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BackgroundImproved preferred gait speed in older adults is associated with increased survival rates. There are inconsistent findings in clinical trials regarding effects of exercise on preferred gait speed, and heterogeneity in interventions in the current reviews and meta-analyses.Objective: to determine the meta-effects of different types or combinations of exercise interventions from randomized controlled trials on improvement in preferred gait speed.MethodsData sources: A literature search was performed; the following databases were searched for studies from 1990 up to 9 December 2013: PubMed, EMBASE, EBSCO (AMED, CINAHL, ERIC, Medline, PsycInfo, and SocINDEX), and the Cochrane Library.Study eligibility criteria: Randomized controlled trials of exercise interventions for older adults ≥ 65 years, that provided quantitative data (mean/SD) on preferred gait speed at baseline and post-intervention, as a primary or secondary outcome measure in the published article were included. Studies were excluded when the PEDro score was ≤4, or if participants were selected for a specific neurological or neurodegenerative disease, Chronic Obstructive Pulmonary Disease, cardiovascular disease, recent lower limb fractures, lower limb joint replacements, or severe cognitive impairments. The meta-effect is presented in Forest plots with 95 % confidenceStudy appraisal and synthesis methods: intervals and random weights assigned to each trial. Homogeneity and risk of publication bias were assessed.ResultsTwenty-five studies were analysed in this meta-analysis. Data from six types or combinations of exercise interventions were pooled into sub-analyses. First, there is a significant positive meta-effect of resistance training progressed to 70-80 % of 1RM on preferred gait speed of 0.13 [CI 95 % 0.09-0.16] m/s. The difference between intervention- and control groups shows a substantial meaningful change (>0.1 m/s). Secondly, a significant positive meta-effect of interventions with a rhythmic component on preferred gait speed of 0.07 [CI 95 % 0.03-0.10] m/s was found. Thirdly, there is a small significant positive meta-effect of progressive resistance training, combined with balance-, and endurance training of 0.05 [CI 95 % 0.00-0.09] m/s. The other sub-analyses show non-significant small positive meta-affects.ConclusionsProgressive resistance training with high intensities, is the most effective exercise modality for improving preferred gait speed. Sufficient muscle strength seems an important condition for improving preferred gait speed. The addition of balance-, and/or endurance training does not contribute to the significant positive effects of progressive resistance training. A promising component is exercise with a rhythmic component. Keeping time to music or rhythm possibly trains higher cognitive functions that are important for gait.Limitations: The focus of the present meta-analysis was at avoiding as much heterogeneity in exercise interventions. However heterogeneity in the research populations could not be completely avoide...

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Converging evidence indicates that motor deficits in cerebral palsy (CP) are related not only to problems with execution, but also to impaired motor planning. Current rehabilitation mainly focuses on alleviating compromised motor execution. Motor imagery is a promising method of training the more 'cognitive' aspects of motor behaviour, and may, therefore, be effective in facilitating motor planning in patients with CP. In this review first we present the specific motor planning problems in CP followed by a discussion of motor imagery and its use in clinical practice. Second, we present the steps to be taken before motor imagery can be used for rehabilitation of upper limb functioning in CP. Motor imagery training has been shown to be a useful addition to existing rehabilitation protocols for poststroke rehabilitation. No such study has been conducted in CP. The age at which children can reliably use motor imagery, as well as the specific way in which motor imagery training needs to be implemented, must be researched before motor imagery training can be employed in children with CP. Based on the positive results for poststroke rehabilitation, and in light of the motor problems in CP, motor imagery training may be a valuable additional tool for rehabilitation in CP.Recently it was proposed that the motor deficits occurring in individuals with cerebral palsy (CP) are related not only to problems with motor execution, but also to impaired motor planning. 1 Nevertheless, current rehabilitation techniques are predominantly focused on alleviating the compromised motor execution facet of action performance, and have not specifically targeted the motor preparation or planning processes. As motor imagery is a promising method of training the more 'cognitive' aspects of motor behaviour, it may be effective in facilitating motor planning in CP. In this article, we will first give a short introduction to motor planning problems in CP. We will then discuss motor imagery, its neural correlates, evidence for the efficacy of motor imagery training for motor performance, and studies that have already been carried out in individuals with motor impairments. In the final section we will present a research agenda for the use of motor imagery for rehabilitation of motor planning in children with CP.

In addition to hand shaping, previous studies have shown that subjects adapt placement of individual digits to object properties such as its weight and center of mass. However, the extent to which digit placement varies based on task context is unknown. In the present study, we investigated where subjects place their digits on a bottle when the upcoming task (lift versus pour) and object content (i.e., amount of liquid: empty, half, and full) were manipulated. Our results showed that subjects anticipated both the upcoming task and content by varying digit placement when grasping the bottle prior to the onset of manipulation. Specifically, subjects increased the vertical distance between the thumb and index finger for pouring but not for lifting. This larger moment arm might have been established to decrease the amount of force required to tilt the bottle. Content also affected digit placement: the digits were placed higher and were wrapped more around the bottle with increasing content. This strategy may maximize grip surface contact, and hence grasp stability. These findings extend previous research showing that grasp planning not only takes place at a macroscopic level (whole-hand position relative to an object), but also at the level of individual digit placement. This finer level of control appears to be sensitive to the expected mechanical properties of the object and how these may affect grasp stability throughout the upcoming manipulation.

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