Journal of rehabilitation research and development
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This article is the second in a series of evidence-based systematic reviews. Data reported cover the impact of dysphagia behavioral interventions on swallow physiology in healthy adults. The behavioral treatments investigated were three postural interventions--side lying, chin tuck, and head rotation--and four swallowing maneuvers--effortful swallow, the Mendelsohn maneuver, supraglottic swallow, and super-supraglottic swallow. ⋯ For non disordered populations, the existing evidence demonstrates differential effects of postural changes and maneuvers on swallowing physiology. Some effects reinforced existing recommendations for the applications of the interventions, while others suggested new ways that the treatments may impact swallow function. Avenues for future research are suggested.
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This article is the second in a series of evidence-based systematic reviews. Data reported cover the impact of dysphagia behavioral interventions on swallow physiology in healthy adults. The behavioral treatments investigated were three postural interventions--side lying, chin tuck, and head rotation--and four swallowing maneuvers--effortful swallow, the Mendelsohn maneuver, supraglottic swallow, and super-supraglottic swallow. ⋯ For non disordered populations, the existing evidence demonstrates differential effects of postural changes and maneuvers on swallowing physiology. Some effects reinforced existing recommendations for the applications of the interventions, while others suggested new ways that the treatments may impact swallow function. Avenues for future research are suggested.
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The objective of this study was to summarize the evidence on the accuracy of screening tools for predicting falling risk in community-living older adults. This study was designed as a systematic review. Prospective studies of clinical fall risk prediction tools that provided data on the number of participants who sustained falls during follow-up were included. ⋯ Most tools discriminated poorly between fallers and nonfallers. We found that existing studies are methodologically variable and the results are inconsistent. Insufficient evidence exists that any screening instrument is adequate for predicting falls.
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The incidence of falls, fall-related injuries, and fall-associated costs continue to rise along with the increase in the aging population. Community-based fall prevention programs for the elderly are proliferating in an attempt to address this health problem. ⋯ This article presents a review of randomized controlled trials that investigated the effectiveness of fall prevention programs for community-dwelling older adults. Following a comprehensive critical analysis of the literature, we present the following guidelines: (1) multifactorial fall prevention programs appear to be more effective for older individuals with a previous fall history versus a nonselect group; (2) medication and vision assessment with appropriate health practitioner referral should be included in a falls screening examination; (3) exercise alone is effective in reducing falls and should include a comprehensive program combining muscle strengthening, balance, and/or endurance training for a minimum of 12 weeks; and (4) home hazard assessment with modifications may be beneficial in reducing falls, especially in a targeted group of individuals.
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This article reviews methods that have been developed as part of a clinical initiative on improving outcome measures for motor function assessment in subjects with spinal cord injury (SCI). Physiological motor outcome measures originally developed for limbs-transcranial magnetic stimulation (TMS) of the motor cortex to elicit motor-evoked potentials (MEPs) and mechanical stimulation to elicit spinal reflexes-have been extended to muscles of the trunk. ⋯ Spinal reflex testing of paravertebral muscles is also described. The principal markers for the thoracic SCI motor level that have emerged from this clinical initiative are (1) the threshold of MEPs in paravertebral muscles in response to TMS of the motor cortex, (2) the facilitation pattern and latency of MEPs in intercostal muscles during voluntary expiratory effort, and (3) the absence of long-latency reflex responses and the exaggeration of short-latency reflex responses in paravertebral muscles.