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Background Mobility disability is a common, debilitating feature of multiple sclerosis (MS). Exercise training has been identified as an approach to improve MS-related mobility disability. However, exercise randomized controlled trials (RCTs) on mobility in MS have generally not selectively targeted those with the onset of irreversible mobility disability. Objectives The current multi-site RCT compared the efficacy of 6-months of supervised, multimodal exercise training with an active control condition for improving mobility, gait, physical fitness, and cognitive outcomes in persons with substantial MS-related mobility disability. Methods 83 participants with substantial MS-related mobility disability underwent initial mobility, gait, fitness, and cognitive processing speed assessments and were randomly assigned to 6-months of supervised multimodal (progressive aerobic, resistance, and balance) exercise training (intervention condition) or stretching-and-toning activities (control condition). Participants completed the same outcome assessments halfway through and immediately following the 6-month study period. Results There were statistically significant improvements in six-minute walk performance ( F (2158) = 3.12, p = 0.05, η p 2 = 0.04), peak power output ( F (2150) = 8.16, p η p 2 = 0.10), and Paced Auditory Serial Addition Test performance ( F (2162) = 4.67, p = 0.01, η p 2 = 0.05), but not gait outcomes, for those who underwent the intervention compared with those who underwent the control condition. Conclusions This RCT provides novel, preliminary evidence that multimodal exercise training may improve endurance walking performance and cognitive processing speed, perhaps based on improvements in cardiorespiratory capacity, in persons with MS with substantial mobility disability. This is critical for informing the development of multi-site exercise rehabilitation programs in larger samples of persons with MS-related mobility disability.

The aim of this study was to determine the effects text messaging has on gait characteristics and reactive balance. Thirty-two subjects were recruited. Data was collected on texting ability in standing, while walking and while in perturbed stance. Data on gait parameters using the GAITRiteTM were collected while walking normally and while walking and texting. Data on reactive balance in perturbed stance (DMA score) using the PROPRIO 5000™ was collected while standing and while standing and texting. Repeated measures statistics were applied. No practical difference in texting ability was found between the three conditions of standing, walking and perturbed stance. A significant difference was found between mean gait characteristics of velocity, cadence, double limb support and mean step length during normal walking and walking while texting (p

This paper presents analyses of the finescale structure of convection in the comma head of two continental winter cyclones and a 16-storm climatology analyzing the distribution of lightning within the comma head. A case study of a deep cyclone is presented illustrating how upper-tropospheric dry air associated with the dry slot can intrude over moist Gulf air, creating two zones of precipitation within the comma head: a northern zone characterized by deep stratiform clouds topped by generating cells and a southern zone marked by elevated convection. Lightning, when it occurred, originated from the elevated convection. A second case study of a cutoff low is presented to examine the relationship between lightning flashes and wintertime convection. Updrafts within convective cells in both storms approached 6–8 m s−1, and convective available potential energy in the cell environment reached approximately 50–250 J kg−1. Radar measurements obtained in convective updraft regions showed enhanced spectral width within the temperature range from −10° to −20°C, while microphysical measurements showed the simultaneous presence of graupel, ice particles, and supercooled water at the same temperatures, together supporting noninductive charging as an important charging mechanism in these storms. A climatology of lightning flashes across the comma head of 16 winter cyclones shows that lightning flashes commonly occur on the southern side of the comma head where dry-slot air is more likely to overrun lower-level moist air. Over 90% of the cloud-to-ground flashes had negative polarity, suggesting the cells were not strongly sheared aloft. About 55% of the flashes were associated with cloud-to-ground flashes while 45% were in-cloud flashes.

Children must meet various physical demands during the school day in order to be successful from both an educational and a social standpoint. They use important motor skills to move in the halls, sit quietly at a desk, and participate with peers on the playground. Physical therapists play an important role in facilitating the development of these motor skills in order to allow for optimal participation and socialization for each student. This chapter provides a description of the various roles played by the physical therapist within the school setting. The physical therapist may provide direct service to children receiving related services, indirect service to teachers and other staff by providing instruction or recommendations for children within the classroom setting, and consultation for staff and administration addressing issues that affect the student population as a whole.

Background: Physical therapists provide care for many patients who are at risk or have been diagnosed with osteoporosis. Currently, little information exists about what physical therapists know about osteoporosis, how they screen for the condition, and how they manage patients with osteoporosis. Purpose: This study assessed knowledge and confidence of physical therapists in screening, examining, and planning interventions for persons diagnosed or at risk for osteoporosis. Methods: A survey was mailed to 250 randomly selected members of the Illinois Physical Therapy Association. A follow-up mailing was sent to those who had not replied within 3 months. Survey items focused knowledge and confidence with screening and developing interventions for persons with osteoporosis. Response rate was 41% with a final sample of 83, 3 respondents meeting the inclusion criterion (working with women age 40-90). Results: The majority of respondents were confident (35%) or somewhat confident (47%) in their ability to recognize risk factors for osteoporosis. The majority correctly identified female gender (68%), history of fracture (88%), and family history of osteoporosis (80%) as risk factors for osteoporosis, and identified changes in height (86%), and changes in posture (90%) as indicators for screening. Only 35% would often or always identify Asian American individuals as appropriate for screening for osteoporosis. Respondents appropriately prescribed log rolling for bed mobility (82%), rest in a supine position (45%), “hip hinge” as a method for sit to stand (48%), and wall slides (52%). Although more than 55% reported never prescribing high-risk exercises such as toe touches, abdominal machines, or abdominal crunches, 33% would prescribe high-risk exercises such as rest in a sitting position (37%) and a “nose over toes” method of sit-stand (36%). Conclusion: It appears physical therapists correctly screen and identify some risk factors for osteoporosis; more education is needed in certain areas of screening and interventions for those with osteoporosis.

As pregnancy progresses, various postural and biomechanical changes occur as a result of altered anthropometrics. A number of pelvic belts and maternity supports are available and marketed to pregnant women to improve posture and body biomechanics. However, the evidence regarding the efficacy of these maternity supports in improving posture or biomechanics has been anecdotal, with no published data being available. The purpose of this study was to examine the potential differences in standing spinal postures and sit-to-stand (STS) biomechanics in pregnant women with and without a maternity support. Five women in their third trimester of pregnancy were fitted with a maternity support for use during the study. A pretest-posttest research design was used. Kinematic analysis was used to measure joint angles and movement time during the STS movement. A flexible ruler was used to measure standing spinal posture with and without the support in place. The addition of the maternity support resulted in less hip flexion during the STS movement. While not statistically significant, lumbar lordosis measured while standing decreased when women wore the maternity support compared with without the support. Results of this pilot study suggest that pregnant women wearing a maternity support may experience changes in hip position during STS movements. In addition, their spinal curve postures may tend to change. However, it is unclear whether altering the biomechanics during the STS movement impacts movement effort or pain complaints.

This study examined balance control in children to determine at what age the integration of sensory information in unperturbed stance is comparable to that of adults. In addition, it examined whether overall performance was related to age, gender and specific physical characteristics, such as height, weight and body mass index (BMI). Seventy-four female and 80 male children between the ages of 6 and 12 years participated in the study, as well as 20 adults, aged 20-22 years. The Sensory Organization Test (SOT), a component of computerized dynamic posturography, was used to assess overall balance as well as the use of specific sensory information in maintaining stability. Analyses of variance revealed significant differences between equilibrium scores of 7- and 8-year-old and 11- and 12-year-old (p.01), with only the 12-year-old participants achieving scores comparable to those of the adult group. A repeated-measures analysis of variance comparing the use of different sensory information across age and gender groups revealed that while all groups demonstrated mature use of somatosensory information, children under 11 did not use visual information as effectively as adults, and only the 12-year-old group demonstrated adult-like use of vestibular information. Correlational analyses revealed a moderate correlation between composite balance scores and age, r(152) = .38, p.001, but poor correlations between the composite equilibrium score and height, weight and BMI (r.13, p.15). Multiple regression analysis revealed that while physical characteristics accounted for approximately 20% of the variability in the composite equilibrium score, age alone accounted for the largest single contribution to the variance (16%). These results support recent findings suggesting that children do not demonstrate adult-like use of sensory information prior to age 12 years.

In a continuing effort to provide the computational community with a reference work comparing all of the available conformer searching methods, we have exposed the standard set of small molecules to two commonly used stochastic searching techniques. Advantages and limitations of these methods are discussed. © 1996 by John Wiley & Sons, Inc.

A method has been developed that allows one to drive a molecule to conformations of lowest energy given the starting conformation, the identity of the rotatable bonds and the step size. This method has proved useful in our hands in the drug design arena where it is frequently more important to get 'low-energy' conformers of a molecule that match some other (e.g. pharmacophoric or enzyme pocket) requirements than to exhaustively enumerate all possible low-energy conformations for each of the molecules to be studied. The method has been shown to work in the test cases studied to date. Furthermore, so far it has been shown to be sufficiently fast to be used for molecules containing up to 70 rotatable bonds.

We demonstrate the use of a genetic algorithm (GA) search procedure for finding low-energy conformations of small to medium organic molecules (1-12 rotatable bonds). GAs are in a class of biologically motivated optimization methods that evolve a population of individuals where individuals who are more «fit» have a higher probability of surviving into subsequent generations. Here, an individual is a conformation of a given molecule and the fitness is the molecule's conformational energy. In the course of a simulated evolution, the population produces conformations having increasingly lower energy. We test the GA method on a suite of 72 molecules and compare the performance against the CSEARCH algorithm in Sybyl

Several methods are available in the literature for the conformational analysis of small molecules. Each of these methods has some advantages and some disadvantages. Also, each of these methods may be expected to perform better or worse on different types of molecules. There is no clear calibration of each of these methods against a “standardized” set of molecules available in the literature. Such a reference work would be useful to the community because it would allow the choice of methods to be based on some facts. We attempted to provide a start to such a calibration in this article with an examination of the SYBYL SEARCH method. Methods for evaluating the performance of this method are described in detail and will be applied to all other available conformational analysis methods in future papers. © John Wiley & Sons, Inc.

The inability to reliably predict relative orientations of drug molecules within our series of antipicornavirus agents has severely limited the usefulness of available structure-activity data in the drug design process. A reported method of overlapping molecules has been evaluated to see if it could provide a solution to this problem. Although it initially succeeded remarkably well with a series of molecules whose bound X-ray structures were known, this success was shown to be only a function of the bound conformation of these molecules. Thus, this method did not provide a general solution to the problem at hand.

To determine whether patients using a wheeled walker post-total knee replacement (TKR) surgery walk differently prior to hospital discharge and 6 weeks after surgery when compared with patients using a standard walker.Fifty-one patients, mean age 67.2 (8.3), seen for TKR were assigned to either a standard walker group (n=23) or front-wheeled walker group (n=28). Most participants were assigned to a walker group on the basis of the type of walker procured in anticipation of the surgery; however, those without a walker were randomly assigned to a group. All participants received postoperative physical therapy consisting of a standardized protocol of exercises and gait training twice a day with the assigned walker. Step length, cadence, gait velocity, step length differential, and walking endurance were measured at discharge from the acute care setting and at 6 weeks following surgery.At discharge from the acute care setting, the gait of the 2 groups was similar, with the exception of faster velocity and a longer step length on the noninvolved lower extremity for the wheeled walker group. Six weeks after surgery, both groups walked with faster velocity, longer step lengths, and faster cadence, with no differences between groups for walking endurance, perceived exertion, fall occurrence after surgery, functional scores, or days necessary to graduate from walker use.The use of a front wheeled walker can facilitate greater velocity and longer step lengths in the immediate days following TKR than the use of a standard walker. However, this study provides no evidence that participants using wheeled walkers require fewer inpatient therapy sessions or have greater long-term gains in ambulation speed or quality. This study suggests that both types of walkers can safely be used for ambulation after TKR surgery.

The goal of this investigation was to explore the use of spectral analysis to examine the data obtained during computerized dynamic posturography (CDP). In particular, we examined whether spectral analysis would provide more detailed information about underlying postural control strategies and potential learning across conditions and trials of the sensory organization test (SOT). Twenty older women between the ages of 60 and 72 (mean = 65.2) were assessed using standard testing protocol. Participants showed significant improvements from the first to the second trials in their equilibrium scores in the more difficult conditions. This finding was reflected in the spectral analysis data by a shift in thefrequencydistributiontowards greaterpower inthe lower frequencyrange. This frequencychange likely reflects a change in the ankle strategy used to maintain balance during the more difficult conditions. # 2006 Elsevier B.V. All rights reserved.