or multifactorial involving other components and referral to podiatry component (four studies). Seven studies were conducted in the community and two in care homes. Quality assessment showed overall low risk for selection bias, but unclear or high risk of detection bias in 4/9 studies. Combining falls rate data showed significant effects for multifaceted podiatry interventions compared to usual care (falls rate ratio 0.77 [95% CI 0.61, 0.99]); and multifactorial interventions including podiatry (falls rate ratio: 0.73 [95% CI 0.54, 0.98]). Single component podiatry interventions demonstrated no significant effects on falls rate. CONCLUSIONS multifaceted podiatry interventions and multifactorial interventions involving referral to podiatry produce significant reductions in falls rate. The effect of multi-component podiatry interventions and of podiatry within multifactorial interventions in care homes is unknown and requires further trial data. PROSPERO REGISTRATION NUMBER CRD42017068300.
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Affiliation(s)
- Gavin Wylie
- School of Nursing and Health Sciences, Section of Ageing and Health, and NHS Tayside Allied Health Professions Directoriate, University of Dundee, 11 Airlie Place, Dundee, UK
| | - Claire Torrens
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, Pathfoot, UK
| | - Pauline Campbell
- Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Helen Frost
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, UK
| | - Adam Lee Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, UK
| | - Hylton B Menz
- Musculoskeletal Reseach Centre, School of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia
| | - Dawn A Skelton
- Institute of Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - Frank Sullivan
- Division of Population and Behavioural Science, Department of Medicine, University of St Andrews, St Andrews, UK
| | - Miles D Witham
- Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Jacqui Morris
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, UK
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Kenny RPW, Eaves DL, Martin D, Hatton AL, Dixon J. The effects of textured insoles on quiet standing balance in four stance types with and without vision. BMC Sports Sci Med Rehabil 2019; 11:5. [PMID: 30992992 PMCID: PMC6449971 DOI: 10.1186/s13102-019-0117-9] [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] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022]
Abstract
Background Wearing a textured shoe insole can decrease postural sway during static balance. Previous studies assessed bipedal and/or unipedal standing. In contrast, we aimed to investigate if textured insoles modulated postural sway during four stance types (bipedal, standard Romberg, tandem Romberg, and unipedal), with and without vision. Methods The repeated measures design involved 28 healthy young adults (13 females; mean age = 26.86 ± 6.6 yrs) performing quiet standing in the four stance types on a force platform, under two different insole conditions (textured insole; TI vs. smooth insole; SI), with eyes open and eyes closed. Postural sway was assessed via the range and standard deviation of the COP excursions in the anterior-posterior and medial-lateral sway, and overall mean velocity. Results The main effect of insole type was statistically significant at the alpha p = 0.05 level (p = 0.045). Compared to smooth insoles, textured insoles reduced the standard deviation of anterior-posterior excursions (APSD). While simple main effect analyses revealed this was most pronounced during eyes closed bipedal standing, insole type did not provide a statistically significant interaction with either stance or vision in this measure, or any other. Postural sway showed statistically significant increases across both stance type (bipedal < standard Romberg < tandem Romberg < unipedal), and vision (eyes closed < eyes open), in almost all measures. Stance and vision did have a statistically significant interaction in each measure, reflecting greater postural disturbances with eyes closed when stance stability decreased. Conclusions Overall, these results support textured insole use in healthy young adults to reduce postural sway measures. This is because APSD is an index of spatial variability, where a decrease is associated with improved balance and possibly translates to reduced falls risk. Placing a novel texture in the shoe presumably modulated somatosensory inputs. It is important to understand the underlying mechanisms by which textured insoles influence postural sway. As such, utilising a healthy adult group allows us to investigate possible mechanisms of textured insoles. Future research could investigate the potential underlying mechanisms of textured insole effects at a neuromuscular and cortical level, in healthy young adults.
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Affiliation(s)
- Ryan P W Kenny
- 1School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX UK
| | - Daniel L Eaves
- 1School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX UK
| | - Denis Martin
- 1School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX UK
| | - Anna L Hatton
- 2School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, AU Australia
| | - John Dixon
- 1School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BX UK
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19
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Ramsey CA, Lamb P, Kaur M, Baxter GD, Ribeiro DC. "How are running shoes assessed? A systematic review of characteristics and measurement tools used to describe running footwear". J Sports Sci 2019; 37:1617-1629. [PMID: 30880578 DOI: 10.1080/02640414.2019.1578449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Many footwear characteristics are argued as risk factors for running related injuries (RRI). Several footwear assessment tools are available; however, their use in studies of RRI is unknown. Objective: This systematic review evaluated the characteristics and methods of assessing footwear in studies of RRI. Design: Five online databases were searched for studies on adult runners, in running style footwear, who experienced running-related pain or injury. The methodological quality of included articles was independently assessed by two raters using a modified Downs and Black checklist. Study and participant characteristics, footwear assessment tools used, and footwear characteristics reported were extracted for qualitative synthesis. Results: Twenty-four articles were included in the review. Low risk of bias was determined for 11 (44%) of the included studies. Twenty-eight different footwear characteristics were grouped into four categories: nomenclature, measurements, qualitative features, and subjective features. Fifteen different methods for assessing the 28 footwear characteristics were reported among the included studies. Only three methods were described previously, as valid and reliable. Conclusion: Differences in assessing footwear may mask the link between footwear characteristics and injury risk. Systematic footwear assessments and nomenclature are needed to evaluate the effects of footwear characteristics on RRI.
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Affiliation(s)
- Codi A Ramsey
- a Institute of Sport, Exercise, and Health, Otago Polytechnic , Dunedin , New Zealand.,b Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy , University of Otago , Dunedin , New Zealand
| | - Peter Lamb
- c School of Physical Education, Sport and Exercise Science , University of Otago , Dunedin , New Zealand
| | - Mandeep Kaur
- b Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy , University of Otago , Dunedin , New Zealand
| | - G David Baxter
- b Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy , University of Otago , Dunedin , New Zealand
| | - Daniel Cury Ribeiro
- b Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy , University of Otago , Dunedin , New Zealand
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20
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Ma CZH, Wong DWC, Wan AHP, Lee WCC. Effects of orthopedic insoles on static balance of older adults wearing thick socks. Prosthet Orthot Int 2018; 42:357-362. [PMID: 29376482 DOI: 10.1177/0309364617752982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The wearing of socks and insoles may affect the ability of the foot to detect tactile input influencing postural balance. OBJECTIVES The aim of this study was to investigate whether (1) thick socks adversely affected the elderly postural balance and (2) orthopedic insoles could improve the elderly postural balance while wearing thick socks. STUDY DESIGN Repeated-measures study design. METHODS In total, 14 healthy older adults were recruited. A monofilament test was conducted to evaluate foot plantar sensation with and without thick socks. Subjects then performed the Romberg tests under three conditions: (1) barefoot, (2) with socks only, and (3) with both socks and insoles. Postural balance was assessed by measuring the center of pressure movement during standing in each experimental condition. RESULTS Thick socks significantly decreased the monofilament score ( p < 0.001), suggesting reduction in ability to detect external forces. All center of pressure parameters increased significantly while wearing thick socks ( p < 0.017), implying reduction of postural stability. They then decreased significantly with the additional use of insoles ( p < 0.017). CONCLUSION Previous studies have documented the changes in plantar pressure distribution with the use of orthopedic insoles. This study further suggests that such changes in contact mechanics could produce some balance-improving effects, which appears not to have been reported earlier. Clinical relevance Wearing thick socks reduces plantar pressure sensitivity and increases postural sway which may increase risk of falls. Orthopedic insoles and footwear with similar design could potentially be a cost-effective method in maintaining postural balance when wearing thick socks.
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Affiliation(s)
| | - Duo Wai-Chi Wong
- 1 The Hong Kong Polytechnic University, Hung Hom, Hong Kong.,2 China Rehabilitation Research Center, Beijing, China
| | | | - Winson Chiu-Chun Lee
- 3 Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
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21
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Cockayne S, Rodgers S, Green L, Fairhurst C, Adamson J, Scantlebury A, Corbacho B, Hewitt CE, Hicks K, Hull R, Keenan AM, Lamb SE, McIntosh C, Menz HB, Redmond A, Richardson Z, Vernon W, Watson J, Torgerson DJ. Clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for falls prevention in older people: a multicentre cohort randomised controlled trial (the REducing Falls with ORthoses and a Multifaceted podiatry intervention trial). Health Technol Assess 2018. [PMID: 28621259 DOI: 10.3310/hta21240] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Falls are a serious cause of morbidity and cost to individuals and society. Evidence suggests that foot problems and inappropriate footwear may increase the risk of falling. Podiatric interventions could help reduce falls; however, there is limited evidence regarding their clinical effectiveness and cost-effectiveness. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of a multifaceted podiatry intervention for preventing falls in community-dwelling older people at risk of falling, relative to usual care. DESIGN A pragmatic, multicentred, cohort randomised controlled trial with an economic evaluation and qualitative study. SETTING Nine NHS trusts in the UK and one site in Ireland. PARTICIPANTS In total, 1010 participants aged ≥ 65 years were randomised (intervention, n = 493; usual care, n = 517) via a secure, remote service. Blinding was not possible. INTERVENTIONS All participants received a falls prevention leaflet and routine care from their podiatrist and general practitioner. The intervention also consisted of footwear advice, footwear provision if required, foot orthoses and foot- and ankle-strengthening exercises. MAIN OUTCOME MEASURES The primary outcome was the incidence rate of falls per participant in the 12 months following randomisation. The secondary outcomes included the proportion of fallers and multiple fallers, time to first fall, fear of falling, fracture rate, health-related quality of life (HRQoL) and cost-effectiveness. RESULTS The primary analysis consisted of 484 (98.2%) intervention and 507 (98.1%) usual-care participants. There was a non-statistically significant reduction in the incidence rate of falls in the intervention group [adjusted incidence rate ratio 0.88, 95% confidence interval (CI) 0.73 to 1.05; p = 0.16]. The proportion of participants experiencing a fall was lower (50% vs. 55%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00; p = 0.05). No differences were observed in key secondary outcomes. No serious, unexpected and related adverse events were reported. The intervention costs £252.17 more per participant (95% CI -£69.48 to £589.38) than usual care, was marginally more beneficial in terms of HRQoL measured via the EuroQoL-5 Dimensions [mean quality-adjusted life-year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314 QALYs] and had a 65% probability of being cost-effective at the National Institute for Health and Care Excellence threshold of £30,000 per QALY gained. The intervention was generally acceptable to podiatrists and trial participants. LIMITATIONS Owing to the difficulty in calculating a sample size for a count outcome, the sample size was based on detecting a difference in the proportion of participants experiencing at least one fall, and not the primary outcome. We are therefore unable to confirm if the trial was sufficiently powered for the primary outcome. The findings are not generalisable to patients who are not receiving podiatry care. CONCLUSIONS The intervention was safe and potentially effective. Although the primary outcome measure did not reach significance, a lower fall rate was observed in the intervention group. The reduction in the proportion of older adults who experienced a fall was of borderline statistical significance. The economic evaluation suggests that the intervention could be cost-effective. FUTURE WORK Further research could examine whether or not the intervention could be delivered in group sessions, by physiotherapists, or in high-risk patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN68240461. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lorraine Green
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine E Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Robin Hull
- Podiatry Department, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Anne-Maree Keenan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah E Lamb
- Oxford NIHR Biomedical Research Unit, Oxford, UK
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, National University of Ireland Galway, Galway, Ireland
| | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Wesley Vernon
- Podiatry Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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22
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Perez-Cruzado D, Gonzalez-Sanchez M, Cuesta-Vargas AI. Differences in Kinematic Variables in Single-Leg Stance between Patients with Stroke and Healthy Elderly People Measured with Inertial Sensors: A Cross-Sectional Study. J Stroke Cerebrovasc Dis 2018; 27:229-239. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022] Open
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Wylie G, Menz HB, McFarlane S, Ogston S, Sullivan F, Williams B, Young Z, Morris J. Podiatry intervention versus usual care to prevent falls in care homes: pilot randomised controlled trial (the PIRFECT study). BMC Geriatr 2017; 17:143. [PMID: 28701161 PMCID: PMC5508629 DOI: 10.1186/s12877-017-0541-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/06/2017] [Indexed: 12/02/2022] Open
Abstract
Background Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents. Methods Informed by Medical Research Council guidance on developing and evaluating complex interventions, we conducted a single blind, pilot randomised controlled trial in six care homes in the East of Scotland. Participants were randomised to either: (i) a three month podiatry intervention comprising core podiatry care, foot and ankle exercises, orthoses and footwear provision or (ii) usual care. Falls-related outcomes (number of falls, time to first fall) and feasibility-related outcomes (recruitment, retention, adherence, data collection rates) were collected. Secondary outcomes included: generic health status, balance, mobility, falls efficacy, and ankle joint strength. Results 474 care home residents were screened. 43 (9.1%) participants were recruited: 23 to the intervention, 20 to control. Nine (21%) participants were lost to follow-up due to declining health or death. It was feasible to deliver the trial elements in the care home setting. 35% of participants completed the exercise programme. 48% reported using the orthoses ‘all or most of the time’. Completion rates of the outcome measures were between 93% and 100%. No adverse events were reported. At the nine month follow-up period, the intervention group per-person fall rate was 0.77 falls vs. 0.83 falls in the control group. Conclusions A podiatry intervention to reduce falls can be delivered to care home residents within a pilot randomised controlled trial of the intervention. Although not powered to determine effectiveness, these preliminary data provide justification for a larger trial, incorporating a full process evaluation, to determine whether this intervention can significantly reduce falls in this high-risk population. Trial registration ClinicalTrials.gov identifier: NCT02178527; Date of registration: 17 June 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0541-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gavin Wylie
- NHS Tayside, Ageing and Health, and School of Nursing & Health Sciences, University of Dundee, Dundee, UK.
| | - Hylton B Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia
| | - Sarah McFarlane
- NHS Tayside and Nursing & Midwifery Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Simon Ogston
- School of Medicine, University of Dundee, Dundee, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Brian Williams
- School of Health and Social Care, Napier University, Edinburgh, UK
| | | | - Jacqui Morris
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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24
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Cockayne S, Adamson J, Clarke A, Corbacho B, Fairhurst C, Green L, Hewitt CE, Hicks K, Kenan AM, Lamb SE, McIntosh C, Menz HB, Redmond AC, Richardson Z, Rodgers S, Vernon W, Watson J, Torgerson DJ. Cohort Randomised Controlled Trial of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People (The REFORM Trial). PLoS One 2017; 12:e0168712. [PMID: 28107372 PMCID: PMC5249075 DOI: 10.1371/journal.pone.0168712] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/03/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. DESIGN Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. RESULTS In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. CONCLUSION There was a small reduction in falls. The intervention may be cost-effective. TRIAL REGISTRATION ISRCTN ISRCTN68240461.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
- * E-mail:
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Belen Corbacho
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Lorraine Green
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Catherine E. Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Anne-Maree Kenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Sarah E. Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Hylton B. Menz
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C. Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - Wesley Vernon
- Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Jordanthorpe Health Centre, Sheffield, United Kingdom
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
| | - David J. Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom
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Paton J, Hatton AL, Rome K, Kent B. Effects of foot and ankle devices on balance, gait and falls in adults with sensory perception loss: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:127-162. [PMID: 28009675 PMCID: PMC5437711 DOI: 10.11124/jbisrir-2016-003229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Foot and ankle devices are being developed as a method of preventing people with sensory perception loss sustaining a fall. Such devices are believed to work by reducing the likelihood of a fall by improving the balance and gait of the user. OBJECTIVES The objective of the review was to evaluate the effectiveness of foot and ankle devices for the prevention of falls and the improvement of balance and gait in adults with sensory perception loss. INCLUSION CRITERIA TYPES OF PARTICIPANTS Participants were community-dwelling adults with bilateral pathological sensory perception loss. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The current review evaluated any foot or ankle device, including but not restricted to, all types of footwear (therapeutic and retail), insoles (customized and prefabricated) and ankle-foot orthoses (AFOs). TYPES OF STUDIES In the absence of randomized controlled trials (RCT), the review considered experimental and epidemiological study designs, except case series, individual case reports and descriptive cross-sectional studies. OUTCOMES The primary outcome was number of falls. Secondary outcome measures were clinical or laboratory measures of balance or gait. SEARCH STRATEGY A search for published and unpublished literature from inception to March 2015 written in the English language was conducted across a number of major electronic databases. A three-step search strategy was developed using MeSH terminology and keywords to ensure all that relevant materials are captured. METHODOLOGICAL QUALITY Methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using standardized Joanna Briggs Institute (JBI) critical appraisal tools. DATA EXTRACTION Quantitative data were extracted from the studies that were identified as meeting the criteria for methodological quality using the standardized JBI data extraction tools. DATA SYNTHESIS Due to the heterogeneity of populations, interventions and outcome measures, meta-analyses were not possible and results are presented in narrative form. RESULTS Nine trials (from 10 papers) involving 238 participants, (14 with multiple sclerosis and 16 with idiopathic peripheral neuropathy, 150 with diabetic neuropathy) and 58 controls were included in the review. No study reported falls as an outcome measure. The results of the included studies found that in people with sensory perception loss, postural sway improved with vibrating insoles and AFO, altering the softness and texture of the top cover had no effect on postural sway, wearing footwear over long distances or AFOs improved step-to-step consistency, and no foot and ankle device was reported to have a negative effect on the balance or gait of people with sensory perception loss. The methodological quality of the included studies was poor. No study used a randomized controlled trial (RCT) methodology. No study incorporated a follow-up period or tested the intervention within the context of the intended clinical environment. CONCLUSION There is limited evidence to suggest that footwear and insole devices can artificially alter postural stability and may reduce the step-to-step variability in adults with sensory perception loss. Varying the material properties of an insole does not notably affect static balance or gait.
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Affiliation(s)
- Joanne Paton
- School of Health Professions, Plymouth University, Plymouth, Devon, United Kingdom
| | - Anna L. Hatton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1010, New Zealand
| | - Bridie Kent
- The University of Plymouth Centre for Innovations in Health and Social Care: a Joanna Briggs Institute Centre of Excellence
- School of Nursing and Midwifery, Plymouth University, Plymouth, Devon, United Kingdom
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Wegener C, Wegener K, Smith R, Schott KH, Burns J. Biomechanical effects of sensorimotor orthoses in adults with Charcot-Marie-Tooth disease. Prosthet Orthot Int 2016; 40:436-46. [PMID: 25934421 DOI: 10.1177/0309364615579318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/10/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Charcot-Marie-Tooth disease is an inherited neuropathy causing progressive weakness, foot deformity and difficulty walking. Clinical anecdotes suggest orthoses designed on the 'sensorimotor' paradigm are beneficial for improving gait in Charcot-Marie-Tooth disease. OBJECTIVES Investigate the effect of sensorimotor orthoses on in-shoe and lower limb biomechanics in adults with Charcot-Marie-Tooth disease. STUDY DESIGN Randomised, repeated-measures, exploratory study. METHODS Eight males and two females with Charcot-Marie-Tooth disease aged 31-68 years fitted with pedorthic shoes and custom-made sensorimotor orthoses were randomly tested at baseline and after 4 weeks of adaptation. In-shoe three-dimensional multi-segment foot and lower limb kinematics and kinetics were collected as were plantar pressures, electromyography and self-reported comfort, stability, cushioning and preference. RESULTS Compared to the shoe only condition, sensorimotor orthoses increased midfoot eversion and plantarflexion, increased ankle eversion and produced small but significant changes at the knee and hip indicating increased internal rotation. The orthoses increased medial ground reaction forces and increased pressure at the heel, midfoot and toes. There were minimal effects on electromyography. The sensorimotor orthoses were rated higher for comfort, cushioning, stability and preference. CONCLUSION Sensorimotor orthoses produced changes in kinematic, kinetic and pressure variables in adults with Charcot-Marie-Tooth disease and were regarded as more comfortable, cushioned and stable during walking. CLINICAL RELEVANCE In this study, the walking ability of patients with Charcot-Marie-Tooth disease improved with the use of foot orthoses designed according to the sensorimotor paradigm. However, the mechanism of action appears to be primarily mechanical in origin. Randomised controlled trials are necessary to evaluate the long-term patient-reported outcomes of sensorimotor orthoses.
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Affiliation(s)
| | | | | | | | - Joshua Burns
- The University of Sydney, Sydney, NSW, Australia The Children's Hospital at Westmead, Sydney, NSW, Australia
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Aboutorabi A, Bahramizadeh M, Arazpour M, Fadayevatan R, Farahmand F, Curran S, Hutchins SW. A systematic review of the effect of foot orthoses and shoe characteristics on balance in healthy older subjects. Prosthet Orthot Int 2016; 40:170-81. [PMID: 26112468 DOI: 10.1177/0309364615588342] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 04/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot orthoses are used to optimize lower extremity function and can improve postural stability by enhancing the afferent somatosensory feedback available to the central nervous system. OBJECTIVE The aim of this review was to evaluate the effect of foot orthoses on balance control in older subjects. STUDY DESIGN Systematic review. METHODS The search strategy was based on the Population Intervention Comparison Outcome method. A search was performed in PubMed, Science Direct, Google Scholar, and ISI Web of Knowledge databases by using selected keywords. A total of 22 articles were selected for final evaluation. RESULTS The results demonstrated that older people should be advised to wear thin, hard-soled footwear with high collars to reduce the risk of falling. The findings for insoles demonstrated an increase in balance control via vibratory or magnetic insoles, but textured insoles do not appear to be beneficial for balance improvement. CONCLUSION Foot orthoses improve postural stability via a somatosensory or biomechanical effect. Use of footwear with the proper features can be an appropriate intervention in order to increase the balance in the older population and reduce falls. CLINICAL RELEVANCE Loss of balance is an important factor in increasing the risk of falling in older subjects. Foot orthoses can improve functional measures of stability in older adults. In this review, results from studies suggest a number of recommendations regarding the optimal footwear for older people to reduce the risk of falling.
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Affiliation(s)
- Atefeh Aboutorabi
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Reza Fadayevatan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Sarah Curran
- Cardiff School of Health Sciences, University of Wales Institute, Llandaff Campus, Cardiff, UK
| | - Stephen W Hutchins
- IHSCR, Faculty of Health & Social Care, University of Salford, Salford, UK
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Ma CZH, Wong DWC, Lam WK, Wan AHP, Lee WCC. Balance Improvement Effects of Biofeedback Systems with State-of-the-Art Wearable Sensors: A Systematic Review. SENSORS 2016; 16:434. [PMID: 27023558 PMCID: PMC4850948 DOI: 10.3390/s16040434] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 12/26/2022]
Abstract
Falls and fall-induced injuries are major global public health problems. Balance and gait disorders have been the second leading cause of falls. Inertial motion sensors and force sensors have been widely used to monitor both static and dynamic balance performance. Based on the detected performance, instant visual, auditory, electrotactile and vibrotactile biofeedback could be provided to augment the somatosensory input and enhance balance control. This review aims to synthesize the research examining the effect of biofeedback systems, with wearable inertial motion sensors and force sensors, on balance performance. Randomized and non-randomized clinical trials were included in this review. All studies were evaluated based on the methodological quality. Sample characteristics, device design and study characteristics were summarized. Most previous studies suggested that biofeedback devices were effective in enhancing static and dynamic balance in healthy young and older adults, and patients with balance and gait disorders. Attention should be paid to the choice of appropriate types of sensors and biofeedback for different intended purposes. Maximizing the computing capacity of the micro-processer, while minimizing the size of the electronic components, appears to be the future direction of optimizing the devices. Wearable balance-improving devices have their potential of serving as balance aids in daily life, which can be used indoors and outdoors.
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Affiliation(s)
- Christina Zong-Hao Ma
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Rehabilitation Engineering Research Institute, China Rehabilitation Research Center, Beijing 100068, China.
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Wing Kai Lam
- Li Ning Sports Science Research Center, Beijing 101111, China.
| | - Anson Hong-Ping Wan
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Winson Chiu-Chun Lee
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Institute of Active Ageing, The Hong Kong Polytechnic University, Hong Kong, China.
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Intra-individual gait pattern variability in specific situations: Implications for forensic gait analysis. Forensic Sci Int 2016; 264:15-23. [PMID: 26990706 DOI: 10.1016/j.forsciint.2016.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 01/10/2016] [Accepted: 02/23/2016] [Indexed: 11/20/2022]
Abstract
In this study, inter- and intra-individual gait pattern differences are examined in various gait situations by means of phase diagrams of the extremity angles (cyclograms). 8 test subjects walked along a walking distance of 6m under different conditions three times each: barefoot, wearing sneakers, wearing combat boots, after muscular fatigue, and wearing a full-face motorcycle helmet restricting vision. The joint angles of foot, knee, and hip were recorded in the sagittal plane. The coupling of movements was represented by time-adjusted cyclograms, and the inter- and intra-individual differences were captured by calculating the similarity between different gait patterns. Gait pattern variability was often greater between the defined test situations than between the individual test subjects. The results have been interpreted considering neurophysiological regulation mechanisms. Footwear, masking, and fatigue were interpreted as disturbance parameters, each being a cause for gait pattern variability and complicating the inference of identity of persons in video recordings.
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30
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Ma CZH, Wan AHP, Wong DWC, Zheng YP, Lee WCC. A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices. SENSORS 2015; 15:31709-22. [PMID: 26694399 PMCID: PMC4721802 DOI: 10.3390/s151229883] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022]
Abstract
Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05), and increased the COP parameters (p < 0.017), indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017). The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits.
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Affiliation(s)
- Christina Zong-Hao Ma
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Rehabilitation Engineering Research Institute, China Rehabilitation Research Center, Beijing 100068, China.
| | - Anson Hong-Ping Wan
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Yong-Ping Zheng
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Winson Chiu-Chun Lee
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
- Institute of Active Ageing, The Hong Kong Polytechnic University, Hong Kong, China.
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31
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Najafi B, de Bruin ED, Reeves ND, Armstrong DG, Menz HB. The role of podiatry in the prevention of falls in older people: a JAPMA special issue. J Am Podiatr Med Assoc 2015; 103:452-6. [PMID: 24297980 DOI: 10.7547/1030452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for falls prevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these guidelines do not specify which intervention activities might be performed. Published in this special issue of JAPMA are nine high-quality articles, including seven original studies and two basic science reviews, focusing on the benefit and impact of footwear and foot and ankle interventions in reducing the risk of falling. The selected studies discuss various relevant questions related to podiatric intervention, including adherence to intervention; preference and perception of older adults in selecting footwear; benefit of insoles, footwear, and nonslip socks in preventing falls; fear of falling related to foot problems; benefit of podiatric surgical intervention; and benefit of foot and ankle exercise in preventing falls.
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Affiliation(s)
- Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona, College of Medicine, Tucson, AZ
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Cockayne S, Adamson J, Corbacho Martin B, Fairhurst C, Hewitt C, Hicks K, Hull R, Keenan AM, Lamb SE, Loughrey L, McIntosh C, Menz HB, Redmond AC, Rodgers S, Vernon W, Watson J, Torgerson D. The REFORM study protocol: a cohort randomised controlled trial of a multifaceted podiatry intervention for the prevention of falls in older people. BMJ Open 2014; 4:e006977. [PMID: 25518875 PMCID: PMC4275677 DOI: 10.1136/bmjopen-2014-006977] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Falls and fall-related injuries are a serious cause of morbidity and cost to society. Foot problems and inappropriate footwear may increase the risk of falls; therefore podiatric interventions may play a role in reducing falls. Two Cochrane systematic reviews identified only one study of a podiatry intervention aimed to reduce falls, which was undertaken in Australia. The REFORM trial aims to evaluate the clinical and cost-effectiveness of a multifaceted podiatry intervention in reducing falls in people aged 65 years and over in a UK and Irish setting. METHODS AND ANALYSIS This multicentre, cohort randomised controlled trial will recruit 2600 participants from routine podiatry clinics in the UK and Ireland to the REFORM cohort. In order to detect a 10% point reduction in falls from 50% to 40%, with 80% power 890 participants will be randomised to receive routine podiatry care and a falls prevention leaflet or routine podiatry care, a falls prevention leaflet and a multifaceted podiatry intervention. The primary outcome is rate of falls (falls/person/time) over 12 months assessed by patient self-report falls diary. Secondary self-report outcome measures include: the proportion of single and multiple fallers and time to first fall over a 12-month period; Short Falls Efficacy Scale-International; fear of falling in the past 4 weeks; Frenchay Activities Index; fracture rate; Geriatric Depression Scale; EuroQoL-five dimensional scale 3-L; health service utilisation at 6 and 12 months. A qualitative study will examine the acceptability of the package of care to participants and podiatrists. ETHICS AND DISSEMINATION The trial has received a favourable opinion from the East of England-Cambridge East Research Ethics Committee and Galway Research Ethics Committee. The trial results will be published in peer-reviewed journals and at conference presentations. TRIAL REGISTRATION NUMBER Current Controlled Trials ISRCTN68240461 assigned 01/07/2011.
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Affiliation(s)
- Sarah Cockayne
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | | | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kate Hicks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Robin Hull
- Podiatry Services, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Harrogate, UK
| | - Anne Maree Keenan
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Critical Care Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Lorraine Loughrey
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Hylton B Menz
- Faculty of Health Sciences, Lower Extremity and Gait Studies Program, La Trobe University, Bundoora, Victoria, Australia
| | - Anthony C Redmond
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Wesley Vernon
- Podiatry Services, Sheffield Teaching Hospitals NHS Foundation Trust, Jordanthorpe Health Centre, Sheffield, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Perez-Cruzado D, González-Sánchez M, Cuesta-Vargas AI. Parameterization and reliability of single-leg balance test assessed with inertial sensors in stroke survivors: a cross-sectional study. Biomed Eng Online 2014; 13:127. [PMID: 25174611 PMCID: PMC4158088 DOI: 10.1186/1475-925x-13-127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 08/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background and purpose There are no published studies on the parameterisation and reliability of the single-leg stance (SLS) test with inertial sensors in stroke patients. Purpose: to analyse the reliability (intra-observer/inter-observer) and sensitivity of inertial sensors used for the SLS test in stroke patients. Secondary objective: to compare the records of the two inertial sensors (trunk and lumbar) to detect any significant differences in the kinematic data obtained in the SLS test. Methods Design: cross-sectional study. While performing the SLS test, two inertial sensors were placed at lumbar (L5-S1) and trunk regions (T7–T8). Setting: Laboratory of Biomechanics (Health Science Faculty - University of Málaga). Participants: Four chronic stroke survivors (over 65 yrs old). Measurement: displacement and velocity, Rotation (X-axis), Flexion/Extension (Y-axis), Inclination (Z-axis); Resultant displacement and velocity (V): ![]()
Along with SLS kinematic variables, descriptive analyses, differences between sensors locations and intra-observer and inter-observer reliability were also calculated. Results Differences between the sensors were significant only for left inclination velocity (p = 0.036) and extension displacement in the non-affected leg with eyes open (p = 0.038). Intra-observer reliability of the trunk sensor ranged from 0.889-0.921 for the displacement and 0.849-0.892 for velocity. Intra-observer reliability of the lumbar sensor was between 0.896-0.949 for the displacement and 0.873-0.894 for velocity. Inter-observer reliability of the trunk sensor was between 0.878-0.917 for the displacement and 0.847-0.884 for velocity. Inter-observer reliability of the lumbar sensor ranged from 0.870-0.940 for the displacement and 0.863-0.884 for velocity. Conclusion There were no significant differences between the kinematic records made by an inertial sensor during the development of the SLS testing between two inertial sensors placed in the lumbar and thoracic regions. In addition, inertial sensors. Have the potential to be reliable, valid and sensitive instruments for kinematic measurements during SLS testing but further research is needed.
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Affiliation(s)
| | | | - Antonio Ignacio Cuesta-Vargas
- Departamento de Psiquiatria y Fisioterapia, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, 29071 Málaga, Spain.
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Cruz-Almeida Y, Black ML, Christou EA, Clark DJ. Site-specific differences in the association between plantar tactile perception and mobility function in older adults. Front Aging Neurosci 2014; 6:68. [PMID: 24782765 PMCID: PMC3990110 DOI: 10.3389/fnagi.2014.00068] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 03/27/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction: Impaired somatosensation is common in older adults and contributes to age-related loss of mobility function. However, little is known about whether somatosensation at different sites on the plantar surface of the foot are differentially related to mobility function. Such a finding may have important implications for clinical care of older adults and other at-risk populations, such as for optimizing interventions (e.g., footwear for augmenting somatosensory feedback) and for improving the efficiency of clinical assessment. Materials and Methods: Tactile perception was evaluated with a 10 g monofilament at four sites on the plantar surface of each foot: great toe (GT), first metatarsal head (MT1), heel (H) and fifth metatarsal head (MT5). Mobility function was assessed with the Berg Balance Scale and walking speed. Results: Sixty-one older adults participated. Tactile perception was significantly positively associated with Berg Balance Score (adjusted r = 0.30 − 0.75; p = 0.03 − < 0.001), with the strongest association found at the site of the MT1. Only at this site was tactile perception found to be significantly associated with usual walking speed (adjusted r = 0.51; p < 0.001) and maximal walking speed (adjusted r = 0.38, p = 0.004). Clinically mild somatosensory impairment at MT1, but not at other sites, was found to yield substantial deficits in both Berg Balance Score and walking speed. Discussion: The present findings indicate that tactile perception at MT1 is more closely linked to mobility function than is tactile perception at GT, MT5 or H. These findings warrant further research to examine whether interventions (e.g., textured insoles) and assessments that preferentially or exclusively focus on the site of MT1 may be more effective for optimizing clinical care.
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Affiliation(s)
- Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida Gainesville, FL, USA
| | - Mieniecia L Black
- Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida Gainesville, FL, USA
| | - David J Clark
- Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA ; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center Gainesville, FL, USA
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