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  • ISSN: 2378-9409
    Volume 3, Issue 2
    Research Article
    Ericka N. Merriwether*, Mary K. Hastings, Michael J. Mueller, Kathryn L. Bohnert, Michael J. Strube, Darrah R. Snozek, and David R. Sinacore
    Introduction: Foot progression angle (FPA) is a predictor of elevated regional plantar stresses and loads, which are indicators of dermal injury risk in individuals with diabetes mellitus and peripheral neuropathy (DMPN). FPA accounts for 15-45% of the variance in plantar stresses and loads in adults with DMPN. However, the biomechanical factors underlying an "out-toeing" gait pattern in this clinical population have not been examined. The primary purpose of this study was to identify static and dynamic predictors of foot progression angle magnitude in adults with and without DMPN.
    Methods: Thirty-three adults with and 12 adults without diabetes mellitus participated. Hip rotation, ankle dorsiflexion, and resting calcaneal stance position were measured using a standard goniometer. Kinematic and kinetic data were collected during walking.
    Results and Discussion: Static predictor variables did not significantly predict foot progression angle magnitude using multiple regression analysis. Of the dynamic predictor variables, thigh and shank lateral rotation accounted for 37% of foot progression angle variance (p<.01).
    Conclusions: Our results show that dynamic measures of external rotation of proximal segments (thigh, shank) during gait are strong predictors of foot progression angle. Static measures of limited joint mobility and joint position do not predict foot progression angle. These findings suggest that targeting the thigh and shank rotation using verbal or tactile cueing may be a potential strategy when trying to alter walking movement patterns towards decreasing external (lateral) FPA to minimize risk of elevated regional plantar stresses in adults with DMPN at risk for ulceration.
    Helene Schmaltz*, Hella Vuong, Dominique Rohmer, Peter Milad, Sebastien Moliere, Francis Veillon, and Anne Charpiot
    Objectives: Identification of clinical criteria for a fast diagnosis of intralabyrinthine hemorrhage and based on an observation and analysis of clinical findings.
    Material and methods: Retrospective study reporting cases of clinically presumed intralabyrinthine hemorrhage identified between 2010 and 2014. Cases were confirmed by magnetic resonance imaging (MRI) after clinical and videonystagmoscopy examination.
    Results: Eight cases of intralabyrinthine hemorrhage were collected, as an acute and severe cochleovestibular deficit. A risk factor was noted in six cases. History and physical examination eliminated the main differential diagnoses, except for the internal auditory artery ischemia. 75% of patients had a complete deafness and a rotatory vertigo. Early spontaneous nystagmus was horizontorotatory, beating towards the unaffected side. Videonystagmoscopy reported 75% of atypical positional nystagmus, which may change over time. Three patients presented an initial areflexia of the lateral semicircular canal (positive Head Impulse Test), two of which associated with a silent videonystagmoscopy and poor cochleovestibular recovery. Half suffered secondarily a typical and ipsilateral benign paroxystic positional vertigo in the weeks following the incident, isolated or repetitive. Hearing improvement was rare.
    Conclusion: The diagnosis of intralabyrinthine hemorrhage is predominantly suspected on clinical history and association of sudden sensorineural hearing loss and vertigo. Simple clinical findings based on videonystagmoscopy may orient the differential diagnosis between hemorrhage and ischemia. A suspected vascular damage of the inner ear with normal videonystagmoscopy and positive Head Impulse Test seems associated with poor functional outcome.
    Kathy Black*, Adrian NS Badana, and Kathryn Hyer
    As communities strive to create age-friendly accommodations that promote the health and wellbeing of a growing aging citizenry, the concomitant growth of caregivers requires additional planning considerations. Increasingly, persons providing care are managing their own aging and negotiating their community's infrastructure for both themselves as well as on behalf of their aged loved ones. This study reports on the findings from a global age-friendly community effort that examined caregivers' perception of the importance of community features across three clustered domains of community life: the built environment; the social environment; and, community and health supports. The study surveyed caregivers (n = 216) and non-caregivers (n = 135) age 50 and older in a Southeastern United States community in which more than half of the residents are age 50 and older and one-third are age 65 and older. Results indicate significant differences across multiple areas with the greatest differences noted in the areas of housing, community supports, and transportation. The findings suggest that caregivers consider their own prospective needs as well as more efficiently managing the needs of their care recipients. Planning to enhance the community features may subsequently benefit aging persons as well as caregivers.
    Mauricio Moreno Aguilar*
    Objective: To determine the diagnostic test properties of subjective hearing loss (SHL) versus pure tone audiometry (PTA) in community-dwelling elderly.
    Methods: Cross-sectional, retrospective comparative design to evaluate a diagnostic test, we include exclusively subjects over 60yrs old. SHL was defined by a positive answer to the question "do you feel you have hearing problems?", and by the diagnosis (presence or absence of hearing loss) made by the expert audiologist in base of the PTA test. Results: The final sample was composed by 335 subjects. 67.5% were represented by male patients. The prevalence of SHL was of 17.6% and the prevalence of hearing loss by PTA was of 21.8%. SHL diagnostic properties were as follow: sensitivity 30.1 (CI95%, 16.7-43.6%), specificity 85.9% (CI95%, 80.5-91.3%), positive predictive value (PPV) 37.2% (CI95%, 21.5-53.0%) and negative predictive value (NPV) 85.9% (CI95%, 75.7-87.4%).
    Conclusion: SHL compared to PTA demonstrate fair good specificity and NPV for the detection of hearing loss, and it might be a useful strategy to identify low risk individuals without hearing problems.
    Review Article
    Yoonmee Joo*, Oi Saeng Hong, and Margaret Wallhagen
    Background: Age - related hearing loss (ARHL) is generally a bilateral sensorineural deficit with an incidence that increases at an accelerated rate with age. Strategies to prevent or delay ARHL should focus on identifiable factors.
    Objective: To determine risk factors contributing to ARHL
    Methods: The Pub Med database was searched using the term "age - related hearing loss." Multiple combinations of terms were searched with the MeSH database using "hearing loss, aged" or "presbycusis" and "risk factors." Then, limits were applied to the literature search: 1) published in English since 2000, 2) human adults, and 3) bilateral sensorineural hearing loss. Review articles were excluded.
    Results: 38 studies identified as relevant to the research question. Genetic factors (genes and gender), environmental factors (noise and chemicals), lifestyle factors (smoking and diet), and individual health factors (ototoxic medications, cardiovascular diseases, diabetes, and obesity) influence ARHL. The findings suggest that both environmental and individual health risk factors can accumulate over a lifetime and contribute to the hearing loss experienced by older people. However, research correlating specific risk factors to ARHL has conflicting results.
    Conclusion: Many risk factors are modifiable and are possible targets for prevention or moderation of ARHL. Identifying further risk and protective factors for ARHL and developing appropriate interventions are worthy goals for further research.
    Implications of Practice: Health providers can play a crucial role in minimizing ARHL by screening for hearing loss in at risk populations in the community or clinics, educating older people about potential risk factors and supporting lifestyle changes to delay or moderate ARHL.
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