Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.

Physical disability has the potential to impede the use of environmental enrichments in rehabilitation programmes. We therefore compared the behaviour of 63 disabled and non-disabled socially housed adult Asiatic black bears rescued from bile farms for 103 observation hours. Amputees were less active than non-amputees, spent less time standing, travelled less between different areas of their outdoor enclosure, and showed less frequent stereotypic behaviour. Blind bears also showed low levels of activity and stereotypic behaviour. Blind bears and male amputees spent less time than non-disabled bears eating food dispersed throughout the enclosure as a foraging enrichment. It is unclear whether their infrequent eating is due to impaired foraging, or to lower energy demands arising from lower activity levels. Blind bears tended to manipulate feeders and other enrichment objects less than sighted bears. Disabled bears did not show any signs of impaired social interactions, and were not competitively displaced from resources by other bears more often than non-disabled bears. Thus, disabled bears rescued from bile farms show deficits in overall activity, with amputees also travelling less around their enclosures and blind bears potentially compromised in some forms of enrichment use. However, it is apparent that they adapt well to the presence of social companions. Several disabled bears also showed a degree of novel behaviour, seemingly compensating for disabilities, suggesting possible avenues for enrichments targeted specifically at these bears. The data also suggest specific hypotheses to test in longitudinal studies of rehabilitation.

To assist physically disabled people with impaired upper limb function, we have developed a new 7-DOF exoskeleton-type robot named Motion Assistive Robotic-Exoskeleton for Superior Extremity (ETS-MARSE) to ease daily upper limb movements and to provide effective rehabilitation therapy to the superior extremity. The ETS-MARSE comprises a shoulder motion support part, an elbow and forearm motion support part, and a wrist motion support part. It is designed to be worn on the lateral side of the upper limb in order to provide naturalistic movements of the shoulder (vertical and horizontal flexion/extension and internal/external rotation), elbow (flexion/extension), forearm (pronation/supination), and wrist joint (radial/ulnar deviation and flexion/extension). This paper focuses on the modeling, design, development, and control of the ETS-MARSE. Experiments were carried out with healthy male human subjects in whom trajectory tracking in the form of passive rehabilitation exercises (i.e., pre-programmed trajectories recommended by a therapist/clinician) were carried out. Experimental results show that the ETS-MARSE can efficiently perform passive rehabilitation therapy.

Motor impairments and cognitive dysfunction are common in multiple sclerosis (MS). We aimed to delineate the relationship between cognitive capacity and upper and lower motor function in 211 MS patients, and 120 healthy volunteers. Lower and upper motor function were assessed with the Timed 25 Foot Walk (T25FW) and the Nine Hole Peg Test (NHPT) as implemented in the Multiple Sclerosis Functional Composite (MSFC). Subjects also underwent neuropsychological evaluation. Hierarchical linear regression analysis was conducted separately for the MS and healthy groups with the T25FW and NHPT serving as the outcome measures. Cognitive performance indices served as predictors. As expected, healthy subjects performed better than the MS group on all measures. Processing speed and executive function tests were significant predictors of lower and upper motor function in both groups. Correlations were more robust in the MS group, where cognitive tests predicted variability in motor function after controlling for disease duration and physical disability. In conclusion, we find evidence of higher order cognitive control of motor function that appears to be particularly salient in this large and representative MS sample. The findings may have implications for risk assessment and treatment of mobility dysfunction in MS. (JINS, 2011, 17, 643–653)

A study was made of 26 adolescents, aged from 13 to 18 years, with different types of severe congenital heart disease, assessing their somatic condition and its impact on mental health and psychosocial functioning. Physical capacity was reduced, more pronounced in girls than in boys, along with an increased rate of psychiatric problems. Associations were found between physical capacity and psychosocial functioning, and between psychosocial functioning and chronic family difficulties. On the other hand, half the patients studied achieved fair function, both physically and with regard to their mental health. The degree of reduced physical capacity is an important etiological factor for impaired mental health in patients with congenital heart disease. This knowledge should be taken into account when dealing with this group of patients. A good social network seems to be a protective factor. It will probably be rewarding to give patients and their families not only an optimal medical follow-up, but also psychological, practical and financial support to improve or create such a network.

Objectives: As part of an outcome study of depression in older people, the relationship between physical disability and depression was explored at baseline and longitudinally. The aims were to identify whether illness in specific body systems or physical disability was associated with a poorer outcome of depression.

Method: Subjects over 65 with depression referred to an old age psychiatry service were recruited. Depression was diagnosed according to ICD-10 criteria. An in-depth initial assessment obtained data concerning depression severity and illness in specific body systems as well as disability levels. Objective and subjective ratings of health status were also made. Subjects were followed up at three, six, 12, 18, and 24 months. Ongoing assessments were made of depressive symptomatology and of physical status.

Results: Subjects with higher disability levels had more severe depression at baseline. There was no relationship between illness in specific body systems and depression severity. At follow up assessments, those with higher disability scores had poorer outcomes as recorded by depression rating scales and by reviewing the longitudinal course of depression in terms of proportions remaining well, suffering relapses or remaining depressed.

Conclusions: There is an ongoing relationship between depression and disability. Older people with greater physical disability have a poorer outcome of depression. Service providers should be aware of this relationship and respond rapidly and assertively to depression in older people with disability. There should be a lower threshold for initiating treatment in this population.

Only a few reports exist of plasma amino acid profiles in the oldest-old, and none exist of the oldest-old with cognitive problems. Therefore, we measured fasting plasma amino acid concentrations in twenty-three healthy community-dwellers aged 90–103 years (group A); eighteen community-dwellers with mild cognitive impairment without dementia aged 91–104 years (group B); thirty-three patients with dementia aged 96–100 years (group C); and sixty healthy young controls aged 20–50 years. Biochemical and anthropometric parameters, and the basic activities of daily living (ADL) were also measured. Independent of cognitive status, in all oldest-old groups, essential:non essential amino acids (EAA:NEAA) was lower than in young controls and positively associated with body muscle mass. Patients with dementia were further characterized by a negative association between EAA:NEAA and the number of dependent ADL. All oldest-old groups had higher values of tyrosine:other large neutral amino acids (LNAA) than young controls. Groups B and C also had a higher phenylalanine:other LNAA. These data show that abnormalities in plasma amino acid profile are common in oldest-old individuals independent of their cognitive status, but that, in oldest-old patients with dementia, they are associated with functional disability. The abnormalities in phenylalanine and tyrosine plasma availability could contribute to the cause or aggravation of concurrent cognitive problems because these amino acids are neurotransmitter precursors and compete with other LNAA for transport into the brain.

Research conducted primarily over the past 5–8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.