Age-associated changes in obstacle negotiation strategies: does size and timing matter?

Publication date: Available online 27 October 2017
Source:Gait & Posture
Author(s): I. Maidan, S. Eyal, I. Kurz, N. Geffen, E. Gazit, L. Ravid, N. Giladi, A. Mirelman, J.M. Hausdorff
IntroductionTripping over an obstacle is one of the most common causes of falls among older adults. However, the effects of aging, obstacle height and anticipation time on negotiation strategies have not been systematically evaluated.MethodsTwenty older adults (ages: 77.7±3.4years; 50% women) and twenty young adults (age: 29.3±3.8years; 50% women) walked through an obstacle course while negotiating anticipated and unanticipated obstacles at heights of 25mm and 75mm. Kinect cameras captured the: (1) distance of the subject’s trailing foot before the obstacles, (2) distance of the leading foot after the obstacles, (3) clearance of the leading foot above the obstacles, and (4) clearance of trailing foot above the obstacles. Linear-mix models assessed changes between groups and conditions.ResultsOlder adults placed their leading foot closer to the obstacle after landing, compared to young adults (p <0.001). This pattern was enhanced in high obstacles (group*height interaction, p=0.033). Older adults had lower clearance over the obstacles, compared to young adults (p=0.007). This was more pronounced during unanticipated obstacles (group*ART interaction, p=0.003). The distance of the leading foot and clearance of the trailing foot after the obstacles were correlated with motor, cognitive, and functional abilities.ConclusionsThese findings suggest that there are age-related changes in obstacle crossing strategies that are dependent on the specific characteristics of the obstacle. The results have important implications for clinical practice, suggesting that functional exercise should include obstacle negotiation training with variable practice of height and available response times. Further studies are needed to better understand the effects of motor and cognitive abilities.



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Age-associated changes in obstacle negotiation strategies: does size and timing matter?

Publication date: Available online 27 October 2017
Source:Gait & Posture
Author(s): I. Maidan, S. Eyal, I. Kurz, N. Geffen, E. Gazit, L. Ravid, N. Giladi, A. Mirelman, J.M. Hausdorff
IntroductionTripping over an obstacle is one of the most common causes of falls among older adults. However, the effects of aging, obstacle height and anticipation time on negotiation strategies have not been systematically evaluated.MethodsTwenty older adults (ages: 77.7±3.4years; 50% women) and twenty young adults (age: 29.3±3.8years; 50% women) walked through an obstacle course while negotiating anticipated and unanticipated obstacles at heights of 25mm and 75mm. Kinect cameras captured the: (1) distance of the subject’s trailing foot before the obstacles, (2) distance of the leading foot after the obstacles, (3) clearance of the leading foot above the obstacles, and (4) clearance of trailing foot above the obstacles. Linear-mix models assessed changes between groups and conditions.ResultsOlder adults placed their leading foot closer to the obstacle after landing, compared to young adults (p <0.001). This pattern was enhanced in high obstacles (group*height interaction, p=0.033). Older adults had lower clearance over the obstacles, compared to young adults (p=0.007). This was more pronounced during unanticipated obstacles (group*ART interaction, p=0.003). The distance of the leading foot and clearance of the trailing foot after the obstacles were correlated with motor, cognitive, and functional abilities.ConclusionsThese findings suggest that there are age-related changes in obstacle crossing strategies that are dependent on the specific characteristics of the obstacle. The results have important implications for clinical practice, suggesting that functional exercise should include obstacle negotiation training with variable practice of height and available response times. Further studies are needed to better understand the effects of motor and cognitive abilities.



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The Efficacy of Venlafaxine, Flunarizine, and Valproic Acid in the Prophylaxis of Vestibular Migraine.

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The Efficacy of Venlafaxine, Flunarizine, and Valproic Acid in the Prophylaxis of Vestibular Migraine.

Front Neurol. 2017;8:524

Authors: Liu F, Ma T, Che X, Wang Q, Yu S

Abstract
BACKGROUND: Different types of medications are currently used in vestibular migraine (VM) prophylaxis, although recommendations for use are generally based on expert opinion rather than on solid data from randomized trials. We evaluated the efficacy and safety of venlafaxine, flunarizine, and valproic acid in a randomized comparison trial for VM prophylaxis.
METHODS: Subjects were randomly allocated to one of three groups (venlafaxine group, flunarizine group, and valproic acid group). To assess the efficacy of treatment on vertigo symptoms, the following parameters were assessed at baseline and 3 months after treatment: Dizziness Handicap Inventory (DHI) scores, number of vertiginous attacks in the previous month, and Vertigo Severity Score (VSS). Adverse events also were evaluated.
RESULTS: A decrease in DHI total scores was shown following treatment with all three medications, with no obvious differences between the groups. Treatment effects differed, however, in the DHI physical, functional, and emotional domains with only venlafaxine showing a decreased effect in all of three domains. Flunarizine and valproic acid showed an effect in only one DHI domain. Venlafaxine and flunarizine showed decreased VSS scores (p = 0 and p = 0.03, respectively). Although valproic acid had no obvious effect on VSS (p = 0.27), decreased vertigo attack frequency was observed in this group (p = 0). Venlafaxine also had an effect on vertigo attack frequency (p = 0), but flunarizine had no obvious effect (p = 0.06). No serious adverse events were reported in the three groups.
CONCLUSION: Our data confirm the efficacy and safety of venlafaxine, flunarizine, and valproic acid in the prophylaxis of VM, venlafaxine had an advantage in terms of emotional domains. Venlafaxine and valproic acid also were shown to be preferable to flunarizine in decreasing the number of vertiginous attacks, but valproic acid was shown to be less effective than venlafaxine and flunarizine to decrease vertigo severity.
TRIAL REGISTRATION: ChiCTR-OPC-17011266 (http://ift.tt/1hvxAeO).

PMID: 29075232 [PubMed]

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Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media.

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Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media.

Acta Otolaryngol. 2017 Oct 26;:1-5

Authors: Deng R, Fang Y, Shen J, Ou X, Liuyan W, Wan B, Yuan Y, Cheng X, Shu Y, Chen B

Abstract
OBJECTIVES: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).
MATERIALS AND METHODS: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.
RESULTS: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05).
CONCLUSIONS: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

PMID: 29073815 [PubMed - as supplied by publisher]

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Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial.

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Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial.

Laryngoscope. 2017 Nov;127 Suppl 7:S1-S13

Authors: Bush ML, Taylor ZR, Noblitt B, Shackleford T, Gal TJ, Shinn JB, Creel LM, Lester C, Westgate PM, Jacobs JA, Studts CR

Abstract
OBJECTIVES/HYPOTHESIS: To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care.
METHODS: Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up nonadherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing.
RESULTS: Sixty-one dyads were enrolled in the study (patient navigator arm = 27, standard of care arm = 34). The percentage of participants nonadherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% vs. 38.2%) (P = .005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth vs. 105.9 days, P = .010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (P = .004).
CONCLUSIONS: Patient navigation decreases nonadherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare; future research is needed to assess the cost and feasibility of larger scale implementation.
LEVEL OF EVIDENCE: 1b. Laryngoscope, 127:S1-S13, 2017.

PMID: 28940335 [PubMed - indexed for MEDLINE]

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Influence of Altered Auditory Feedback on Oral-Nasal Balance in Speech.

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Influence of Altered Auditory Feedback on Oral-Nasal Balance in Speech.

J Speech Lang Hear Res. 2017 Oct 26;:1-9

Authors: de Boer G, Bressmann T

Abstract
Purpose: This study explored the role of auditory feedback in the regulation of oral-nasal balance in speech.
Method: Twenty typical female speakers wore a Nasometer 6450 (KayPentax) headset and headphones while continuously repeating a sentence with oral and nasal sounds. Oral-nasal balance was quantified with nasalance scores. The signals from 2 additional oral and nasal microphones were played back to the participants through the headphones. The relative loudness of the nasal channel in the mix was gradually changed so that the speakers heard themselves as more or less nasal. An additional amplitude control group of 9 female speakers completed the same task while hearing themselves louder or softer in the headphones.
Results: A repeated-measures analysis of variance of the mean nasalance scores of the stimulus sentence at baseline, minimum, and maximum nasal feedback conditions demonstrated a significant effect of the nasal feedback condition. Post hoc analyses found that the mean nasalance scores were lowest for the maximum nasal feedback condition. The scores of the minimum nasal feedback condition were significantly higher than 2 of the 3 baseline feedback conditions. The amplitude control group did not show any effects of volume changes on nasalance scores.
Conclusions: Increased nasal feedback led to a compensatory adjustment in the opposite direction, confirming that oral-nasal balance is regulated by auditory feedback. However, a lack of nasal feedback did not lead to a consistent compensatory response of similar magnitude.

PMID: 29075769 [PubMed - as supplied by publisher]

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Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide.

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Hearing preservation cochlear implantation in children: The HEARRING Group consensus and practice guide.

Cochlear Implants Int. 2017 Oct 26;:1-13

Authors: Rajan G, Tavora-Vieira D, Baumgartner WD, Godey B, Müller J, O'Driscoll M, Skarzynski H, Skarzynski P, Usami SI, Adunka O, Agrawal S, Bruce I, De Bodt M, Caversaccio M, Pilsbury H, Gavilán J, Hagen R, Hagr A, Kameswaran M, Karltorp E, Kompis M, Kuzovkov V, Lassaletta L, Yongxin L, Lorensr A, Manoj M, Martin J, Mertens G, Mlynski R, Parnese L, Pulibalathingal S, Radeloff A, Raine CH, Rajeswaran R, Schmutzhard J, Sprinzl G, Staecker H, Stephan K, Sugarova S, Zernotti M, Zorowka P, Van de Heyning P

Abstract
OBJECTIVES: To provide multidisciplinary cochlear implant teams with a current consensus statement to support hearing preservation cochlear implantation (HPCI) in children, including those children with symptomatic partial deafness (PD) where the intention is to use electric-acoustic stimulation (EAS). The main objectives are to provide guidelines on who is a candidate, how to assess these children and when to implant if Med-El Flex electrode arrays are chosen for implantation.
METHODS: The HEARRING group reviewed the current evidence and practice regarding the management of children to be considered for HPCI surgery emphasizing the assessment needed prior to implantation in order to demonstrate the benefits in these children over time. The consensus statement addresses following three key questions: (1) Should these children be treated? (2) How to identify these children? (3) How to manage these children?
SUMMARY: The HEARRING group concludes that irrespective of the degree of residual hearing present, the concepts of hearing and structure preservation should be applied in every child undergoing cochlear implantation and that HPCI is a safe and reliable treatment option. Early detection and multidisciplinary assessment are key to the identification of children with symptomatic PD, these children should undergo HPCI as early as possible.

PMID: 29073844 [PubMed - as supplied by publisher]

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