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This study analyzed various components and compensatory strategies of balance in individuals with visual impairments. It found that people with visual impairments use different strategies to maintain balance than do sighted people, in an effort to trade efficiency for safety.A common problem associated with a visual impairment (blindness or low vision) is the use of sensory and vestibular information to establish patterns of movement and positions in space (efficient movement). Spatial concepts and the use of these concepts are required to maintain a base of support and center of gravity before one initiates a movement (Pereira, 1990). Concurrently, individuals must respond to changes in the environment by modifying and self-correcting their movement. For example, when a change in terrain or obstacles is encountered, they need to change their gait patterns to accommodate these changes.People with visual impairments place a greater demand on somatosensory and vestibular information to establish movement patterns, and their positions in space are compromised by the lack of vision or This study was supported by a grant from the Rehabilitation Research R&D Center, Atlanta VAMedical Center. minimal vision. Their orientation and mobility (O&M) depend on using sensory information other than vision to initiate changes in the center of gravity and in the base of support before they initiate a movement. Their standing balance is diminished because the loss of vision affects the vestibular system via feedback from the visual system (Maeda, Nakamuro, Otomo, Higuchi, & Motohashi, 1998). In addition, other compensatory mechanisms must provide the sensory input that is used to initiate movement and to complete the response if vision is not available or restricted. Although it appears that vision is essential for balance, especially in children, the lack of vision does not explain the movement difficulties that many individuals may encounter (Stones & Kozma, 1987).From a review of the literature, it is evident that visual impairments may affect movement in a variety of ways. For example, it is evident that major differences in movement between people who are sighted and those who are visually impaired occur

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Background: The shoulder mobility screen of the Functional Movement Screen™ (FMS™) and the upper extremity patterns of the Selective Functional Movement Assessment (SFMA) assess global, multi-joint movement capabilities in the upper-extremities. Identifying which assessment can most accurately determine if baseball players are at an increased risk of experiencing overuse symptoms in the shoulder or elbow throughout a competitive season may reduce throwing-related injuries requiring medical attention. Purpose: The purpose of this study was to determine if preseason FMS™ or SFMA scores were related to overuse severity scores in the shoulder or elbow during the preseason and competitive season. Study design: Cohort study. Methods: Sixty healthy, male, Division III collegiate baseball players (mean age = 20.1 ± 2.0 years) underwent preseason testing using the FMS™ shoulder mobility screen, and SFMA upper extremity patterns. Their scores were dichotomized into good and bad movement scores, and were compared to weekly questionnaires registering overuse symptoms and pain severity in the shoulder or elbow during the season. Results: Poor FMS™ performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason independent of grade and position (adjusted odds ratio [OR] = 5.14, p = 0.03). Poor SFMA performance was associated with an increased likelihood of experiencing at least one overuse symptom during the preseason (adjusted OR = 6.10, p = 0.03) and during the competitive season (adjusted OR = 17.07, p = 0.03) independent of grade and position. Conclusion: FMS™ shoulder mobility and SFMA upper extremity pattern performance were related to the likelihood of experiencing overuse symptoms during a baseball season. Participants with poor FMSTM performances may be more likely to experience at least one overuse symptom in their shoulder or elbow during the preseason. Additionally, individuals with poor SFMA performances may be more likely to report overuse symptoms during the preseason or competitive season.

Approximately 3.8 million persons over age 65 are visually impaired (that is, are blind or have low vision), of whom about 173,000 are legally blind veterans (Department of Veterans Affairs, 2003). The population of legally blind veterans is projected to increase to nearly 1 million by 2010 (Veterans Benefits Administration, 2001). As these demographic changes occur, it is important to gain a better understanding of the effects of orientation and mobility (O&M) training on older people with visual impairments, including those served by the Georgia Veterans Affairs Blind Rehabilitation Center (BRC), on specific movement functions, especially gait and balance, and the potential for falls and injury. The lack of objective quantitative functional measures related to the outcomes of rehabilitation programs serving visually impaired persons limits the documentation and improvement of services to legally blind veterans. REVIEW OF THE LITERATUREThere are no protocols for determining changes in gait and balance in visually impaired persons who have completed O&M instruction at the BRC. Current assessments of patients' O&M skills are done through qualitative evaluations by mobility instructors in the form of "dropoff' lessons (Long, Rieser, & Hill, 2000 and/or "critical incident mobility assessment" (Geruschat, Turano, & Stahl, 1998). Yet, quanti-This project was funded by the Department of Veterans Affairs, Office of Rehabilitation Research and Development, Project C1861P.tative parameters for gait and balance are available and are predictive of a reduced ability to negotiate safely in one's environment and the risk of falls among older sighted people (Buchner et aI., 1996; Kressig et. aI., 2001;Watelain, Barbier, Allard, Thevenon, & Angue, 2000). Since there is a high correlation between physical function (i.e., gait, balance) and the ability to perform activities of daily living (ADLs), which include moving efficiently and safely in the environment as taught in O&M training, it is a logical step to measure functional parameters as a means of predicting an individual's ability to incorporate O&M skills into his or her daily routine. More quantitative measures of gait and balance may thus be useful outcome measures of O&M training. The use of such biomechanical measures may help BRC programs assess the effects of training on mobility problems and the risk of falls.Measures of gait and balance for sighted adults across the life span have been well documented in the literature and are predictive of function and the risk of falls in older individuals