The effect of divided attention on gait stability following concussion. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial Balance performance with a cognitive task: a dual-task testing paradigm. Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department Prevalence of neurocognitive and balance deficits in collegiate aged football players without clinically diagnosed concussion. Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation. Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Clinical versus Functional Reaction Time: Implications for Postconcussion Management EFFECTS OF A SEASON OF SUBCONCUSSIVE CONTACT ON CHILD- SCAT3 SCORES IN 8-12 YEAR-OLD MALE ATHLETES. Cognition in the days following concussion: comparison of symptomatic versus asymptomatic athletes. Structural brain alterations following adult non-CNS cancers: a systematic review of the neuroimaging literature Determinants of weight loss maintenance: a systematic review. The capture-mark-recapture technique can be used as a stopping rule when searching in systematic reviews. Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. Erratum to: Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies A randomized controlled pilot study assessing the feasibility of combined motor–cognitive training and its effect on gait characteristics in the elderly Is chemical antithrombotic prophylaxis effective in elective thoracolumbar spine surgery? Results of a systematic review Persistent motor system abnormalities in formerly concussed athletes. Effects of Light Treatment on Sleep, Cognition, Mood, and Behavior in Alzheimer’s Disease: A Systematic Review Balance and cognitive performance during a dual-task: preliminary implications for use in concussion assessment.
BACKGROUND The need to identify functional impairment following a brain injury is critical to prevent re-injury during the period of recovery . While many neuropsychological tests have been developed to assess cognitive performance , relatively little information on gait and dynamic stability is available on motor task performance for young adults following concussion . This study was performed to investigate the effect of divided attention following concussion on various gait variables . It was hypothesized that , when compared to uninjured controls , concussed subjects would demonstrate deficits in maintenance of dynamic stability . METHODS Ten subjects with Grade 2 concussion completed testing within 48 h of injury as well as 10 age- , height- , weight- , and activity-matched controls . The gait protocol consisted of level walking under two conditions : ( 1 ) undivided attention ( single-task ) and ( 2 ) while simultaneously completing simple mental tasks ( dual-task ) . Whole-body motion data were collected using a six-camera motion analysis system . A 13-segment biomechanical model was used to compute whole body center of mass motion and velocity . FINDINGS Walking with a concurrent cognitive task result ed in significant changes in gait and center of mass measurements for both groups . Concussed subjects were found to be able to conservatively adjust their whole body center of mass motion to maintain dynamic stability while walking without divided attention . However , while walking with divided attention , subjects with concussion demonstrated a significantly greater medio-lateral center of mass sway . INTERPRETATION These data suggest that the ability to control and maintain stability in the frontal plane during walking is diminished under divided attention in individuals following a concussion Purpose : People with dementia fall more often than cognitively healthy older adults , but their risk factors are not well understood . A review is needed to determine a fall risk profile for this population . The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia . Methods : Articles published between January 1988 and October 2014 in EMBASE , PubMed , PsycINFO , and CINAHL were search ed . Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment , prospect i ve cohort design , detailed fall definition , falls as the primary outcome , and multi-variable regression analysis . Two authors independently review ed and extracted data on study characteristics , quality assessment , and outcomes . Adjusted risk estimates were extracted from the articles . Results : A total of 17 studies met the inclusion criteria . Risk factors were categorized into demographic , balance , gait , vision , functional status , medications , psychosocial , severity of dementia , and other . Risk factors varied with living setting and were not consistent across all studies within a setting . Conclusion : Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors , some shared with older adults in general and others unique to the disease . Risk factors vary between community- and institution-dwelling sample s of adults with dementia or cognitive impairment Background Exercise interventions often do not combine physical and cognitive training . However , this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training . Methods A multicenter parallel r and omized controlled trial was conducted to compare a motor to a cognitive-motor exercise program .  A total of 182 eligible residents of homes-for-the-aged ( n = 159 ) or elderly living in the vicinity of the homes ( n = 23 ) were r and omly assigned to either strength-balance ( SB ) or strength-balance-cognitive ( SBC ) training . Both groups conducted similar strength-balance training during 12 weeks . SBC additionally absolved computerized cognitive training . Outcomes were dual task costs of walking , physical performance , simple reaction time , executive functions , divided attention , fear of falling and fall rate . Participants were analysed with an intention to treat approach . Results The 182 participants ( mean age ± SD : 81.5 ± 7.3 years ) were allocated to either SB ( n = 98 ) or SBC ( n = 84 ) . The attrition rate was 14.3 % . Interaction effects were observed for dual task costs of step length ( preferred walking speed : F(1,174 ) = 4.94 , p = 0.028 , η2 = 0.027 , fast walking speed : F(1,166 ) = 6.14 , p = 0.009 , η2 = 0.040 ) and dual task costs of the st and ard deviation of step length ( F(1,166 ) = 6.14 , p = 0.014 , η2 = 0.036 ) , in favor of SBC . Significant interactions in favor of SBC revealed for in gait initiation ( F(1,166 ) = 9.16 , p = 0.003 , η2 = 0.052 ) , ‘ reaction time ’ ( F(1,180 ) = 5.243 , p = 0.023 , η2 = 0.028 ) & ‘ missed answers ’ ( F(1,180 ) = 11.839 , p = 0.001 , η2 = 0.062 ) as part of the test for divided attention . Within-group comparison revealed significant improvements in dual task costs of walking ( preferred speed ; velocity ( p = 0.002 ) , step time ( p = 0.018 ) , step length ( p = 0.028 ) , fast speed ; velocity ( p < 0.001 ) , step time ( p = 0.035 ) , step length ( p = 0.001 ) ) , simple reaction time ( p < 0.001 ) , executive functioning ( Trail making test B ; p < 0.001 ) , divided attention ( p < 0.001 ) , fear of falling ( p < 0.001 ) , and fall rate ( p < 0.001 ) . Conclusions Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking , gait initiation , and divided attention . The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls . Trial registration This trial has been registered under IS RCT PURPOSE Athletic performance dem and s simultaneous use of cognitive and postural control capabilities . Decrements to both systems have been observed following concussion . This study evaluated a dual-task methodology to establish the tenability of using this testing model in concussed athletes . METHODS Nonconcussed subjects were assessed over 2 d. Subjects were introduced to the task-switching cognitive assessment test and a NeuroCom Smart Balance Master postural control assessment protocol on day 1 . In the following session , subjects were evaluated on  postural control and cognitive function tests independently ( single task ) , and then concurrently ( dual task ) . RESULTS Significant improvements were seen in three of the four balance conditions and in three of the four reaction times when the cognitive and balance task were performed simultaneously ( P<0.05 ) . No significant balance by cognitive task interaction was revealed ( P>0.05 ) ; however , significant differences existed in reaction time based on stimulus position and increasing balance dem and s ( P<0.05 ) . CONCLUSION Combining the cognitive and balance assessment s result ed in healthy subjects showing improved performance when compared with individual task performance . The dual-task methodology brought about systematic changes to reaction time in relation to increasing balance dem and s. The ability of this protocol to detect changes in postural control or cognitive function following concussive injury requires further study During aging , the prefrontal cortex ( PFC ) undergoes age-dependent neuronal changes influencing cognitive and motor functions . Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults . Especially , video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults . The aim of this study was to compare conventional balance training with video game-based physical exercise , a so-called exergame , on the relative power ( RP ) of electroencephalographic ( EEG ) frequencies over the PFC , executive function ( EF ) , and gait performance .  Twenty-seven participants ( mean age 79.2 ± 7.3 years ) were r and omly assigned to one of two groups . All participants completed 24 trainings including three times a 30 min session/week . The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [ L(14 ) = 6.23 , p = 0.007 ] . Comparing pre- vs. post-test , EFs improved both within the exergame ( working memory : z = −2.28 , p = 0.021 ; divided attention auditory : z = −2.51 , p = 0.009 ; divided attention visual : z = −2.06 , p = 0.040 ; go/no-go : z = −2.55 , p = 0.008 ; set-shifting : z = −2.90 , p = 0.002 ) and within the balance group ( set-shifting : z = −2.04 , p = 0.042 ) . Moreover , spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions ( speed normal walking : z = −2.90 , p = 0.002 ; speed fast walking : z = −2.97 , p = 0.001 ; cadence normal walking : z = −2.97 , p = 0.001 ; stride length fast walking : z = −2.69 , p = 0.005 ) and within the balance group under single-task conditions ( speed normal walking : z = −2.54 , p = 0.009 ; speed fast walking : z = −1.98 , p = 0.049 ; cadence normal walking : z = −2.79 , p = 0.003 ) . These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and /or function in varying proportion Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making STUDY DESIGN Prospect i ve cohort . OBJECTIVES To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition . BACKGROUND Neurocognitive testing , balance assessment s , and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected . Previous literature suggests many concussions go unreported . Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider . METHODS Forty-five Division IA collegiate football players participated in this study . Preseason baseline scores using the  Balance Error Scoring System , the Immediate Post-Concussion Assessment and Cognitive Testing , and the Postconcussion Symptom Scale  were compared to posttest results obtained 48 hours following a game . Prevalence of symptoms was analyzed and reported . RESULTS Thirty-two ( 71 % ) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale , Balance Error Scoring System , or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing . Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function . CONCLUSION In a cohort of football players tested 48 hours following their last game of the season , who did not seek medical attention related to a concussion , a significant number demonstrated limitations in neurocognitive and balance performance , suggesting that further research may need to be performed to improve recognition of an athlete 's deficits and to improve the ability to assess concussion . LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence , level 3b The present study highlights the effects of the dual-task cognitive-gait intervention ( CGI ) on working memory and gait functions in older adults with a history of falls . Thirteen older adults with a history of falls were recruited from local community centers and r and omly stratified into either the control ( n = 5 ) or experimental ( n = 8) group . The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor ( walking ) and cognitive ( memory recall ) task whereas the control group received a placebo treatment ( walking with simple music ) . The intervention was provided 30 minutes per session , over a 6-week period . Memory measures included a combination of word recall and arithmetic task . Gait function measures included velocity and center of pressure ( COP ) stability . Non-parametric tests were used at p < 0.05 . The experimental group showed a greater memory performance than the control ( p < 0.05 ) . However , no significant intervention-related changes in gait velocity and stability were observed . Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition OBJECTIVE This article review s the available literature about the use of novel methods of rehabilitation using virtual reality interventions for people living with posttraumatic brain injuries . MATERIAL S AND METHODS The MEDLINE , EMBASE , SCOPUS , and Cochrane Library data bases were search ed using the terms " virtual reality " OR " video games " AND " traumatic brain injury . " Included studies investigated therapeutic use of virtual reality in adults with a brain trauma result ing from acquired closed head injury , reported outcomes that included measures of motor or cognitive functionality , and were published in a peer- review ed journal written in English . RESULTS Eighteen articles fulfilled inclusion criteria . Eight were case studies , five studies had a quasi-experimental design with a pre-post comparison , and five were pilot r and omized control trials or comparative studies . The virtual reality systems used were commercial or custom design ed for the study and ranged from expensive , fully immersive systems to cheap online games or videogames . In before-after comparisons , improvements in balance were seen in four case studies and two small r and omized control trials . Between-group comparisons in these r and omized control trials showed no difference between virtual reality and traditional therapy . Post-training improvements were also seen for upper extremity functions ( five small studies ) and for various cognitive function measures ( four case studies and one pilot r and omized control trial ) . Attitudes of participants toward virtual reality interventions was more positive than for traditional therapy ( three studies ) . CONCLUSIONS The evidence that the use of virtual reality in rehabilitation of traumatic brain injury improves motor and cognitive functionality is currently very limited . However , this approach has the potential to provide alternative , possibly more affordable and available rehabilitation therapy for traumatic brain injury in setting s where access to therapy is limited by geographical or financial constraints ABSTRACT Purpose This study aim ed to examine the association between clinical and functional reaction time ( RT ) assessment s with and without simultaneous cognitive tasks among healthy individuals . Methods Participants ( n = 41 , 49 % female ; 22.5 ± 2.1 yr ; 172.5 ± 11.9 cm ; 71.0 ± 13.7 kg ) completed clinical ( drop stick , Stroop ) and functional ( gait , jump l and ing , single-leg hop , anticipated cut , unanticipated cut ) RT assessment s in r and om order . All RT assessment s , except Stroop and unanticipated cut , were completed under single- ( movement only ) and dual-task conditions ( movement and subtracting by 6s or 7s ) . Drop stick involved catching a r and omly dropped rod embedded in a weighted disk . Stroop assessed RT via  computerized neurocognitive testing . An instrumented walkway measured gait RT when center-of-pressure moved after r and om stimulus . All other functional RT assessment s involved participants jumping forward and performing a vertical jump ( jump l and ing ) , balancing on one leg ( single-leg hop ) , or a 45 ° cut in a known ( anticipated cut ) or unknown ( unanticipated cut ) direction . RT was determined when the sacrum moved following r and om visual stimulus . Pearson correlation coefficients and a 5 × 2 repeated- measures ANOVA compared RT assessment s and cognitive conditions . Results Stroop RT outcomes did not significantly correlate with functional RT assessment s ( r range = −0.10 to 0.24 ) . A significant assessment by cognitive task interaction ( F4,160 = 14.01 ; P < 0.001 ) revealed faster single-task RT among all assessment s compared with dual-task ( mean differences , −0.11 to −0.09 s ; P < 0.001 ) , except drop stick ( P = 0.195 ) . Single-leg hop ( 0.58 ± 0.11 s ) was significantly slower compared with jump l and ing ( 0.53 ± 0.10 s ) , anticipated cut ( 0.49 ± 0.09 s ) , gait ( 0.29 ± 0.07 s ) , and drop stick ( 0.21 ± 0.03 s ; P values ≤ 0.001 ) . Dual-task assessment s were significantly slower than single-task assessment s ( mean difference , 0.08 s ; P < 0.001 ) . Conclusions Clinical and functional RT assessment s were not correlated with each other , suggesting that sport-like RT is not being assessed after concussion . Functional and dual-task RT assessment s may add clinical value and warrant further exploration after concussion BACKGROUND Each year , over 173,000 children and adolescents visit emergency departments due to sports and recreation related concussions , an increase of 60 % over the last decade due to the rise in the number of children participating in sport . While numerous authors have sought to address the epidemiology of concussions across multiple age groups who participate in contact sports , a recent review of literature did not reveal a substantial amount of published articles that addressed the issue of subconcussive contact . Multiple tools have been developed to assess acute episodes of concussion . Among the assessment protocol s many include an assessment of balance , short and long term memory recall , and balance . The Child-SCAT3 was design ed specifically to evaluate concussions in children 5 - 12 years of age . OBJECTIVE The purpose of this study was to determine the effect of a season of subconcussive contact on  Child-SCAT3  scores in 8 - 12 year old males compared to their age matched peers who participated in non-contact sports .  A secondary purpose was to evaluate how scores of the sub- components of the Child-SCAT3 compare between contact and non-contact athletes . DESIGN A prospect i ve cohort study was performed of 71 male athletes ( 58 football , 13 baseball ) ages 8 - 12 ( contact mean age 10.30 years , SD 1.20 ; non-contact mean age 10.03 years , SD 1.26 ) over the course of a season . METHODS Portions of The Child-SCAT3 were administered and scored in pre-adolescent athletes prior to and following a season of participation in football ( contact sport group ) and baseball ( non-contact sport group ) . The outcome measures of interest included the portions related to Cognitive ability , Balance , and Coordination . RESULTS No statistically significant differences were found in group , time or time and group interaction for any of the utilized portions of the Child-SCAT3 . Statistically significant differences were found between groups for preseason cognitive orientation and postseason immediate memory . Cognitive orientation and coordination were also found to be statistically significantly improved across both groups over the course of the season . LIMITATIONS This study was potentially limited by the number of control subjects tested . CONCLUSIONS A season of subconcussive contact in football was not detrimental to cognitive and balance scores on the Child-SCAT3 . LEVEL OF EVIDENCE 3 BACKGROUND Concussion is a common neurological injury occurring during contact sport . Current guidelines recommend that no athlete should return to play while symptomatic or displaying cognitive dysfunction . This study compared post-concussion cognitive function in recently concussed athletes who were symptomatic/asymptomatic at the time of assessment with that of non-injured ( control ) athletes . METHODS Prospect i ve study of 615 male Australian Rules footballers . Before the season , all participants ( while healthy ) completed a battery of baseline computerised ( CogSport ) and paper and pencil cognitive tasks .  Sixty one injured athletes ( symptomatic = 25 and asymptomatic = 36 ) were reassessed within 11 days of being concussed ; 84 controls were also reassessed . The serial cognitive function of the three groups was compared using analysis of variance . RESULTS The performance of the symptomatic group declined at the post-concussion assessment on computerised tests of simple , choice , and complex reaction times compared with the asymptomatic and control groups . The magnitude of changes was large according to conventional statistical criteria . On paper and pencil tests , the symptomatic group displayed no change at re assessment , whereas large improvements were seen in the other two groups . CONCLUSION Injured athletes experiencing symptoms of concussion displayed impaired motor function and attention , although their learning and memory were preserved . These athletes displayed no change in performance on paper and pencil tests in contrast with the improvement observed in asymptomatic and non-injured athletes . Athletes experiencing symptoms of concussion should be withheld from training and competition until both symptoms and cognitive dysfunction have resolved Abstract Background : Cancer and cancer treatments may impact the brain through several pathways leading to cognitive impairment . Neuroimaging evidence has begun to eluci date the neurobiological underpinnings of cancer-related cognitive impairment . The aim of this paper was to systematic ally review available literature on structural brain alterations following adult non- central nervous system ( CNS ) cancers and associated treatments . Methods : This review followed PRISMA guidelines and was registered in PROSPERO ( ID#107387 ) . Comprehensive search es were conducted in June 2018 using PubMed and Web of Science . Inclusion criteria were English peer- review ed journal articles of formal , controlled studies that examined structural neuroimaging outcomes in adult non-CNS cancer patients and survivors . Selected articles were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies . Results : Thirty-six publications of prospect i ve and cross-sectional studies met inclusion criteria and were included . Structural brain alterations following cancer and its treatment were reported in a majority of the publications as evidence d by reduced global and local gray matter volumes , impaired white matter microstructural integrity , and brain network alterations . Structural alterations were most often evident when cancer-treated groups were compared with healthy controls , and more subtle when compared with cancer controls . Regarding the existence of pretreatment impairments , the evidence was equivocal . There was significant between- study heterogeneity in imaging analytical approaches and use of statistical adjustments . Over half reported associations with cognitive outcomes , though regions and associated cognitive domains were heterogeneous . Conclusions : Structural brain alterations following cancer and cancer treatments were reported in a majority of the review ed studies . However , the extent of observed alterations depended on the choice of comparison groups . Method ological issues exist that will need to be addressed systematic ally to ensure the validity of findings . Large-scale prospect i ve studies with extended assessment points are warranted to replicate and build upon initial findings BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity . We have therefore systematic ally synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity . METHODS With the use of the Preferred Reporting Items for Systematic Review s and Meta-Analyses statement , prospect i ve studies were identified from search es in PubMed and PsycINFO from 2006 to 2016 . We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication .  Included articles were scored on their method ological quality , and a best- evidence synthesis was applied to summarize the results . RESULTS Our search result ed in 8,222 articles of which 67 articles were selected . In total , 124 determinants were identified of which 5 were demographic , 59 were behavioural , 51 were psychological/cognitive and 9 were social and physical environmental determinants . We found consistent evidence that demographic determinants were not predictive of weight loss maintenance . Behavioural and cognitive determinants that promote a reduction in energy intake , an increase in energy expenditure and monitoring of this balance are predictive determinants . CONCLUSION This review identifies key determinants in weight loss maintenance . However , more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance OBJECTIVE Research ers have no empirically based search stopping rule when looking for potentially relevant articles for inclusion in systematic review s. We tested a stopping strategy based on capture-mark-recapture ( CMR ; i.e. , the Horizon Estimate ) statistical modeling to estimate the total number of articles in the domain of clinical decision support tools for osteoporosis disease management using four large bibliographic data bases ( Medline , EMBASE , CINAHL , and EBM review s ) . STUDY DESIGN AND SETTING Retrospective evaluation of the Horizon Estimate using a systematic review of r and omized controlled trials ( RCTs ) at two levels of article screening : title and abstract ( 1,246 potentially relevant articles ) and full text ( 42 potentially relevant articles ) . RESULTS The CMR model suggests that the total number of potential articles was 1,838 for the first level of screening , and 49 for the full-text level . The four data bases provided 68 % of known articles for the first level of screening and 81 % for full-text screening . CONCLUSIONS The CMR technique can be used in systematic review s to estimate the closeness to capturing the total body of literature on a given topic . More studies are needed to objective ly determine the usefulness of Horizon Estimates as a stopping rule strategy for systematic review search ing This study examined transfer effects of fall training on fear of falling ( Falls Efficacy Scale-International [ FES-I ] ) , balance performance , and spatiotemporal gait characteristics in older adults . Eighteen community-dwelling older adults ( ages 65 - 85 ) were r and omly assigned to an intervention or control group . The intervention group completed 12 training sessions ( 60 min , 6 weeks ) . During pre- and posttesting , we measured FES-I , balance performance ( double limb , closed eyes ; single limb , open eyes ; double limb , open eyes with motor-interfered task ) , and gait parameters ( e.g. , velocity ; cadence ; stride time , stride width , and stride length ; variability of stride time and stride length ) under single- and motor-interfered tasks . Dual tasks were applied to appraise improvements of cognitive processing during balance and gait . FES-I ( p = .33 ) and postural sway did not significantly change ( 0.36 < p < .79 ) . Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task ( p = .05 , ηp 2 = .22 ) . Fall training did not sufficiently improve fear of falling , balance , or gait performance under single- or dual-task conditions in healthy older adults Background : The stimulant methylpheni date ( MPH ) has been a mainstay of treatment for attention-deficit/hyperactivity disorder ( ADHD ) for many years . Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations , a new generation of long-acting MPH formulations has emerged . Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy ; however , to date , relatively few head-to-head studies have been performed . The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection . Methods : A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms : attention deficit disorder with hyperactivity/drug therapy ; methylpheni date /therapeutic use and All Fields : Concerta ; Ritalin LA ; OROS and ADHD ; Medikinet ; Equasym XL and ADHD ; long-acting methylpheni date ; Diffucaps and ADHD ; SODAS and methylpheni date . No filters were applied and no language , publication date or publication status limitations were imposed . Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age ; non- systematic review articles and unpublished data were not included . Results : Of 15,295 references returned in the literature search and screened by title , 34 articles were identified for inclusion : nine articles from pharmacokinetic studies ( nine studies ) ; nine articles from laboratory school studies ( six studies ) ; two articles from r and omized controlled trials ( two studies ) ; three articles from switching studies ( two studies ) and three articles from one observational study . Conclusions : Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available . At a group level , efficacy across the day generally follows the pharmacokinetic profile of the MPH formulation . No formulation is clearly superior to another ; careful consideration of patient needs and subtle differences between formulations is required to optimize treatment . For patients achieving suboptimal symptom control , switching long-acting MPH formulations may be beneficial . When switching formulations , it is usually appropriate to titrate the immediate-release component of the formulation ; a limitation of current studies is a focus on total daily dose rather than equivalent immediate-release components . Further studies are necessary to provide guidance in clinical practice , particularly in the treatment of adults and pre-school children and the impact of comorbidities and symptom severity on treatment response Objective : ( 1 ) To develop a motor – cognition training programme ; ( 2 ) to evaluate the ability to recruit and retain elderly people ; ( 3 ) to assess the effects of the interventions . Design : Pilot r and omized controlled trial . Setting : Assisted living facility . Participants : Sixteen subjects ( 11 female ) living in an assisted living facility were r and omized to a motor or motor – cognition group . Interventions : Both groups received machine-driven strength training and balance exercises for 45 minutes , twice weekly , for 12 weeks . In addition , the motor – cognition group received computerized training for attention 3–5 times per week for 10 weeks . Main outcome measures : Baseline and post-intervention ( 12 weeks ) assessment s focused on recruitment , attrition and adherence . Secondary outcome measures assessed dual-task costs of gait ( velocity , cadence , step time , step length ) , exp and ed timed get-up- and -go , falls efficacy and reaction time . Results : Of 35 subjects initially approached , 16 started and 14 completed the study , result ing in 46 % recruitment , 19 % attrition and > 80 % adherence rates . There is more evidence of altered levels in the motor – cognitive treatment group with significant differences in average change for fear of falling ( P = 0.017 ) and foot reaction time ( P = 0.046 ) . No statistical significance was reached for gait parameters . Conclusions : Motor – cognition training is feasible and shows trends to stronger improvement in walking and reaction time . The application in a main study is deemed feasible . A minimum of ±55 subjects per group are required to achieve a power of 80 % at the 5 % level of significance based on step length and considering the expectable attrition rate in a required larger scale study Study design : Systematic review Study rationale and context : There is controversy regarding the efficacy and safety of chemical prophylaxis to prevent deep venous thrombosis ( DVT ) and pulmonary embolism ( PE ) in elective spinal procedures .Commonly performed elective spine surgeries done through a posterior approach have a very low associated risk of DVT/PE . The lack of consensus is due in part to a limited amount of quality evidence based literature dealing with this issue . Objective : To compare chemical prophylaxis with no chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery . Methods : We undertook a systematic review of the literature to assess the efficacy and safety of chemical prophylaxis in preventing venous thromboembolism in elective thoracolumbar spine surgery . Pubmed , EMBASE , Cochrane , National Guideline Clearinghouse Data bases as well as bibliographies of key articles were search ed . Articles were review ed by two independently working review ers . Inclusion and exclusion criteria were set and each article was subject to a predefined quality rating scheme . Results : We identified only two articles meeting our inclusion criteria . Neither study demonstrated a significant difference between chemical prophylaxis versus no prophylaxis in preventing thromboembolic events . There was an increased incidence of perioperative bleeding with low dose Coumadin in one of the studies . Conclusion : The incidence of DVT and PE in commonly performed elective posterior spinal procedures is very low . While there is a limited amount of r and omized literature looking at this issue , the current literature does not support the routine use of chemical prophylaxis for low risk patients undergoing these procedures CONTEXT The known detrimental effects of sport concussions on motor system function include balance problems , slowed motor execution , and abnormal motor cortex excitability . OBJECTIVE To assess whether these concussion-related alterations of motor system function are still evident in collegiate football players who sustained concussions but returned to competition more than 9 months before testing . DESIGN Case-control study . SETTING University laboratory . PATIENTS OR OTHER PARTICIPANTS A group of 21 active , university-level football players who had experienced concussions was compared with 15 university football players who had not sustained concussions . INTERVENTION(S ) A force platform was used to assess center-of-pressure ( COP ) displacement and COP oscillation regularity ( approximate entropy ) as measures of postural stability in the upright position . A rapid alternating-movement task was also used to assess motor execution speed . Transcranial magnetic stimulation over the motor cortex was used to measure long-interval intracortical inhibition and the cortical silent period , presumably reflecting y-aminobutyric acid subtype B receptor-mediated intracortical inhibition . MAIN OUTCOME MEASURE(S ) COP displacement and oscillation regularity , motor execution speed , long-interval intracortical inhibition , cortical silent period . RESULTS Relative to controls , previously concussed athletes showed persistently lower COP oscillation r and omness , normal performance on a rapid alternating-movement task , and more M1 intracortical inhibition that was related to the number of previous concussions . CONCLUSIONS Sport concussions were associated with pervasive changes in postural control and more M1 intracortical inhibition , providing neurophysiologic and behavioral evidence of lasting , sub clinical changes in motor system integrity in concussed athletes Background : Bright light treatment is a therapeutic intervention mainly used to treat sleep and circadian disturbances in Alzheimer ’s disease ( AD ) patients . Recently , a h and ful of studies also focused on the effect on cognition and behavior . Conflicting findings are reported in the literature , and no definite conclusions have been drawn about its specific therapeutic effect . Summary : The aim of this review is to provide a critical evaluation of available evidence in this field , highlighting the specific characteristics of effective bright light treatment . Eligible studies were required to assess at least one of the following outcome measures : sleep , cognition , mood , and /or behavior ( e.g. , depression , agitation ) . A total of 32 articles were included in this systematic review and identified as research intervention studies about light treatment in AD . The quality of the papers was evaluated based on the US Preventive Service Task Force guidelines . Key Messages : Overall , the current literature suggests that the effects of light treatment  in AD patients are mixed and may be influenced by several factors , but with a general trend toward a positive effect . Bright light seems to be a promising intervention treatment without significant adverse effects ; therefore , further well- design ed r and omized controlled trials are needed taking into account the highlighted recommendations OBJECTIVES To determine the reliability and effects of a dual-task paradigm on  balance and cognitive function  compared to a single-task paradigm . DESIGN Repeated measures . METHODS Healthy participants ( n=23 ) completed a variation of the Sensory Organization Test and the incongruent Stroop test individually ( single-task ) and concurrently ( dual-task ) during two testing sessions . RESULTS The Sensory Organization Test and incongruent Stroop test had moderate to high reliability ( 1.00>ICC2,k>0.60 ) under the dual-task conditions . Reaction time was significantly longer ( t21=-2.54 , p=0.019 ) under the dual-task conditions , while balance scores under one of the four conditions of the Sensory Organization Test ( sway floor/fixed wall ) were statistically better ( t22=-3.03 , p=0.006 ) under the dual-task conditions . However , this difference in balance scores may not be clinical ly meaningful . CONCLUSIONS These findings illustrate that the Sensory Organization Test and incongruent Stroop task can be reliably incorporated into a dual-task assessment paradigm . The slowed reaction time under the dual-task paradigm indicates that the dual-task provided an additional cost to cognitive function . Dual-task concussion assessment paradigms involving these two tasks are psychometrically appropriate as well as more representative of actual sporting situations . However , more research should be conducted in a concussed population to further vali date this cl aim
Response times are greater , gait strategies are less efficient , and postural control deficits are greater in concussed participants compared with healthy controls both immediately and for some period following concussive injury , specifically under divided attention conditions .
Dual task assessment s in some cases were more reliable than single task assessment s and may be better able to detect lingering effects following concussion .
This article is a systematic review of the literature on divided attention assessment inclusive of a cognitive and motor task ( balance or gait ) for use in concussion management .