Effects of enhanced somatosensory information on postural stability in older people and people with Parkinson’s disease

The somatosensory system plays an important role in balance control and age-related changes to this system have been implicated in falls. Parkinson’s disease (PD) is a chronic and progressive disease of the brain, characterized by postural instability and gait disturbance. Previous research has shown that deficiencies in somatosensory feedback may contribute to the poorer postural control demonstrated by PD individuals. However, few studies have comprehensively explored differences in somatosensory function and postural control between PD participants and healthy older individuals. The soles of the feet contain many cutaneous mechanoreceptors that provide important somatosensory information sources for postural control. Different types of insole devices have been developed to enhance this somatosensory information and improve postural stability, but these devices are often too complex and expensive to integrate into daily life. Textured insoles provide a more passive intervention that may be an inexpensive and accessible means to enhance the somatosensory input from the plantar surface of the feet. However, to date, there has been little work conducted to test the efficacy of enhanced somatosensory input induced by textured insoles in both healthy and PD populations during standing and walking. Therefore, the aims of this thesis were to determine: 1) whether textured insole surfaces can improve postural stability by enhancing somatosensory information in younger and older adults, 2) the differences between healthy older participants and PD participants for measures of physiological function and postural stability during standing and walking, 3) how changes in somatosensory information affect postural stability in both groups during standing and walking; and 4), whether textured insoles can improve postural stability in both groups during standing and walking. To address these aims, Study 1 recruited seven older individuals and ten healthy young controls to investigate the effects of two textured insole surfaces on postural stability while performing standing balance tests on a force plate. Participants were tested under three insole surface conditions: 1) barefoot; 2) standing on a hard textured insole surface; and 3), standing on a soft textured insole surface. Measurements derived from the centre of pressure displacement included the range of anterior-posterior and medial-lateral displacement, path length and the 90% confidence elliptical area (C90 area). Results of study 1 revealed a significant Group*Surface*Insole interaction for the four measures. Both textured insole surfaces reduced postural sway for the older group, especially in the eyes closed condition on the foam surface. However, participants reported that the soft textured insole surface was more comfortable and, hence, the soft textured insoles were adopted for Studies 2 and 3. For Study 2, 20 healthy older adults (controls) and 20 participants with Parkinson’s disease were recruited. Participants were evaluated using a series of physiological assessments that included touch sensitivity, vibratory perception, and pain and temperature threshold detection. Furthermore, nerve function and somatosensory evoked potentials tests were utilized to provide detailed information regarding peripheral nerve function for these participants. Standing balance and walking were assessed on different surfaces using a force plate and the 3D Vicon motion analysis system, respectively. Data derived from the force plate included the range of anterior-posterior and medial-lateral sway, while measures of stride length, stride period, cadence, double support time, stance phase, velocity and stride timing variability were reported for the walking assessment. The results of this study demonstrated that the PD group had decrements in somatosensory function compared to the healthy older control group. For electrodiagnosis, PD participants had poorer nerve function than controls, as evidenced by slower nerve conduction velocities and longer latencies in sural nerve and prolonged latency in the P37 somatosensory evoked potential. Furthermore, the PD group displayed more postural sway in both the anterior-posterior and medial-lateral directions relative to controls and these differences were increased when standing on a foam surface. With respect to the gait assessment, the PD group took shorter strides and had a reduced stride period compared with the control group. Furthermore, the PD group spent more time in the stance phase and had increased cadence and stride timing variability than the controls. Compared with walking on the firm surface, the two groups demonstrated different gait adaptations while walking on the uneven surface. Controls increased their stride length and stride period and decreased their cadence, which resulted in a consistent walking velocity on both surfaces. Conversely, while the PD patients also increased their stride period and decreased their cadence and stance period on the uneven surface, they did not increase their stride length and, hence walked slower on the uneven surface. In the PD group, there was a strong positive association between decreased somatosensory function and decreased clinical balance, as assessed by the Tinetti test. Poorer somatosensory function was also strongly positively correlated with the temporospatial gait parameters, especially shorter stride length. Study 3 evaluated the effects of manipulating the somatosensory information from the plantar surface of the feet using textured insoles in the same populations assessed in Study 2. For this study, participants performed the standing and walking balance tests under three footwear conditions: 1) barefoot; 2) with smooth insoles; and 3), with textured insoles. Standing balance and walking were evaluated using a force plate and a Vicon motion analysis system and the data were analysed in the same way outlined for Study 2. The findings showed that the smooth and textured insoles caused different effects on postural control during both the standing and walking trials. Both insoles decreased medial-lateral sway to the same level on the firm surface. The greatest benefits were observed in the PD group while wearing the textured insole. When standing under a more challenging condition on the foam surface with eyes closed, only the textured insole decreased medial-lateral sway in the PD group. With respect to the gait trials, both insoles increased walking velocity, stride length and stride time and decreased cadence, but these changes were more pronounced for the textured insoles. The effects of the textured insoles were evident under challenging conditions in the PD group and increased walking velocity and stride length, while decreasing cadence. Textured insoles were also effective in reducing the time spent in the double support and stance phases of the gait cycle and did not increase stride timing variability, as was the case for the smooth insoles for the PD group. The results of this study suggest that textured insoles, such as those evaluated in this research, may provide a low-cost means of improving postural stability in high-risk groups, such as people with PD, which may act as an important intervention to prevent falls.

The Gold Coast marine precinct : pre-packaging entrepreneurship

We investigate the evolving quality of entrepreneurship in the Gold Coast Marine Precinct, a purpose-built industrial district in Southeast Queensland, Australia. Our findings are that the environment in the Precinct can be conducive to a better quality of entrepreneurship than may be feasible for firms in other settings; that a successful industrial district can be created artificially, with appropriate social relationships evolving afterwards; and that improvements in information and communications technology have undermined some aspects of traditional behaviour in the Precinct, but the essential nature of internal relationships remains intact.

Inside the pleasure dome : cultural tourism on Australia’s Gold Coast

The City of the Gold Coast in Queensland, Australia, will host the Commonwealth Games in 2018. In advance of the Games, the City is beginning to reposition the traditional marketing programs that were based around the four S’s- ‘sun, sand, surf and sex.’ There is a new emphasis on urban sophistication, sport, science, education and the environment. At the same time, local communities are asking for renewed attention to residential issues, particularly relating to recognising the importance of culture to the region. In this paper I explore the development of integrated computer technologies (ICTs) as a way of linking tourism, culture and place in the experience economy of the Gold Coast. The discussion is framed by theories of the post-tourist, contemporary cultural tourism and the role of mobile technologies, and the figure of the ‘referential tourist.’ An examination of stakeholder responses to changing business and social frameworks on the Gold Coast shows how discussions about a range of issues coalesce around cultural tourism. Local communities have the opportunity to engage with the new tourist as they move quickly between leisure and cultural experiences, at once connected to tourist expectations but increasingly self-directed. The Surfers Paradise Nights campaign, which is based around social media, is a case in point. This campaign aims to interest visitors in becoming a part of a familiar third place, an online space, but one that will sustain an emotive connection to the physical location and events. The paper also draws on research carried out in Brisbane, Queensland, in relation to building connections between place and culture on designated, self-directed journeys via iPhone technology. Participant responses indicate the importance of narrative to developing cultural frameworks.

Stakeholder engagement and asset management : a case study of the Gold Coast airport, Queensland

One of the fastest growing industries – aviation – faces serious and compounding challenges in maintaining healthy relationships with community stakeholders. One area in aviation creating community conflict is noise pollution. However, current understandings of the factors that affect noise annoyance of the community are poorly conceptualized. More importantly, the way community needs and expectations could be incorporated in airport governance has been inadequately framed to address the issue of aircraft noise. This paper proposes the util-ity of adopting an integrated strategic asset management (ISAM) framework [1] to explore the dynamic nature of relationships between and airport and its surrounding area. The case of the Gold Coast Airport (OOL) operator and community stakeholders is used. This paper begins with an overview of the ISAM framework in the context of airport governance and sustainable development – as a way to find a balance between economic opportunities and societal concerns through stakeholder engagement. Next, an exploratory case study is adopted as a method to explore the noise-related complaints, complainants, and possible causes. Fol-lowing this, the paper reviews three approaches to community stakeholder engagement in Australia, Japan, and UK and discusses their implications in the con-text of OOL. The paper concludes with a contention that airport governance is likely to be much more effective with the adoption of ISAM framework than without it.

Sustainable retirement village for older people: A case study in Brisbane, Australia

Retirement villages are regarded as a viable accommodation option for the ever increasing ageing population in Australia. This paper aims to identify sustainability features and practices adopted in retirement villages and associated benefits to improve the life quality of older people. A case study of an existing retirement village 10kms from Brisbane CBD was conducted involving a series of interviews with the village managers and residents together with documents relating to the village's operations and activities. The environmentally friendly features that were incorporated into the development mainly include green design for the site and floor plan and waste management in daily operation. More importantly, a variety of facilities are provided to strengthen the social engagement and interactions among the residents. Additionally, different daily services are provided to assist independent living and improve the health conditions of residents. Also, the relatively low vacancy rate in this village indicates that these sustainability features offer good value of money for the residents. The paper provides a first look at sustainable retirement villages in terms of triple bottom line sustainability with emphasis on social aspects, reveals the importance in maintaining an appropriate balance, and provides examples of how this can be achieved in practice.

The knowledge of doing: Exploring the knowledge of support to older people with an intellectual disability

This ethnography presents a contextualised understanding of frontline knowledge used in the support to people ageing with an intellectual disability who live in accommodation and support services in south-east Queensland. The study identified that disability support workers accessed a range of knowledges which they synthesised into a dynamic and responsive locale knowledge, and subsequently translated into everyday acts of support within contexts of multi-faceted complexity. Findings from the study have numerous implications for the knowledge development activities of formal service and educational systems within Australia's newly implemented National Disability Insurance Scheme.

The effectiveness of communication interventions in providing older people with information on access to in-home health and social care services: A systematic review protocol

The objective of this review is to locate, critically appraise and synthesize evidence on the effectiveness of communication strategies for providing older people access to information regarding in-home health and social care services. The review question is: What is the effectiveness of communication interventions in providing older people with information about in-home health and social care services?

Social networks and lifelong learning in older people

Various socio-demographic factors are causing our society to coexist every day with a group of elderly population that remains active and inserted into the daily dynamics. However, it is believed that there are certain barriers that make this group of people to not adequately address the technologies and even social networks. The creation of the University Programs for the Elderly (PUM), however, is leading to a new stage, since older people who participate come into contact with all kinds of content and rigor, updating own university education, thus changing the way to tackle the most innovative and different situations. In this study, we analyze what is the knowledge and use of older people, PUM, attending the University of Jaen have of the social networks and the assessment made of the need for these programs. To achieve this, we used a methodology in which qualitative and quantitative processes were articulated, through the analysis of data obtained from interviews and a focus groups with program Aquad 7. The data collected show that there is still some ignorance about social networks by older people, but everyone values their usefulness and necessity. Participants believe that they will be least affected of the risks of these technologies and demand a greater training in these contained within the PUM.

Older people's experience of utilisation and administration of medicines in a health- and social care context

BACKGROUND: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care. AIM: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care. DESIGN: A qualitative descriptive study. METHODS: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used. FINDINGS: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process. CONCLUSIONS: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine. RELEVANCE TO CLINICAL PRACTICE: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care.

Japanese investment on the Gold Coast : the interface of globalization and locality

This study explored the interface between the forces of globalization and a given place, at a given time, the Gold Coast during the 1980s. The global economic boom of the 1980s was one in which the role of Japan was particularly important. In less than half a decade capital flows from Japan surged to make it the world's largest investor. Locations in the Pacific Basin were favoured destinations for Japanese investment, one of the most significant was the Gold Coast. Japanese capital and tourism helped transform its urban area from a national resort to an international tourist destination and resort centre, The surge of capital arriving to the Gold Coast was a function of economic conditions in Japan, as was its steep reduction after November 1989, Thus the Gold Coast became integrated into global capital flows and so dependent on decisions made in Tokyo, one of the main financial centres of the world. However this study has also sought to explore a more complex reality; namely, that this place also became the interface of complex cultural forces and perceptions. The wealth of the Japanese investors on the Gold Coast enabled them to realize their dream of developing projects in the most fashionable global styles. These styles were essentially Western, and it was onto these that their Japanese owners ascribed their own meanings; meanings that reflected the cultural baggage that they had brought from Japan, and through which were filtered the economic and environmental realities of the Gold Coast. The Gold Coast as locality also included residents. Hence it became an interface between two different groups of people, the Japanese and the strongly Anglo-Celtic local community. Some in the local community perceived the Japanese presence as a threat to their perception of the Gold Coast, in fact, a threat to their perception of Australia's national identity. A campaign based on the politics of memory of the Japanese developed on the Gold Coast. Within weeks it became a national debate in which isolationalist, if not xenophobic traditionalists, concentrated on the Gold Coast challenged the economic rationalism and multicultural tolerance of the self-interested and ideologically convinced advocates of globalization. Governments at all levels sought to arbitrate, to legitimize standpoints, but more often than not were seen to move into positions of ineffectual flexibility. The forces of globalization on the Gold Coast were catalysts for change that in turn provoked local opposition which rapidly became a debate about national identity and direction. It is in the exploration of the complex and contradictory economic, cultural and political forces engendered by globalization that this study has sought to make a distinctive contribution.