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Fear-avoidance (FA) beliefs are significantly associated with the experience of pain, especially when the pain becomes chronic in nature. The anticipated threat of intense pain will often result in the constant vigilance and monitoring of pain sensations, which, in turn, can cause even low-intensity sensations of pain to become unbearable for the person. Just the anticipation of increased pain or reinjury can further stimulate avoidance behaviors. A vicious cycle may develop, in which fears of increased pain or reinjury contribute to the avoidance of many activities, leading to inactivity and, ultimately, to greater disability. Anyone who assesses and treats pain-related disability should also be prepared to assess and treat pain-related FA.

Loss of function and postural instability occur in Parkinson disease (PD). Dynamic exercise interventions are successful in improving motor control and physical function. However, most programs are based in a health facility or physical therapy setting and involve travel. With the limitations associated with PD (e.g. health care and medication cost as well as travel limitations) these therapies may be inaccessible and exclude some individuals from maintaining or increasing their function. The purpose of this study was to evaluate the effectiveness of a home-based exercise intervention on postural control in individuals with PD. Multivariate analysis of covariance was performed on individuals with PD (N=10) and healthy aged matched controls (N=10). Participants were assessed utilizing computerized dynamic posturography (CDP) before and after a 10-week exercise intervention. Participants were instructed on proper technique prior to the intervention, were given an illustrated home program, and were monitored weekly concerning their progress. Pre intervention assessment demonstrated that individuals with PD had statically lower scores on a Sensory Organization Test (p < .05). Following the intervention, results indicated no statistical difference between individuals with PD and aged match controls (p > .05). This initial study indicates that a home exercise intervention is an effective method of improving postural control in individuals with PD. Results from this investigation support further study to determine the extent to which both preventative and restorative home based programs can improve postural control.

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This study analyzed various components and compensatory strategies of balance in individuals with visual impairments. It found that people with visual impairments use different strategies to maintain balance than do sighted people, in an effort to trade efficiency for safety.A common problem associated with a visual impairment (blindness or low vision) is the use of sensory and vestibular information to establish patterns of movement and positions in space (efficient movement). Spatial concepts and the use of these concepts are required to maintain a base of support and center of gravity before one initiates a movement (Pereira, 1990). Concurrently, individuals must respond to changes in the environment by modifying and self-correcting their movement. For example, when a change in terrain or obstacles is encountered, they need to change their gait patterns to accommodate these changes.People with visual impairments place a greater demand on somatosensory and vestibular information to establish movement patterns, and their positions in space are compromised by the lack of vision or This study was supported by a grant from the Rehabilitation Research R&D Center, Atlanta VAMedical Center. minimal vision. Their orientation and mobility (O&M) depend on using sensory information other than vision to initiate changes in the center of gravity and in the base of support before they initiate a movement. Their standing balance is diminished because the loss of vision affects the vestibular system via feedback from the visual system (Maeda, Nakamuro, Otomo, Higuchi, & Motohashi, 1998). In addition, other compensatory mechanisms must provide the sensory input that is used to initiate movement and to complete the response if vision is not available or restricted. Although it appears that vision is essential for balance, especially in children, the lack of vision does not explain the movement difficulties that many individuals may encounter (Stones & Kozma, 1987).From a review of the literature, it is evident that visual impairments may affect movement in a variety of ways. For example, it is evident that major differences in movement between people who are sighted and those who are visually impaired occur