Normal Changes in Gait and Mobility Problems in the Elderly

The Contribution of Machine Learning in the Validation of Commercial Wearable Sensors for Gait Monitoring in Patients: A Systematic Review

Gait, balance, and coordination are important in the development of chronic disease, but the ability to accurately assess these in the daily lives of patients may be limited by traditional biased assessment tools. Wearable sensors offer the possibility of minimizing the main limitations of traditional assessment tools by generating quantitative data on a regular basis, which can greatly improve the home monitoring of patients. However, these commercial sensors must be validated in this context with rigorous validation methods. This scoping review summarizes the state-of-the-art between 2010 and 2020 in terms of the use of commercial wearable devices for gait monitoring in patients. For this specific period, 10 databases were searched and 564 records were retrieved from the associated search. This scoping review included 70 studies investigating one or more wearable sensors used to automatically track patient gait in the field. The majority of studies (95%) utilized accelerometers either by itself (N = 17 of 70) or embedded into a device (N = 57 of 70) and/or gyroscopes (51%) to automatically monitor gait via wearable sensors. All of the studies (N = 70) used one or more validation methods in which “ground truth” data were reported. Regarding the validation of wearable sensors, studies using machine learning have become more numerous since 2010, at 17% of included studies. This scoping review highlights the current state of the ability of commercial sensors to enhance traditional methods of gait assessment by passively monitoring gait in daily life, over long periods of time, and with minimal user interaction. Considering our review of the last 10 years in this field, machine learning approaches are algorithms to be considered for the future. These are in fact data-based approaches which, as long as the data collected are numerous, annotated, and representative, allow for the training of an effective model. In this context, commercial wearable sensors allowing for increased data collection and good patient adherence through efforts of miniaturization, energy consumption, and comfort will contribute to its future success.

Improving Digital Patient Care: Lessons Learned from Patient-Reported and Expert-Reported Experience Measures for the Clinical Practice of Multidimensional Walking Assessment

Background: Walking assessment (WA) enables meaningful patient mobility assessment. In this context, patient satisfaction with WA can influence assessment compliance and indirectly affect outcomes. One opportunity to assess patient satisfaction is patient-reported and expert-reported experience measures (PREM). Research on PREMs and WA in daily clinical multiple sclerosis (MS) practice does not exist yet. Methods: We surveyed people with MS about their experience and assessed healthcare professionals’ experience via an interview after patients completed WA. Results: Gait parameters were related to perceived difficulty and strain during performance. Less impaired patients perceived the WA to be less difficult and exhausting but were less likely to use WA results for themselves. Men and patients with higher impairment would perform WA more frequently. A good workflow, a fully performed WA with standardized testing, fully functional measurement systems, support and safeguarding by staff in case of falls, direct feedback after the testing, and patients’ motivation are identified by the experts as necessary factors for a successful WA. Conclusions: As patients’ experience has an impact on patients’ outcomes, long-term monitoring of PREMs should become an integral part of the healthcare service to identify and avoid problems early.

Reasons for Exclusion of Apparently Healthy Mature Adult and Senior Dogs From a Clinical Trial

Background: Interventional clinical trials intended to maintain health in aging dogs are unusual and require particular attention to exclusion criteria.

Objectives: To describe reasons for exclusion when a mature adult and senior canine population with normal health status was sought.

Animals: Fifty six companion dogs nominated for a randomized controlled trial (RCT).

Procedures: Exclusions occurred within Stage 1 (S1): owner-provided survey information; Stage 2 (S2): medical records review; and Stage 3 (S3): screening examination and within Owner, Dog, or Other factor categories.

Results: Of 56 nominated dogs, 39 were excluded at S1 (n = 19), S2 (n = 5), and S3 (n = 15), respectively. Dogs were excluded for Owner (n = 4), Dog (n = 27), Other (n = 6), and concurrent (Owner + Dog; n = 2) factors. The most common exclusion period was S1 (n = 19), with weight outside the target range being the most common exclusion factor in that stage (n = 10). Heart murmurs were the second most common exclusion factor (S1: n = 1; S3: n = 5); suspected or confirmed systemic illness was third most common (S1: n = 2; S2: n = 3; S3: n = 2). Among dogs who passed S1 and S2 screening (n = 32), 15 dogs (48%) were excluded at S3, for heart murmur > grade II/VI (n = 5), cardiac arrhythmias (n = 2), and clinicopathologic abnormalities (n = 2).

Conclusions and Clinical Relevance: Dogs nominated for a clinical trial for healthy mature adult and senior dogs were excluded for size, previous diagnoses, and newly discovered cardiac abnormalities. For future interventions in mature adult and senior dogs of normal health status, it is important to define expected age-related abnormalities to ensure that meaningful exclusion criteria are used.

ENHANCED ACTIVE CONTRACTION OF THE TRANSVERSUS ABDOMINIS DURING WALKING

ABSTRACT Introduction: We applied three-dimensional gait analysis to assess the effects of enhanced active contraction of the transversus abdominis (EACTA) during walking. We sought to evaluate the effect of EACTA during walking in order to improve walking quality. Methods: Thirty college students were recruited and trained to perform EACTA during walking. We examined gait parameters under different conditions, including EACTA and habitual ACTA (natural walking with mild contraction of the feedforward mechanism of ACTA, HACTA) during walking using three-dimensional gait analysis. We compared differences in gait parameters under the two walking conditions using SPSS 16.0 statistical software. Results: The following gait parameters were significantly lower under EACTA conditions than under HACTA conditions (P < 0.05): stance phase, 59.151% ± 1.903% vs. 59.825% ± 1.495%; stride time, 1.104 s ± 0.080 s vs. 1.134 s ± 0.073 s:; stance time, 0.656 s ± 0.057 s vs. 0.678 s ± 0.053 s; and swing time, 0.447 s ± 0.028 s vs. 0.454 s ± 0.031 s, respectively. Gait parameters single support phase and mean velocity were significantly higher for EACTA than for HACTA conditions (both P < 0.05). Conclusions: Overall, the results revealed that EACTA during walking can improve gait. This method is simple, and EACTA training during walking to improve gait quality in daily life could provide a positive basis for people to strengthen the transverse abdominal muscle. Level of evidence III; Retrospective comparative study .

Rehabilitation Nutrition and Exercise Therapy for Sarcopenia

Sarcopenia is an age-related loss of skeletal muscle associated with adverse outcomes such as falls, fractures, disability, and increased mortality in older people and hospitalized patients. About half of older male nursing home residents have sarcopenia. The diagnostic criteria by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) have led to increased interest in sarcopenia. Exercise and nutritional management are crucial for the prevention and treatment of sarcopenia. Nutritional therapy for sarcopenia that includes 20 g of whey protein and 800 IU of vitamin D twice a day improves lower limb strength. Exercise therapy for sarcopenia, such as resistance training and 6 months of home exercises, improves muscle strength and physical function. Combination therapy that includes both nutritional and exercise therapy improves gait speed and knee extension strength more than either exercise alone or nutrition therapy alone. Excessive bedrest and mismanagement of nutrition in medical facilities can lead to iatrogenic sarcopenia. Iatrogenic sarcopenia is sarcopenia caused by the activities of health care workers in health care facilities. Appropriate nutritional management and exercise programs through rehabilitation nutrition are important for prevention and treatment of iatrogenic sarcopenia. Nutritional and exercise therapy should be started very early after admission and adjusted to the level of inflammation and disease status. Repeated assessment, diagnosis, goal setting, interventions, and monitoring using the rehabilitation nutrition care process is important to maximize treatment effectiveness and improve patients' functional recovery and quality of life.

Correlation between clinical tests for gait and stability using biomechanical variables in the gait of institutionalized elderly subjects

Study aim: This study aims to identify biomechanical gait variables explaining clinical test results in institutionalized elderly people.

Material and methods: Twenty-nine elderly (82.0 ± 6.3 years) residents in a nursing home were assessed. They were able to walk 10 meters without walking aids. First, the spontaneous gait was assessed using inertial measurement units in a 10-meter long corridor. Fifteen biomechanical gait variables were analyzed. Then, three clinical tests usually used in elderly subjects were applied: the Timed Up and Go (TUG) test, the Tinetti Scale and the Sit to Stand (STS) test. A correlation matrix using Pearson’s correlation coefficient between clinical and biomechanical variables was performed, obtaining a total of 45 potential correlations. A stepwise multiple linear regression analysis was then performed to determine the influence of each variable.

Results: TUG, Tinetti and STS were significantly correlated with similar biomechanical variables, including temporal, temporo-spatial and kinematic variables. Adults over 80 years old and women showed stronger correlations. Single support and ankle angle at takeoff were the two most important variables in stepwise regression analysis.

Conclusions: In institutionalized elderly subjects, clinical variables for gait and postural stability are correlated with the biomechanical gait variables, especially in women and adults aged over 80 years.

Increased Likelihood of Falling in Older Cannabis Users vs. Non-Users

Cannabis is one of the most common drugs in the United States and is the third most prevalent substance consumed by adults aged 50 years and older. Normal aging is associated with physiological changes that make older adults vulnerable to impaired function and geriatric conditions (e.g., falls, cognitive impairment). However, the impact of medical cannabis use on fall risk in older adults remains unexplored. The purpose of this study was to investigate if cannabis use in older adults influences fall risk, cognitive function, and motor function. It was hypothesized that older chronic cannabis users would perform worse than non-users on gait, balance, and cognitive tests. Sixteen older adults, split into cannabis Users and age- and sex-matched Non-Users groups (n = 8/group), participated in the study. The results indicate a higher fall risk, worse one leg standing balance performance, and slower gait speed in Users vs. Non-Users. No significant differences in cognitive function were found. Thus, chronic cannabis use was purported to exacerbate the poorer balance control and slower gait velocity associated with normal aging. Future mechanistic (e.g., neuroimaging) investigations of the short- and long-term effects of using a variety of cannabis products (e.g., THC/CBD ratios, routes of administration) on cognitive function, motor function, and fall incidence in older adults are suggested.

Age-related changes in postural control in older women: transitional tasks in step initiation

Background

Aging, being a natural process, involves many functional and structural changes within the body. Identifying the age-related postural changes will provide insight into the role of aging on postural control during locomotion. The aim of this study was to identify age-related postural changes during a transitional task under different conditions.

Methods

Sixty healthy females divided into three age groups: A (50-60 y/o), B (60-70 y/o), and C (70-80 y/o). The transitional task was measured by two force platforms. The procedure consisted of three phases: quiet standing, transfer onto a second platform, and quiet standing on the second platform. Four different conditions were applied: unperturbed transfer, obstacle crossing, step-up, and step-down. Double-support time, transit time, and stability time before and after the step task were analyzed.

Results

The transit time was longer by 30% for subjects over 70 y/o. The double-support time was longer by 11% among adults 60-70 y/o, while in people over 70 y/o it was longer by almost 50% compared to the 50-60 y/o subjects. The stability time before the transitional task was longer by 17% among adults over 60 y/o compared to middle-age subjects. The stability times before and after the transitional task were longer for adults in the 50-60 y/o category.

Conclusion

The proposed procedure is adequate for assessing age-related changes in postural control while undergoing a transitional task. An analysis of the double-support time and stability time before and after the step task enabled the detection of early signs of balance changes in middle-age adults. Independent of age, the transitional task parameters changed with the increasing difficulty of the tasks.

Predictive factors of functional mobility in older women after 12 weeks of resistance training

To analyze the association between functional mobility and anthropometric and functional characteristics of older women after 12 weeks of resistance training. METHODS: Forty-seven community-dwelling older women underwent 12 weeks of supervised resistance training twice a week. The dependent variable (mobility measured by the Timed Up and Go test) and the independent variables (age, body mass index, fat-free mass of the lower limbs, waist circumference, peak knee torque at 60º/s, peak knee torque at 180º/s, functional reach test, and 30-second chair stand test) were measured before and after the intervention. RESULTS: A multivariate analysis showed that age, body mass index, waist circumference, and the 30-second stand test predicted 30% (R2 = 0.30; p = 0.001; F = 5.53) of the total variance regarding an improvement in mobility after resistance training (p < 0.0001; [95% CI 0.72–1.20]; the effect size was considered large [0.90]) when comparing women before and after the intervention. CONCLUSIONS: Age, body mass index, waist circumference, and the 30-second stand test predicted 30% of the increase in functional mobility.

Psychometric Evaluation of an ICF-Based Instrumental Activities of Daily Living Assessment With Older Adults With Cognitive Decline

IMPORTANCE

Identifying cognitive or physical limitations that contribute to difficulties in instrumental activities of daily living (IADLs) is critical for adequate intervention with community-dwelling older adults with cognitive decline.

OBJECTIVE

To establish the validity and responsiveness of an IADL scale based on the International Classification of Functioning, Disability and Health (the ICF-IADL) with respect to both cognitive and physical limitations.

DESIGN

Cross-sectional study.

SETTING

Multiple community care and senior centers.

PARTICIPANTS

Eighty-two older adults.

INTERVENTION

Combination of physical exercise and cognitive training.

MEASURES

Five criterion measures-Lawton IADL Scale, Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSS), Word Lists Test (WLT), and Timed Up and Go Test (TUG).

RESULTS

The ICF-IADL's three summary scales-Disability Index (DI), Cognitive Disability Index (CDI), and Physical Disability Index (PDI)-had good concurrent validity with the Lawton IADL Scale. The DI and CDI had moderate to good associations with the MoCA. The DI's and CDI's predictive validity for scores on the Lawton IADL Scale, MoCA, and TUG was moderate to good and that of the PDI was fair. Responsiveness was large for the DI, moderate for the CDI, and small for the PDI.

CONCLUSIONS AND RELEVANCE

The ICF-IADL can be used to measure disability in IADLs related to cognitive and physical limitations. The DI and CDI were better than the PDI in predicting outcomes in general cognitive function and dynamic balance and were more responsive to change after intervention than the PDI.

WHAT THIS ARTICLE ADDS

The ICF-IADL addresses both cognitive and physical limitations and can be a valid assessment of IADLs. Occupational therapists can use it to determine difficulties in IADLs and causes of those difficulties, guide treatment planning, and monitor intervention effectiveness with community-dwelling older adults with cognitive decline.

Effects of individual progressive single- and dual-task training on gait and cognition among older healthy adults: a randomized-controlled comparison study

PURPOSE

Dual-task training has beneficial effects on older individuals for gait and cognition. This study was aimed to make a comparison between the effects of individual progressive single- and dual-task training on gait and cognition among healthy older individuals.

METHODS

A total of 32 participants were divided randomly into two groups as the single-task group (n = 16, 64.6 ± 3.3 years, 7 males and 9 females) and dual-task group (n = 16, 65.6 ± 2.6 years, 8 males and 8 females). The 10-m walk test with the LEGSys device was used to assess spatio-temporal gait parameters. The cognitive parameters were evaluated using the Standardized Mini-Mental State Exam and Stroop Test. An individual progressive 60 min single- and dual-task training programs were applied twice per week for a period of 6 weeks.

RESULTS

There were significant differences for both gait and cognition variables in the dual-task training group (p < 0.05), according to the comparison of pre- and post-treatment results. In the single-task training group, there were significant differences only in gait parameters with single-task conditions (p < 0.05). The comparisons of the delta values between the groups indicated that the dual-task training group was better compared to the single-task training group in gait speed, cadence, and many cognitive variables (p < 0.05).

CONCLUSION

Individual progressive dual-task training is an effective and useful method that improves gait performance and cognitive skills among older individuals.

TRIAL REGISTRATION NUMBER AND DATE

NCT03777111, 12/13/2018.

Mobility in Older Community-Dwelling Persons: A Narrative Review

Due to the demographic changes and the increasing awareness of the role of physical function, mobility in older age is becoming an important topic. Mobility limitations have been reported as increasingly prevalent in older persons affecting about 35% of persons aged 70 and the majority of persons over 85 years. Mobility limitations have been associated with increased fall risk, hospitalization, a decreased quality of life, and even mortality. As concepts of mobility are multifactorial and complex, in this narrative review, definitions, physical factors, and their age-related changes associated with mobility will be presented. Also, areas of cognitive decline and their impact on mobility, as well as neuromuscular factors related to mobility will be addressed. Another section will relate psychological factors such as Fall-related psychological concerns and sedentary behavior to mobility. Assessment of mobility as well as effective exercise interventions are only shortly addressed. In the last part, gaps and future work on mobility in older persons are discussed.

Dispersion of knee helical axes during walking in young and elderly healthy subjects

Knee joint rotation center displacement can be estimated in vivo through the analysis of helical axis (HAs) dispersion. HAs can be analyzed during walking, providing information on joint stability. The study aim was to describe knee HAs dispersion during walking in dominant and non-dominant legs of young and elderly healthy subjects. Twenty young (YG: age 23.3 ± 2.4 years) and twenty elderly (EG: age 69.3 ± 4.6 years) healthy subjects were asked to walk on a treadmill at a self-selected speed with reflective markers placed bilaterally on thighs and shanks to detect HAs dispersion and knee kinematics with an optoelectronic system. HAs dispersion was described during the following four phases of gait cycle: (1) flexion from 95% of the previous gait cycle to 10% of the subsequent gait cycle, (2) extension from 10% to 40%, (3) flexion from 40% to 75% and (4) extension from 75% to 95% of the gait cycle. Mean Distance (MD) and Mean Angle (MA) were used as HAs dispersion indexes during each gait phase. Participants showed greater MD and MA in sagittal and frontal planes during the first and second phases. EG revealed higher MD (p = 0.001) and MA (p < 0.001) during the first phase and higher MA (p = 0.001) during the fourth phase in both dominant and non-dominant legs on the sagittal plane. HAs dispersion could be related to the amount of forces acting on knee (first two phases) and knee degeneration (elderly). These results may be used as reference data in further studies on HAs dispersion in presence of knee pathologies or after knee surgery or rehabilitation.

Low-trauma ankle fractures in Brazil: secular trends in patients over 50 years old from 2004 to 2013

PURPOSE

The most common sites of low-energy trauma fractures are the femur, vertebra, humerus, and forearm. Ankle fractures have significant morbidity and high costs for surgical procedure. Forearm fractures are common nonvertebral fractures. Forearm fractures are classified as fragility fractures and predictive for fractures at other sites, although do not allow osteoporosis diagnosis. It is controversial whether ankle fractures are osteoporosis fractures.

METHODS

Retrospective observational study, with secular trend analysis, in patients over 50 years old admitted in the Brazilian Public Health System, from 2004 to 2013. We collected hospitalization data according to the ICD-10 for low-trauma ankle and forearm fractures. Fracture rate was calculated according to gender, age, and geographic region, performed linear regression analysis, and estimated fracture rates for 2030. Comparison of ankle and forearm rates was also performed, grouping them in 3-year block. ANOVA test was used to compare each block.

RESULTS

Ankle fracture rate was 21.39 fractures per 100,000 inhabitants, 23.98 in females and 18.49 in males. Fracture rates were higher in the South and Southeast regions. In absolute numbers, although ankle fracture rate increased with age, there was a significant decrease in the population over 80 years old. Data showed stabilization in ankle fractures from 2004 to 2013, in women and men. In 3-year block analysis, men had higher ankle fracture rates than forearm. However, in women, forearm rates were higher than ankle.

CONCLUSION

Our data suggest that ankle fractures in men would be considered as a sentinel fracture with a similar clinical impact of forearm fracture.

The effects of dual-task cognitive interference on gait and turning in Huntington's disease

Huntington’s disease (HD) is characterized by motor, cognitive, and psychiatric dysfunction. HD progression causes loss of automaticity, such that previously automatic tasks require greater attentional resources. Dual-task (DT) paradigms and fast-paced gait may stress the locomotor system, revealing deficits not seen under single-task (ST). However, the impact of gait “stress tests” on HD individuals needs further investigation. Therefore, the aims of this study were to investigate whether: 1) fast-paced and dual-task walking uncover deficits in gait and turning not seen under single-task, 2) cognitive and gait outcomes relate to fall incidence, and 3) gait deficits measured with wearable inertial sensors correlate with motor symptom severity in HD as measured by the Unified Huntington’s disease Rating Scale-total motor score (UHDRS-TMS). Seventeen HD (55 ± 9.7 years) and 17 age-matched controls (56.5 ± 9.3 years) underwent quantitative gait testing via a 25m, two-minute walk test with APDM^TM inertial sensors. Gait was assessed under a 1) ST, self-selected pace, 2) fast-as-possible (FAP) pace, and 3) verbal fluency DT. The UHDRS-TMS and a cognitive test battery were administered, and a retrospective fall history was obtained. During ST, DT, and FAP conditions, HD participants demonstrated slower gait, shorter stride length, and greater lateral step and stride length variability compared to controls (p<0.00001 to 0.034). Significant dual-task costs (DTC) were observed for turns; HD participants took more time (p = 0.013) and steps (p = 0.028) to complete a turn under DT compared to controls. Higher UHDRS-TMS correlated with greater stride length variability, less double-support, and more swing-phase time under all conditions. Decreased processing speed was associated with increased gait variability under ST and FAP conditions. Unexpectedly, participant’s self-reported falls did not correlate with any gait or turn parameters. HD participants demonstrated significantly greater DTC for turning, which is less automatic than straight walking, requiring coordination of body segments, anticipatory control, and cortical regulation. Turn complexity likely makes it more susceptible to cognitive interference in HD.

Capacidade de avaliação de testes de desempenho físico para identificar baixa massa muscular em mulheres de meia-idade e idosas

Resumo Objetivo Verificar a capacidade de avaliação de testes de desempenho físico na identificação da baixa massa muscular (MM) em mulheres de meia-idade e idosas. Método Estudo transversal realizado com 540 mulheres de meia-idade (40-59 anos) e idosas (≥60 anos), nos municípios de Parnamirim e Santa Cruz, no Rio Grande do Norte, Brasil. Foram avaliadas MM, força de preensão palmar, extensão de joelho e velocidade da marcha. A baixa MM foi definida pelo índice de massa muscular esquelética menor que os 20% mais baixos para cada grupo de idade. Foram utilizados os testes: t de Student, qui-quadrado, análise de curva ROC para calcular a área sob a curva e ponto de corte de cada teste na discriminação das participantes com baixa MM. Foi considerado p<0,05 e IC de 95%. Resultados Para o grupo de meia-idade, as forças de preensão palmar e de extensão do joelho apresentaram sensibilidade (71,6% e 72,5%, respectivamente) e especificidade (59,4% e 56,0%, respectivamente) moderadas na identificação de baixa MM. Para as idosas, a velocidade da marcha e a força de preensão manual apresentaram boa sensibilidade (77,8% e 81,6%, respectivamente) e especificidade moderada (51,4% e 64,5%, respectivamente). A capacidade discriminatória da velocidade da marcha para as mulheres de meia-idade e da força de extensão do joelho para as mulheres idosas foi insatisfatória. Conclusão As medidas de força muscular são úteis para a triagem de baixa MM em mulheres de meia-idade, enquanto os testes de força de preensão manual e velocidade de marcha são úteis para idosas.

Effects of pre-surgery physiotherapy on walking ability and lower extremity strength in patients with degenerative lumbar spine disorder: Secondary outcomes of the PREPARE randomised controlled trial

BACKGROUND

Degenerative lumbar spine disorders are common among musculoskeletal disorders. When disabling pain and radiculopathy persists after adequate course of rehabilitation and imaging confirms compressive pathology, surgical decompression is indicated. Prehabilitation aiming to augment functional capacity pre-surgery may improve physical function and activity levels pre and post-surgery. This study aims to evaluate the effect and dose-response of pre-surgery physiotherapy on quadriceps femoris strength and walking ability in patients with degenerative lumbar spine disorders compared to waiting-list controls and their association with postoperative physical activity level.

METHOD

In this single blinded, 2-arm randomised controlled trial, 197 patients were consecutively recruited. Inclusion criteria were: MRI confirmed diagnosis and scheduled for surgery due to disc herniation, lumbar spinal stenosis, degenerative disc disease or spondylolisthesis, ages 25-80 years. Patients were randomised to 9 weeks of pre-surgery physiotherapy or to waiting-list. Patient reported physical activity level, walking ability according to Oswestry Disability Index item 4, walking distance according to the SWESPINE national register and physical outcome measures including the timed ten-meter walk test, maximum voluntary isometric quadriceps femoris muscle strength, patient-rated were collected at baseline and follow-up. Parametric or non-parametric within and between group comparisons as well as multivariate regression was performed.

RESULTS

Patients who received pre-surgery physiotherapy significantly improved in all variables from baseline to follow-up (p < 0.001 - p < 0.05) and in comparison to waiting-list controls (p < 0.001 - p < 0.028). Patients adhering to ≥12 treatment sessions significantly improved in all variables (p < 0.001 - p < 0.032) and those receiving 0-11 treatment session in only normal walking speed (p0.035) but there were no significant differences when comparing dosages. Physical outcome measures after pre-surgery physiotherapy together significantly explain 27.5% of the variation in physical activity level 1 year after surgery with pre-surgery physical activity level having a significant multivariate association.

CONCLUSION

Pre-surgery physiotherapy increased walking ability and lower extremity strength in patients with degenerative lumbar spine disorders compared to waiting-list controls. A clear treatment dose-response response relationship was not found. These results implicate that pre-surgery physiotherapy can influence functional capacity before surgical treatment and has moderate associations with maintained postoperative physical activity levels mostly explained by physical activity level pre-surgery.

TRIAL REGISTRATION

NCT02454400 . Trial registration date: August 31st 2015, retrospectively registered.

Advanced Age Is Not a Barrier to Total Knee Arthroplasty: A Detailed Analysis of Outcomes and Complications in an Elderly Cohort Compared With Average Age Total Knee Arthroplasty Patients

BACKGROUND

Life expectancy and higher complication rates have made the routine use of total knee arthroplasty (TKA) in elderly patients disputed by some authors. The purpose of this study was to assess patient and implant survivorship, complication and revision rates, and patient-reported outcomes (PROMS) in a cohort of patients aged above 80 years undergoing TKA. A comparison with a propensity matched cohort of patients of average age within our database for TKA was performed.

METHODS

A retrospective review of prospectively collected data identified 644 patients over the age of 80 years undergoing a TKA within a 14-year period. After calculating the average age of all TKA patients within the reviewed database, a cohort deemed average age was created within 1 standard deviation of the average age and matched using the following criteria: gender, surgeon, diagnosis, procedure type, and year. The primary outcomes were survivorship of the implant and the patient. The secondary outcomes were complications, transfusion rates, discharge destination, and PROMS.

RESULTS

The revision rate was low for both groups (P = .051). Implant survivorship at 10 years was similar (P = .07). Mortality rate was higher in the elderly (P < .001). General complication rate was higher in the elderly (P = .031). Surgical complications rates were similar (P = .702). The PROMS at final follow-up were 4% lower in the elderly (P < .001).

CONCLUSION

TKA in the elderly is a safe procedure. With measures minimizing the perioperative complications and blood loss, the outcome can be expected to be similar to patients of average age. The projected implant and patient survivorship in the elderly cohort is long enough to suggest that TKA in the elderly could have a high impact on remaining quality of life. Level III retrospective study.

IS MUSCULAR AND FUNCTIONAL PERFORMANCE RELATED TO GAIT SYMMETRY IN OLDER ADULTS? A SYSTEMATIC REVIEW

BACKGROUND

Gait asymmetries are a matter of discussion concerning gait adaptation in older adults. While most studies perform unilateral gait assessments, the hypothesis that asymmetry in gait biomechanics is influenced by muscular and functional performance in older people needs to be confirmed.

PURPOSE

Here we performed a systematic review (CRD42018093189) to discuss the relationship between muscular and functional performance and gait asymmetries in older adults.

MATERIALS AND METHODS

Searches were performed using Medline via Pubmed, Scopus, PEDro, Cochrane Central, and Lilacs databases. Studies investigating leg asymmetries during overground locomotion and recording kinetics, kinematics or muscular activation parameters to determine at least one muscular or functional parameter were included.

RESULTS

Findings show that gait asymmetries, especially in step temporal parameters, are mainly related to functional outcomes, but the relationship with muscular performance was not possible to determine.

CONCLUSIONS

The relationship of gait asymmetry with muscular performance is still unknown, and there is a lack of investigations. Improvements in performance of functional tasks lead to a more symmetric gait.

Classification of arm swing as a clinical marker of advancing spinal deformity among community-dwelling female volunteers 60 years or older

The clinical characteristics of adult spinal deformity (ASD) include worsening of deformity during gait, which leads to unstable posture and propensity to fall. The purpose of this study was to classify arm swing and to analyse its clinical implications. Clinical and radiographic evaluations were performed with 168 community-dwelling female volunteers recruited from a population register in Hokkaido, Japan, with a mean age of 67.3 ± 4.7 years, and arm swing was classified into four groups according to maximum forward and backward arm swing distance: (1) predominantly forward swing with forward swing always larger than backward swing (FS, n = 138), (2) equal or equivocal swing (ES, n = 8), (3) predominantly backward swing with backward swing always larger than forward swing (BS, n = 20), and (4) thigh-hand type without arm swing with their hands placed on thighs (TH, n = 2). BS and FS showed significant differences in radiographic lumbar lordosis (BS 19.4 ± 18.1° vs. FS 40.6 ± 14.5°, P < 0.01 ANOVA), pelvic tilt (BS 40.0 ± 7.3° vs. FS 22.9 ± 8.9°, p < 0.01), number of vertebral fractures (BS 1.2 ± 1.4 vs. FS 0.3 ± 0.6, p < 0.01), and trunk extensor muscle strength (BS 374.9 ± 134.8 N vs. FS 478.1 ± 172.6 N, p < 0.05). Arm swing correlated with severity of radiographic ASD, osteoporotic changes, and back muscle weakness. The number of ASD patients, which includes patients with de novo/idiopathic scoliosis, degenerative/osteoporotic kyphosis, and other neuromuscular deformities, has been increasing, and further study should clarify the importance of dynamic evaluation of ASD among elderly patients.

Oscillatory Corticospinal Activity during Static Contraction of Ankle Muscles Is Reduced in Healthy Old versus Young Adults

Aging is accompanied by impaired motor function, but age-related changes in neural networks responsible for generating movement are not well understood. We aimed to investigate the functional oscillatory coupling between activity in the sensorimotor cortex and ankle muscles during static contraction. Fifteen young (20–26 yr) and fifteen older (65–73 yr) subjects were instructed to match a target force by performing static ankle dorsi- or plantar flexion, while electroencephalographic (EEG) activity was recorded from the cortex and electromyographic (EMG) activity was recorded from dorsi- (proximal and distal anterior tibia) and plantar (soleus and medial gastrocnemius) flexor muscles. EEG-EMG and EMG-EMG beta band (15–35 Hz) coherence was analyzed as an index of corticospinal activity. Our results demonstrated that beta cortico-, intra-, and intermuscular coherence was reduced in old versus young subjects during static contractions. Old subjects demonstrated significantly greater error than young subjects while matching target forces, but force precision was not related to beta coherence. We interpret this as an age-related decrease in effective oscillatory corticospinal activity during steady-state motor output. Additionally, our data indicate a potential effect of alpha coherence and tremor on performance. These results may be instrumental in developing new interventions to strengthen sensorimotor control in elderly subjects.

Effect of interactive cognitive motor training on gait and balance among older adults: A randomized controlled trial

BACKGROUND

Aging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals' physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation.

OBJECTIVES

To investigate the effect of interactive cognitive motor training on older adults' gait and balance from immediate to long-term time points.

DESIGN

A double-blind randomized control trial.

SETTINGS

Four senior service centers and community service centers in Taiwan.

PARTICIPANTS

62 older adults who met the inclusion criteria.

METHODS

The study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests.

RESULTS

Stride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02).

CONCLUSIONS

The research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases.