Modification des performances au Timed « Up and Go » test et à l'appui monopodal par l'addition d'une charge cognitive : valeur discriminative des résultats

A Systematic Review Exploring the Theories Underlying the Improvement of Balance and Reduction in Falls Following Dual-Task Training among Older Adults

BACKGROUND

Balance impairment causes frequent falls in older adults, and preventing falls remains challenging. Dual-task (DT) training reduces falls by improving balance, but the precise theory is not fully understood. This review aims to explore the theories underlying the effectiveness of DT in improving balance and reducing falls in older adults.

METHODS

Eleven electronic databases were searched from database inception to June 2022. Two reviewers independently performed study screening and data extraction. The risk of bias (RoB) in the included studies was assessed using the Cochrane Collaboration RoB 2 tool.

RESULTS

The searches yielded 1478 citations, of which 30 studies met the inclusion criteria and were included in the review. Twenty-two of the 30 included studies utilized the motor-cognitive type of DT for training, while six used motor-motor and two utilized cognitive-cognitive DT. The included studies reported 20 different theories to explain the effectiveness of DT for improving balance and reducing falls in older adults. The predominant theory identified in the included studies was attention theory (n = 14). Overall, 26 studies reported improved balance and five studies found a reduction in fall incidence following DT training. Balance and falls improved significantly in 15 motor-cognitive DT intervention studies.

CONCLUSION

Attention shifting between two tasks is reported to occur following DT training. Motor-cognitive DT training improves balance and reduces fall incidence in older adults by shifting attention based on the difficulty and priority of a task from the motor to the cognitive task.

What could posturography tell us about balance in essential tremor?

BACKGROUND

Essential tremor (ET) is a neurological disorder characterized primarily by action tremor. Balance impairments in ET patients were formerly considered to be uncommon and simply age-related. However quantitative assessment with posturography has revealed impairments in control of both static and dynamic balance.

RESEARCH QUESTION

The aim of the present study is to assess postural stability with different posturographic techniques in ET patients.

METHODS

A prospective cross-sectional study conducted in two University Hospitals. Eleven patients diagnosed with essential tremor and twelve healthy controls were included. Balance assessment were performed with: sensory organization test (SOT) and limits of stability (LOS) of the computer dynamic posturography (CDP), results of free-field body sway analysis with mobile posturography (Vertiguard®), modified timed up and go test (TUG), Dizziness handicap inventory (DHI) and activities-specific balance confidence scale (ABC).

RESULTS

Patients with ET showed poorer scores in the SOT than controls for composite balance and somatosensory input. They also performed worse in LOS tests and Vertiguard® device indicated a higher risk of falling. There were no differences in the modified TUG. The mean score of DHI was 15.64 and 85.16 for ABC.

SIGNIFICANCE

Posturography assessment (CDP and Vertiguard®) is more accurate in showing balance impairment in ET patients than clinical evaluation (modified TUG). Balance impairment involves deteriorated processing of somatosensory input which could be explained by cerebellar dysfunction. Balance deficits could be included into future diagnostic criteria.

Vestibular rehabilitation with mobile posturography as a "low-cost" alternative to vestibular rehabilitation with computerized dynamic posturography, in old people with imbalance: a randomized clinical trial

BACKGROUND

Vestibular rehabilitation (VR), specifically, VR with dynamic computerized posturography (CDP) has proven to be useful to improve balance and reduce the risk of falling in old patients. Its major handicap is probably its cost, which has hindered its generalisation. One solution to reduce this cost is performing VR with mobile posturography systems, which allow assessment of stability at the center of body mass in daily-life conditions. Also, rehabilitation with vibrotactile neurofeedback training could be used in dynamic tasks.

OBJECTIVE

To assess whether two different protocols of vestibular rehabilitation (using CDP and the Vertiguard system) show significant differences in the improvement of balance among older persons with imbalance METHODS: A clinical trial comparing VR with CDP exercises and VR with mobile posturography (Vertiguard) exercises, was designed. The participants were people over 65 years, with imbalance. The composite (average balance) in the sensory organization test (SOT) of the CDP was the main outcome measure; it was compared before and 3 weeks after VR, and between both intervention groups.

RESULTS

40 patients were included in the study (19 in the CDP-VR group and 21 in the Vertiguard-VR group). Average balance was significantly improved in both intervention groups (51% pre-VR vs 60% post-VR, p = 0.002, CDP-VR group; 49% pre-VR vs 57% post-VR, p = 0.008, Vertiguard-VR group); no significant differences in this improvement were found comparing both groups (p = 0.580).

DISCUSSION AND CONCLUSIONS

VR using mobile posturography is useful to improve stability in old people with instability, showing similar improvement rates to those of VR using CDP.

UNIQUE IDENTIFIER

NCT03034655 www.clinicaltrials.gov Registered on 25 January 2017.

Insomnia and falls in older adults: are they linked to executive dysfunction?

BACKGROUND

Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group.

METHODS

This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered.

RESULTS

The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P < 0.001). Semantic and working memory dual tasks were correlated with clock-drawing test only in the insomnia group (r = -0.316, P = 0.031; r = -0.319, P = 0.029). Depression (odds ratio (OR) = 9.65, P = 0.001) and Trail Making Test A (OR = 1.025, P = 0.07) were independently associated with insomnia. Four-metre walking speed (OR = 2.342, P = 0.025), insomnia (OR = 3.453; P = 0.028), and the semantic memory dual task (OR = 1.589; P = 0.025) were also independently associated with falls.

CONCLUSION

Our study showed that dual tasking and executive function are related to falls in patients with insomnia. Managing insomnia and assessment of executive dysfunction may have beneficial effects on preventing falls.

Presbyvestibulopathy, Comorbidities, and Perception of Disability: A Cross-Sectional Study

Objective: To assess the perception of disability in patients with presbyvestibulopathy and to determine the factors (demographic, balance test scores, and comorbidities) that determine higher levels of disability.

Material and Methods: This was a cross-sectional study conducted in a tertiary university hospital. There were 103 patients who fulfilled the diagnostic criteria for presbyvestibulopathy and were included. Dizziness Handicap Inventory (DHI) score was the main variable used to quantify disability. Influence on DHI score, sex, age, time of evolution, equilibriometric parameters (posturographic scores and timed up and go test), history of falls, comorbidities (high blood pressure, diabetes, and dyslipidemia), psychotropic drug use, tobacco or alcohol use, living environment (urban or rural), and active lifestyle were analyzed.

Results: Most of the DHI scores showed a moderate (46 patients, 44.7%) or severe (39 participants, 37.9%) handicap. DHI scores were higher in women (59.8 vs. 36.1, p < 0.001), patients with obesity (58.92 vs. 48.68; p = 0.019), benzodiazepine (59.9 vs. 49.1, p = 0.008) or other psychotropic drug (60.7 vs. 49.2, p = 0.017) users, and fallers (57.1 vs. 47.3, p = 0.048). There was also a significant positive correlation between DHI score, time (Rho coefficient: 0.371, p < 0.001), and steps (Rho coefficient: 0.284, p = 0.004) used in the TUG and with the short FES-I questionnaire (a shortened version of the Falls Efficacy Scale-International) score (Rho coefficient: 0.695, p < 0.001). DHI scores were lower in alcohol consumers than in non-drinkers (46.6 vs. 56, p = 0.048). No significant correlation was found between DHI scores and age, time of evolution, posturographic scores, comorbidities, environment (rural or urban), or active lifestyle.

Conclusion: Most patients with presbyvestibulopathy show an important subjective perception of disability in relation to their symptoms. This perception is substantially higher in women than in men. The most influential factors are difficulties in walking, fear of falling, and obesity.

Unique Identifier: NCT03034655, www.clinicaltrials.gov.

Differences between two types of dual tasks according to the educational level in older adults

INTRODUCTION

For dual-task paradigms, the timed up and go (TUG) test along with other cognitive or motor tasks has been used to evaluate and predict the risk of falling in older adults. However, the interference between motor-cognitive tasks can differ by the cognitive task.

OBJECTIVE

To evaluate the performance of the TUG test under a single task condition and two dual-task conditions in older adults and to explore the effect of educational level on task performance.

METHODS

A total of 418 older adults (328 females) voluntarily participated in this study. The TUG test was administered as a single task and a dual task with one secondary simultaneous task: counting aloud backward from 100 or naming animals. Comparisons were performed to determine the interference caused by each cognitive task on the motor task, and correlation analysis was performed to explore the role of educational level.

RESULTS

The animal task led to a poorer TUG performance and a higher dual-task cost than did the counting task. Furthermore, the motor task led to a higher percentage of errors and cognitive stops in the animal task. Educational level plays a significant role in the interaction between tasks.

CONCLUSIONS

Between-task interference differs by the type of cognitive task performed and the educational level of the participants. The results of the present study should be considered when dual-task assessments are planned for older adults.

Modified Timed Up and Go Test for Tendency to Fall and Balance Assessment in Elderly Patients With Gait Instability

Objective: To compare the results from the modified Timed Up and Go Test (TUG) with posturographic variables, the subjective perception of disability due to gait instability, and the number of falls in a sample of the elderly population with imbalance, to confirm that the TUG Test is a useful clinical instrument to assess the tendency to fall in individuals of this age group.

Materials and Methods: Cross-sectional study conducted in a tertiary university hospital, in 174 people aged 65 years or older with gait instability. Modified TUG Test was performed; time, step count and the need for support during the test were the analyzed variables. They were compared with the number of falls, Computerized Dynamic Posturography scores, and questionnaires scores (Dizziness Handicap Inventory and a shortened version of the Falls Efficacy Scale-International).

Results: The average time to complete the TUG Test was 21.24 ± 8.18 s, and the average step count was 27.36 ± 7.93. One hundred two patients (58.6%) required no support to complete the test, whereas the other 72 (41.4%) used supports. The time taken to complete the Test was significantly related with having or not having fallen in the previous year, with the scores of the questionnaires, and with various parameters of dynamic posturography. A higher percentage of patients who took more than 15 s had fallen in the previous year than those who took up to 15 s to complete the test [P = 0.012; OR = 2.378; 95% CI (1.183, 4.780)]. No significant correlation was found between the step count and the number of falls in the previous year, with falling during the test or not, or with being a single or a frequent faller. No relation was found between the need for supports and the number of falls, with having or not having fallen in the previous year, or with being a single or frequent faller.

Conclusion: The modified TUG Test is in relation with the presence or absence of falls. Time is the essential parameter for analyzing the risk of falling and the 15-s threshold is a good value to differentiate elderly patients at high risk of falling.

Unique Identifier: NCT03034655, www.clinicaltrials.gov.

Vestibular Rehabilitation Using Posturographic System in Elderly Patients with Postural Instability: Can the Number of Sessions Be Reduced?

Purpose

Vestibular rehabilitation (VR) using posturography systems has proved useful in improving balance among elderly patients with postural instability. However, its high cost hinders its use. The objective of this study is to assess whether two different protocols of VR with posturography, one of them longer (ten sessions) and the other shorter (five sessions), show significant differences in the improvement of balance among old patients with instability.

Patients and Methods

This is a prospective, experimental, single-center (Department of Otorhinolaryngology of a tertiary referral hospital), randomized (into balanced patient blocks) study with two parallel arms, in 40 people over 65 years of age, with instability and at a high risk of falling. The percentage of the average balance (composite) in the sensory organization test (SOT) of the CDP (main outcome measure), other CDP scores, time and steps in the "timed up and go" test, scores of Dizziness Handicap Inventory (DHI), short Falls Efficacy Scale - International (short FES-I), and Vertiguard were compared before and 3 weeks after VR between both intervention groups.

Results

The two treatment groups (20 patients per group) were comparable in age, sex, and pre-VR balance evaluation. In both groups, we observed a significant improvement in global balance (composite) after VR (49±11.34 vs 57±13.48, p=0.007, in the group undergoing 10 sessions; 51±12.55 vs 60±12.99, p=0.002, 5 sessions). In both groups, we also observed improvements in other posturographic parameters (in the SOT and limits of stability) but not in the timed up and go scores or in the questionnaires. Comparison of the improvement level achieved in both groups revealed no significant differences between them.

Conclusion

The protocols of vestibular rehabilitation by posturography of 5 sessions in elderly patients with postural instability are as effective as those of 10 sessions for improving balance among elderly patients with postural instability.

Trial Registration

ClinicalTrials.gov identifier: NCT03034655. Registered on 25 January 2017.

Dual task performance and history of falls in community-dwelling older adults

INTRODUCTION

Falls are a common problem for older adults, and the identification of people at high risk of falling is a major challenge to health systems.

OBJECTIVE

To evaluate the association between the history of falls and single-task Timed Up and Go Test (single TUG) or dual-task TUG variables.

METHODS

Three hundred seventy seven community-dwelling older persons, with ages ranging from 65 and 92 years, participated in this cross-sectional study. Each participant performed two tests: single TUG and dual TUG. The cognitive task for dual TUG consisted of counting backward by one from 100 while performing the test. The number of cognitive errors, cognitive stops and motor stops were recorded. A new variable comprising time, errors and stops in the dual TUG was computed.

RESULTS

The number of falls was significantly associated with mean single and dual TUG performance, mean cognitive errors, mean cognitive stops and mean motor stops. The score in the single TUG time was not able to significantly classify participants as fallers or non-fallers in any of the sexes. On the other hand, the variable "dual TUG time spent adding cognitive stops and cognitive errors" achieved the best ability to classify women as fallers or non-fallers, while "dual task cost" and "dual TUG time spent adding cognitive stops" were the best variables to classify men.

CONCLUSIONS

Dual TUG including cognitive stops and cognitive errors may be more capable than the single TUG to detect differences and accurately classify fallers and non-fallers in the elderly.

Optimising costs in reducing rate of falls in older people with the improvement of balance by means of vestibular rehabilitation (ReFOVeRe study): a randomized controlled trial comparing computerised dynamic posturography vs mobile vibrotactile posturography system

BACKGROUND

Accidental falls, especially for the elderly, are a major health issue. Balance disorders are one of their main causes. Vestibular rehabilitation (VR) has proven to be useful in improving balance of elderly patients with instability. Its major handicap is probably its cost, which has prevented its generalisation. So, we have designed a clinical trial with posturographic VR, to assess the optimum number of sessions necessary for a substantial improvement and to compare computerised dynamic posturography (CDP) (visual feedback) and mobile posturography (vibrotactile feedback).

METHODS

Design: randomized controlled trial. It is an experimental study, single-center, open, randomized (balanced blocks of patients) in four branches in parallel, in 220 elderly patients with high risk of falls; follow-up period: twelve months.

SETTING

Department of Otorhinolaryngology of a tertiary referral hospital.

PARTICIPANTS

people over 65 years, fulfilling two or more of the following requirements: a) at least one fall in the last twelve months. b) take at least 16 s or require some support in perform the "timed up and go" test. c) a percentage of average balance in the sensory organization test (SOT) of the CDP < 68%. d) at least one fall in any of the conditions in SOT-CDP. e) a score in Vertiguard's gSBDT > 60%.

INTERVENTION

Four differents protocols of vestibular rehabilitation (randomization of the patients).

MAIN OUTCOME MEASURE

The percentage of average balance in the SOT-CDP. Secondary measures: time and supports in the "timed up and go" test, scores of the CDP and Vertiguard, and rate of falls.

DISCUSSION

Posturographic VR has been proven to be useful for improving balance and reducing the number of falls among the aged. However, its elevated cost has limited its use. It is possible to implement two strategies that improve the cost-benefit of posturography. The first involves optimising the number of rehabilitation sessions; the second is based on the use of cheaper posturography systems.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03034655. Registered on 25 January 2017.

[Influence of dual-tasking on straight ahead and curved walking in older adults]

BACKGROUND

Walking is not an automatic movement task but requires continuous attention resources. While walking and undertaking an additional task (dual tasking), gait changes occur which are associated with falls in older adults. To date, the evaluation of gait characteristics under dual task conditions is typically performed during walking straight ahead (SW); however, everyday life also requires more complex walking maneuvers such as walking in a curve (CW). Complex walking maneuvers may require higher attentional resources and thus might have a greater impact on the gait under dual task conditions.

OBJECTIVE

The aim was to compare the gait characteristics under dual task conditions during SW and CW.

MATERIAL AND METHODS

In 30 community-dwelling older adults (mean age: 71.6 ± 6.6 years) gait parameters including single leg support phase, velocity, cadence, step length and width were measured by electronic gait analysis (GAITRite®, CIR Systems Inc., Franklin, New Jersey, USA) during SW and CW under single and dual task conditions. For each gait parameter the relative change from single to dual task condition was calculated as dual task costs (DTC) and compared using paired t‑tests.

RESULTS

For the single leg support phase, velocity, cadence and step width, descriptive results showed increased DTC during CW (2.08-23.74%) as compared to SW (1.39-12.90%). For cadence (DTC: SW 6.81 ± 12.58%, CW 10.54 ± 13.46%, p = 0.026) and step width (DTC: SW -12.90 ± 18.01%, CW -23.74 ± 56.37%, p = 0.004) the differences were statistically significant.

CONCLUSION

The relative decline in gait performance under dual task conditions is greater during CW than during SW. The results suggest that CW requires greater attentional resources as compared to SW. In turn, the risk of falling might be increased during CW under dual task conditions. The present findings may contribute to the development of new, ecologically valid assessment and training strategies taking complex walking maneuvers into account.

Quantitative Balance and Gait Measurement in Patients with Frontotemporal Dementia and Alzheimer Diseases: A Pilot Study

INTRODUCTION

Alzhiemers disease and Frontotemporal dementia are common neurodegenerative dementias with a wide prevalence. Falls are a common cause of morbidity in these patients. Identifying subclinical involvement of these parameters might serve as a tool in differential analysis of these distinct parameters involved in these conditions and also help in planning preventive strategies to prevent falls.

PATIENTS AND METHODS

Eight patients in age and gender matched patients in each group were compared with normal controls. Standardizes methods of gait and balance aseesment were done in all persons.

RESULTS

Results revealed subclinical involvement of gait and balancesin all groups specially during divided attention. The parameters were significantly more affected in patients. Patients with AD and FTD had involement of over all ambulation index balance more affected in AD patients FTD patients showed step cycle, stride length abnormalities.

DISCUSSION

There is balance and gait involvement in normal ageing as well as patients with AD and FTD. The pattern of involvement in AD correlates with WHERE pathway involvement and FTD with frontal subcortical circuits involvement.

CONCLUSION

Identification the differential patterns of involvement in subclinical stage might help to differentiate normal ageing and the different types of cortical dementias. This could serve as an additional biomarker and also assist in initiating appropriate training methods to prevent future falls.

Dual-Task Does Not Increase Slip and Fall Risk in Healthy Young and Older Adults during Walking

Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants' fall risks are modified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task walking have no destabilizing effect on gait and slip responses in healthy individuals. We also found that, during dual-tasking, healthy individuals adopted cautious gait mode (CGM) strategy that is characterized by reduced walking speed, shorter step length, increased step width, and reduced heel contact velocity and is likely to be an adaptation to minimize attentional demand and decrease slip and fall risk during limited available attentional resources. Exploring interactions between gait variability and cognitive functions while walking may lead to designing appropriate fall interventions among healthy and patient population with fall risk.

The effects of a simultaneous cognitive or motor task on the kinematics of walking in older fallers and non-fallers

Human gait has been widely investigated under dual-task conditions because it has been demonstrated to be an important way to uncover differences in gait biomechanics between older fallers and non-fallers. However, exactly how simultaneous tasks affect the kinematics of walking remains unclear. In the present study, gait kinematic properties of older fallers and non-fallers were compared under cognitive and motor dual-task conditions. The gait kinematic properties of interest were recorded under three different conditions: walking at preferred speed, walking when performing a cognitive task (naming animals), and walking when performing a motor task (transferring a coin from one pocket to the other). The following variables were analyzed: gait speed, cadence, stride time, step length, single support, stride time variability, and the dual-task cost. In addition, functional balance was evaluated by means of the Balance Evaluation - Systems Test (BESTest). Two-way repeated-measures ANOVAs revealed significant main effects of walking conditions. However, no significant main effects of group (fallers vs. non-fallers) and no significant interaction effects between group and walking condition were observed. The BESTest revealed that functional balance in fallers was worse than in non-fallers. The cognitive task leads to more significant changes in gait kinematics than does a motor task and the step length and stride time variability were variables more sensitive to that cognitive influence.

Effects of Vestibular Rehabilitation on Balance Control in Older People with Chronic Dizziness: A Randomized Clinical Trial

OBJECTIVE

The aim of this study was to compare the effects of vestibular rehabilitation protocols on balance control in elderly with dizziness.

DESIGN

This is a randomized clinical trial with 3-mo follow-up period. The sample was composed of 82 older individuals with chronic dizziness from vestibular disorders. The control group was treated according to the Conventional Cawthorne & Cooksey protocol (n = 40), and the experimental group was submitted to a Multimodal Cawthorne & Cooksey protocol (n = 42). Measures included Dynamic Gait Index, fall history, hand grip strength, Time Up-and-Go Test, sit-to-stand test, multidirectional reach, and static balance tests.

RESULTS

With the exception of history of falls, Forward Functional Reach, Unipedal Right and Left Leg Eyes Closed, and Sensorial Romberg Eyes Open, all outcomes improved after treatments. Such results persisted at follow-up period, with the exception of the Tandem Eyes Open and the Timed Up-and-Go manual. The between-group differences for Sensorial Romberg Eyes Closed (4.27 secs) and Unipedal Left Leg Eyes Open (4.08 secs) were significant after treatment, favoring the Multimodal protocol.

CONCLUSIONS

Both protocols resulted in improvement on elderly's balance control, which was maintained during a short-term period. The multimodal protocol presented better performance on specific static balance tests.

Balance Disorders in the Elderly: Does Instability Increase Over Time?

OBJECTIVES

To analyze the equilibriometric differences between 2 populations of elderly patients (young elderly and very elderly) with instability induced solely by age.

METHODS

Cross-sectional study, with 2 study groups classified according to patient age (cut-points in twenty-fifth and seventy-fifth percentiles of the age of the sample).

POPULATION

64 patients aged 65 years or more. Two groups of 32 subjects were established: group A (people 65 years of age or older but less than 72.6, twenty-fifth percentile) and group B (patients 82.5 years, seventh-fifth percentile, or older). Main analyzed variables: timed up-and-go test, sensory organization test of the computerized dynamic posturography, Dizziness Handicap Inventory (DHI), and Short Falls Efficacy Scale-International (FES-I) questionnaires. Student's t test or the Mann-Whitney test were used.

RESULTS

The older patients obtain poorer scores in the equilibriometric tests but not in all of them. In the sensory organization test, the older patients make poorer use of visual and vestibular information; they also require more time and steps for the timed up-and-go. With regards to the questionnaires, fear of falling is greater (higher Short FES-I scores) but not subjective perception of disability (DHI scores without differences).

CONCLUSIONS

There is a need to establish aged subgroups of elderly patients with instability, adapting therapeutic strategies.

Dual-tasking over an extended walking distance is associated with falls among community-dwelling older adults

Aim

Dual-task methods, in which walking is the primary task, are not sufficient for accurately screening for the risk of falls among healthy older adults. Therefore, the goal of this research was to investigate whether using a dual-task method over an extended walking distance can predict falls among community-dwelling older adults.

Methods

We enrolled independent community-dwelling adults aged ≥65 years. Physical performance, cognitive function, psychological function, and a dual-task test were assessed at baseline. Our dual-task test required the subjects to walk 60 m while stepping over lines. The intervals between the lines ranged from 50–100 cm and were unequal. Falls and fall-related injuries were measured over a 12-month follow-up period using monthly postal surveys.

Results

Ninety-two of 118 subjects (mean age, 75.4±5.5 years) completed the 12-month follow-up. Sixteen (17.4%) of fallers had injurious falls or fell more than or equal to two times. There were no significant differences between the fallers and non-fallers, except in age and in the number of missteps during the dual-task test when walking ≥40 m. The Kaplan–Meier analysis revealed that those who had more than one misstep while walking ≥40 m had a significantly higher incidence of injurious or multiple falls than those who had no missteps.

Conclusion

Our findings suggest that the dual-task method with an extended walking distance may be able to predict falls among community-dwelling older adults.

Toward Automating Clinical Assessments: A Survey of the Timed Up and Go

Older adults often suffer from functional impairments that affect their ability to perform everyday tasks. To detect the onset and changes in abilities, healthcare professionals administer standardized assessments. Recently, technology has been utilized to complement these clinical assessments to gain a more objective and detailed view of functionality. In the clinic and at home, technology is able to provide more information about patient performance and reduce subjectivity in outcome measures. The timed up and go (TUG) test is one such assessment recently instrumented with technology in several studies, yielding promising results toward the future of automating clinical assessments. Potential benefits of technological TUG implementations include additional performance parameters, generated reports, and the ability to be self-administered in the home. In this paper, we provide an overview of the TUG test and technologies utilized for TUG instrumentation. We then critically review the technological advancements and follow up with an evaluation of the benefits and limitations of each approach. Finally, we analyze the gaps in the implementations and discuss challenges for future research toward automated self-administered assessment in the home.

Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis

Background

The Timed Up and Go test (TUG) is a commonly used screening tool to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall predictive value of the TUG in community-dwelling older adults.

Methods

A literature search was performed to identify all studies that validated the TUG test. The methodological quality of the selected studies was assessed using the QUADAS-2 tool, a validated tool for the quality assessment of diagnostic accuracy studies. A TUG score of ≥13.5 seconds was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled estimates of sensitivity and specificity at ≥13.5 seconds. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity.

Results

Twenty-five studies were included in the systematic review and 10 studies were included in meta-analysis. The TUG test was found to be more useful at ruling in rather than ruling out falls in individuals classified as high risk (>13.5 sec), with a higher pooled specificity (0.74, 95% CI 0.52-0.88) than sensitivity (0.31, 95% CI 0.13-0.57). Logistic regression analysis indicated that the TUG score is not a significant predictor of falls (OR = 1.01, 95% CI 1.00-1.02, p = 0.05).

Conclusion

The Timed Up and Go test has limited ability to predict falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls in this setting.

Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial

BACKGROUND

There are several protocols designed to treat vestibular disorders that focus on habituation, substitution, adaptation, and compensation exercises. However, protocols that contemplate not only vestibular stimulation but also other components that are essential to the body balance control in older people are rare. This study aims to compare the effectiveness of two vestibular rehabilitation protocols (conventional versus multimodal) on the functional capacity and body balance control of older people with chronic dizziness due to vestibular disorders.

METHODS/DESIGN

A randomized, single-blind, controlled clinical trial with a 3 months follow-up period will be performed. The sample will be composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. The subjects will be evaluated at baseline, post-treatment and follow-up. Primary outcomes will be determined in accordance with the Dizziness Handicap Inventory (functional capacity) and the Dynamic Gait Index (body balance). Secondary outcomes include dizziness features, functional records, body balance control tests, and psychological information. The older individuals (minimum sample n = 68) will be randomized to either the conventional or multimodal Cawthorne&Cooksey protocols. The protocols will be performed during individual 50-minute sessions, twice a week, for 2 months (a total of 16 sessions). The outcomes of both protocols will be compared according to the intention-to-treat analysis.

DISCUSSION

Vestibular rehabilitation through the Cawthorne&Cooksey protocol has already proved to be effective. However, the addition of other components related to body balance control has been proposed to improve the rehabilitation of older people with chronic dizziness from vestibular disorders.

TRIAL REGISTRATION

ACTRN12610000018011.

Age-related deficits of dual-task walking: a review

This review summarizes our present knowledge about elderly people's problems with walking. We highlight the plastic changes in the brain that allow a partial compensation of these age-related deficits and discuss the associated costs and limitations. Experimental evidence for the crucial role of executive functions and working memory is presented, leading us to the hypothesis that it is difficult for seniors to coordinate two streams of visual information, one related to navigation through visually defined space, and the other to a visually demanding second task. This hypothesis predicts that interventions aimed at the efficiency of visuovisual coordination in the elderly will ameliorate their deficits in dual-task walking.

A screening tool with five risk factors was developed for fall-risk prediction in community-dwelling elderly

OBJECTIVE

To develop a simple clinical screening tool for community-dwelling older adults.

STUDY DESIGN AND SETTING

A prospective multicenter cohort study was performed among healthy subjects of 65 years and older, examined in 10 health examination centers for the French health insurance. Falls were ascertained monthly by telephone for 12-month follow-up. Multivariate analyses using Cox regression models were performed. Regression coefficients of the predictors in the final model were added up to obtain the total score. The discriminative power was assessed using the area under the curve (AUC).

RESULTS

Thousand seven hundred fifty-nine subjects were included. The mean age was 70.7 years and 51% were women. At least one fall occurred among 563 (32%) participants. Gender, living alone, psychoactive drug use, osteoarthritis, previous falls, and a change in the position of the arms during the one-leg balance (OLB) test were the strongest predictors. These predictors were used to build a risk score. The AUC of the score was 0.70. For a cutoff point of 1.68 in a total of 4.90, the positive predictive value and negative predictive value were 72.0% and 72.7%, respectively.

CONCLUSION

A screening tool with five risk factors and the OLB test could predict falls in healthy community-dwelling older adults.