Foot pain is associated with specific conditions of the feet and disability in instrumental activities of daily living. Adequate assessment and treatment of foot problems may prevent foot pain and potentially reduce risk of disability. This hypothesis needs to be tested in longitudinal studies and specific intervention trials.

The severity of FP in elderly female patients (without apparent comorbid conditions) is related to the severity of vertebral pain, emotional status, muscular impairments, and motor function but not to osteoporosis, and FP has a measurable effect on disability. In contrast, the presence of vertebral fractures in patients with FP is associated with lower BMD but not patients' clinical and functional status. Therefore, FP, back pain, and mobility problems can occur without osteoporosis. Older women with FP and vertebral pain may be candidates for rehabilitation interventions that address muscular impairments, posture, and behavior modification. Randomized controlled trials are needed to support these conclusions.

Objective-To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.Methods-Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain.Results-After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P < .00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P < .003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P = .01).Address correspondence to Mary Stuart, ScD, Health Administration and Policy Program, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. stuart@umbc.edu. Drs Stuart and Benvenuti contributed to this work equally.For reprints and permission queries, please visit SAGE's Web site at http://www.sagepub.com/journalsPermissions.nav. NIH Public Access Author ManuscriptNeurorehabil Neural Repair. Author manuscript; available in PMC 2011 January 20. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-APA-stroke appears to be safe, feasible, and efficacious in a community setting. KeywordsStroke; Exercise; Community; Rehabilitation Stroke is one of the leading causes of death and long-term disability. 1 The Framingham study found that at 6 months following a stroke (ie, after the period of natural recovery 2 ) 50% of stroke survivors aged 65 years or older had some hemiparesis and 30% were unable to walk without assistance. 3 Due in part to the sedentary lifestyle associated with these limitations, the stroke survivor is at increased risk of diabetes, glucose intolerance, heart disease, subsequent stroke death, and depression. 4,5 There is substantial evidence supporting a protective role for exercise in the prevention of stroke. 1 For stroke survivors, increasing evidence also links exercise to improved cardiovascular health, with decreased ris...

In the present study, we investigated the effects of the Titchener circles illusion in perception and action. In this illusion, two identical discs can be perceived as being different in size when one is surrounded by an annulus of smaller circles and the other is surrounded by an annulus of larger circles. This classic size-contrast illusion, known as Ebbinghaus or Titchener Circles Illusion, has a strong perceptual effect. By contrast, it has recently been demonstrated that when subjects are required to pick up one of the discs, their grip aperture during reaching is largely appropriate to the size of the target. This result has been considered as evidence of a clear dissociation between visual perception and visuomotor behaviour in the intact human brain. In this study, we suggest and investigate an alternative explanation for these results. We argue that, in a previous study, while perception was subjected to the simultaneous influence of the large and small circles displays, in the grasping task only the annulus of circles surrounding the target object was influential. We tested this hypothesis by requiring 18 subjects to perceptually estimate and grasp a disc centred in a single annulus of Titchener circles. The results showed that both the perceptual estimation and the hand shaping while grasping the disc were similarly influenced by the illusion. Moreover, the stronger the perceptual illusion, the greater the effect on the grip scaling. We discuss the results as evidence of an interaction between the functional pathways for perception and action in the intact human brain.

The high incidence of serious chest infections in patients with Parkinson's disease is unexplained, but an impairment in cough reflex may have a role. Maximal voluntary cough (MVC) and reflex cough (RC) to inhalation of ultrasonically nebulized distilled water were analyzed in patients with Parkinson's disease and age-matched control subjects by monitoring the integrated electromyographic activity (IEMG) of abdominal muscles. The peak amplitude of IEMG activity (IEMGP) was expressed as a fraction of the highest IEMGP value observed during MVC corrected to account for possible losses in abdominal muscle force due to reduced central muscle activation. Cough intensity was indexed in terms of both the IEMGP and the ratio of IEMGP to the duration of the expiratory ramp (TEC), i.e., the rate of rise of IEMG activity. Cough threshold was slightly higher in patients than in control subjects, but the difference failed to reach statistical significance. Compared with control subjects, patients displayed a lower IEMGP during maximal expiratory pressure maneuvers (PEmax), MVC, and RC (p always < 0.01); TEC during RC was longer (p < 0.01) than in controls. Consequently, the rate of rise of IEMG activity during cough was always lower in patients (p < 0. 01), especially during RC. Finally, PEmax, and both the peak and rate of rise of IEMG activity during RC were inversely related to the level of clinical disability (Spearman rank correlation coefficient, rs = -0.88, -0.86, and -0.85, respectively, p always < 0.01). The results indicate that the central neural mechanisms subserving the recruitment of motor units and/or the increase in their frequency of discharge during voluntary and, even more markedly, RC are impaired in patients with Parkinson's disease.