The Obstacle Is The Way Epub Download

This systematic review and critical evaluation of the literature investigates whether advanced age compromises obstacle crossing for unconstrained and time-constrained conditions. Eight electronic databases were searched for articles with terms relating to obstacle crossing during walking in their title, abstract or keywords. 15 articles were reviewed from an initial yield of 727 articles. The methodological quality of each article was critiqued and data extracted by two reviewers. Young and older adults were shown to contact obstacles infrequently when adequate time was available to adapt foot placement in relation to the obstacle. When less time was available to adjust the foot trajectory, older adults contacted obstacles more often than younger people. Older adults adopted a slower, more conservative obstacle crossing strategy. They demonstrated greater hip flexion during the swing phase of gait for the lead and trail limbs as well as greater hip flexion, hip adduction and ankle dorsiflexion during the stance phase for the lead and trail limbs. There was also evidence of reduced internal moments across the hip and ankle during key events in the obstacle crossing gait cycle in older adults. Despite using a more conservative obstacle crossing strategy, older adults are at greater risk of contacting obstacles for time-constrained conditions.

Movement of malaria across international borders poses a major obstacle to achieving malaria elimination in the 34 countries that have committed to this goal. In border areas, malaria prevalence is often higher than in other areas due to lower access to health services, treatment-seeking behaviour of marginalized populations that typically inhabit border areas, difficulties in deploying prevention programmes to hard-to-reach communities, often in difficult terrain, and constant movement of people across porous national boundaries. Malaria elimination in border areas will be challenging and key to addressing the challenges is strengthening of surveillance activities for rapid identification of any importation or reintroduction of malaria. This could involve taking advantage of technological advances, such as spatial decision support systems, which can be deployed to assist programme managers to carry out preventive and reactive measures, and mobile phone technology, which can be used to capture the movement of people in the border areas and likely sources of malaria importation. Additionally, joint collaboration in the prevention and control of cross-border malaria by neighbouring countries, and reinforcement of early diagnosis and prompt treatment are ways forward in addressing the problem of cross-border malaria.

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The causes of falls illustrate that a valid assessment should include different demands and tasks. In previous studies, gait assessments for fall prevention comprise of the measurement of gait speed (general), Timed Up and Go (TUG), the Tinetti gait assessment tool, or the GAITRite system [27]. For several years, different approaches such as the development of obstacle courses for older adults have been utilized because it is suggested that the frequency of falls is associated with an effective ability to master obstacles [5, 9, 22, 28, 29, 30]. There is a necessity for older adults to adapt their movements that would, in turn, facilitate them to accomplish the obstacles and not to reach their limits of stability and balance. Thus, they will have a lower risk of falling when obstacles and changing surfaces occur [18]. The respective authors concluded that the integration of different environmental conditions in tests is essential [20, 33] to combat these obstacles.

The following test was developed to follow these demands. With their approach, the authors considered, initially, the assessment of gait and, secondly, movements and surfaces where falls are most likely to occur. Other studies identified this in different stations but not in one single track. Therefore, it was chosen to combine these to devise a new measurement. The Multisurface Obstacle Test for Older Adults (MSOT) is innovative in so far that the short track consists of different obstacles and movement skills taken from everyday life of older adults. The cost effectiveness of implementing the test with minimal and additional technical effort for practitioners, who work with older adults, was easily utilized that is important for integration. The proposed study is presented in the first part of phase I [11] (diagnostic study). The range of results obtained with the MSOT was analyzed in healthy older adults.

The MSOT integrated different ground surfaces that simulated different locations and tasks were reported with high incidences of falls in previous studies [4, 20, 32]. To fulfill these presuppositions, they were minimized into a track of 10 m. This track provides a functionally oriented assessment of real-life conditions and tasks to the environmental conditions regularly experienced by older adults. The primary object was to reproduce a situation similar to that experienced in the real world by older adults. The MSOT was developed by sport scientists, working in the field of movement science, sport gerontology, and fall prevention. Initially, specific fall movements and obstacles were researched and discussed, which resulted in a selection of suitable obstacles to be implemented. The developed track was tested by individual participants, discussed with colleagues, and modified on the basis of their feedback. At the end of the pilot phase, the final version of the MSOT was determined and documented.

The total length of the test track was 10 m (cf. Fig. 1; Appendix Fig. 3). The first and last meters provide space for acceleration and deceleration; therefore, the distance timed includes only the intermediate distance of 8 m (testing zone). The testing zone consists of different surface conditions and obstacles to overcome while walking (cf. Fig. 1; Appendix Fig. 3). After 0.5-m flat surface, the first obstacle (length: 2 m) simulates road kerbs. It is constructed of a wooden box (step on 10 cm height, step off 8 cm height; length: 0.6 m) and a 2-cm high area (0.8 m length). Together with a second box (step on 13 cm height, step off 15 cm height; length: 0.6 m), the first obstacle should simulate different kerb heights and edges located on pavements or in the home.

All integrated obstacles and ground surfaces were executed safely by the participants and no falls occurred. In conclusion, the MSOT was executed within the specific target group of untrained older adults.

The aim of the new MSOT was to integrate different everyday movements and challenging surface conditions from real-life environments into one single track. This purpose was fulfilled on the common distance in the often conducted gait analysis distance. A course with different stations, which needs substantial space and material, has only limited applicability [22, 23, 29] though it might provide a greater understanding, especially when information is separated for the different obstacles and surfaces.

There are several areas concerning future work for the MSOT, which will be discussed in detail. The first consideration is to conduct a series of experimental studies focusing on dual-task conditions during the MSOT. For example, the older adults would be provided with an additional cognitive or transport motor task during the walk on the track. These additional tasks reflect closely to everyday situations in the life of older adults. This kind of dual-task analysis attained rising importance in attention tasks. Different changes with increasing age influence more the dual-task conditions in contrast to the graduation of a single track. The second consideration could assess and examine the differences between fallers and nonfallers between subgroups because one limitation of the current study is the exclusion of fallers. This means the presented results will not be ascertained for the overall population (including fallers). The third consideration would be to conduct the MSOT in an outdoor environment that could then be compared to the indoor analysis of the MSOT measurement. The fourth consideration is to take a prospective approach to replace some or all of the surface grounds/obstacles and replace with a different set of surfaces. This could enable the analysis of different sensory challenges by older adults in connection with the MSOT. The penultimate consideration is to validate the MSOT in regards to the assessment of the relationship between correlations and standardized measurements such as TUG, Chair Stand Test (CST), or maximum step length test. It is suggested by conducting this assessment; it could assist in the deployment of one measure as opposed to a combination of three measures in future studies relating to this area of interest. Finally, in relation to fall prevention, the MSOT could be utilized to categorize prospective participants as fallers and nonfallers, thus enabling the MSOT to be a prediction tool for falling.

A prototype of the SPAM has been developed using Yamaha JWII power assist hubs, sonar and infrared rangefinders, and a microprocessor. The prototype limits the user to moving straight forward, straight backward, or turning in place, and increases the resistance of the wheels based on the proximity of obstacles. The result is haptic feedback to the user regarding the environment surrounding the wheelchair.

One of the few products that is commercially-available and accommodates a manual wheelchair is the Wheelchair Pathfinder [10], a commercial product sold by Nurion Industries that can be attached to a manual or power wheelchair. The Wheelchair Pathfinder uses sonar sensors to identify obstacles to the right, left or front of the wheelchair and a laser range finder to detect drop-offs in front of the wheelchair. Feedback is provided to the user through vibrations or differently-pitched beeps. The Wheelchair Pathfinder differs from the SPAM in that the Wheelchair Pathfinder has limited sensor coverage and cannot alter the speed or direction of travel of the wheelchair to avoid obstacles. be457b7860