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Abdollahi M, Rashedi E, Kuber PM, Jahangiri S, Kazempour B, Dombovy M, Azadeh-Fard N. Post-Stroke Functional Changes: In-Depth Analysis of Clinical Tests and Motor-Cognitive Dual-Tasking Using Wearable Sensors. Bioengineering (Basel) 2024; 11:349. [PMID: 38671771 PMCID: PMC11048064 DOI: 10.3390/bioengineering11040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Clinical tests like Timed Up and Go (TUG) facilitate the assessment of post-stroke mobility, but they lack detailed measures. In this study, 21 stroke survivors and 20 control participants underwent TUG, sit-to-stand (STS), and the 10 Meter Walk Test (10MWT). Tests incorporated single tasks (STs) and motor-cognitive dual-task (DTs) involving reverse counting from 200 in decrements of 10. Eight wearable motion sensors were placed on feet, shanks, thighs, sacrum, and sternum to record kinematic data. These data were analyzed to investigate the effects of stroke and DT conditions on the extracted features across segmented portions of the tests. The findings showed that stroke survivors (SS) took 23% longer for total TUG (p < 0.001), with 31% longer turn time (p = 0.035). TUG time increased by 20% (p < 0.001) from STs to DTs. In DTs, turning time increased by 31% (p = 0.005). Specifically, SS showed 20% lower trunk angular velocity in sit-to-stand (p = 0.003), 21% longer 10-Meter Walk time (p = 0.010), and 18% slower gait speed (p = 0.012). As expected, turning was especially challenging and worsened with divided attention. The outcomes of our study demonstrate the benefits of instrumented clinical tests and DTs in effectively identifying motor deficits post-stroke across sitting, standing, walking, and turning activities, thereby indicating that quantitative motion analysis can optimize rehabilitation procedures.
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Affiliation(s)
- Masoud Abdollahi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Ehsan Rashedi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Pranav Madhav Kuber
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Sonia Jahangiri
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Behnam Kazempour
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY 14626, USA;
| | - Nasibeh Azadeh-Fard
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
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Biehl-Printes C, Irigaray TQ, Dornelles JOF, Baptista RR. Unraveling the unparalleled benefits of orienteering versus hiking on gait performance and cognition: A randomized clinical trial. Arch Gerontol Geriatr 2024; 117:105201. [PMID: 37729673 DOI: 10.1016/j.archger.2023.105201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/16/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
METHODS Physical activities and sports in nature offer opportunities for leisure, health, and well-being. A randomized clinical trial (RCT) compared the effects of training, dualtask orienteering and single-task hiking in independent older adults (n = 90) allocated into three groups: orienteering group (OG), hiking group (HG) and control group (CG). Timed Up and Go (TUG) tests, including a dual-task (TUG-DT), and cognitive tests were administered. Differences were analyzed by Generalized Estimating Equations (GEE) and the effect size (ES) was calculated. Unpaired and paired tests were used for the evaluation of basic differences and after 24 weeks of intervention. RESULTS This RCT highlights the interaction effects between groups and time. Only the OG in TUGDT reduced by 6 s, with change of 42% (ES=0.77). Likewise, Dual TUG + cognitive stops (TUG-DT+ CS) and Dual TUG + cognitive stops + cognitive errors (TUG-DT + CS + CE), reduced 7 (ES=0.85) and 8 (ES=0.90) seconds (<0.001). The task cost improved by 75% for OG and 24% for HG (p = 0.001), with an ES of 0.56 for OG. For cognition, there was a 49.2% increase (ES=2.00) for OG and 16.5% for HG in executive functions and visuospatial skills, a 31.4% increase (ES=1.64) for OG and 14.7% for HG in processing speed, and a 39.8% increase (ES=1.62) for OG and 6.5% for HG in memory. All interactions were <0.001. CONCLUSION The orienteering demonstrated that has potential benefits in effectively improving gait performance and preventing cognitive decline in older adults. Brazilian Registry of Clinical Trials (ReBEC): RBR-99jmmpf.
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Affiliation(s)
- Clarissa Biehl-Printes
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681 Prédio, 12, 2º andar, Prédio 12A, Sala 202 - Partenon - Porto Alegre/RS CEP: 90619-900, Porto Alegre, Brazil; Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681 Prédio 40 - 8º andar, sala 804 Partenon - Porto Alegre/RS CEP: 90619-900, Porto Alegre, Brazil.
| | - Tatiana Quarti Irigaray
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681 - Prédio 81 - 6º andar - sala 603 - Partenon - Porto Alegre/RS CEP 90619-900, Porto Alegre, Brazil
| | | | - Rafael Reimann Baptista
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681 Prédio, 12, 2º andar, Prédio 12A, Sala 202 - Partenon - Porto Alegre/RS CEP: 90619-900, Porto Alegre, Brazil; Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681 Prédio 40 - 8º andar, sala 804 Partenon - Porto Alegre/RS CEP: 90619-900, Porto Alegre, Brazil; School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681 - Prédio 81 - 6º andar - sala 603 - Partenon - Porto Alegre/RS CEP 90619-900, Porto Alegre, Brazil
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Silveira H, Lima J, Plácido J, Ferreira JV, Ferreira R, Laks J, Deslandes A. Dual-Task Performance, Balance and Aerobic Capacity as Predictors of Falls in Older Adults with Cardiovascular Disease: A Comparative Study. Behav Sci (Basel) 2023; 13:488. [PMID: 37366740 DOI: 10.3390/bs13060488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Cardiovascular diseases (CVD) are highly prevalent and strongly associated with the risk of falls in the elderly. Falls are associated with impairments in cognition and functional or gait performance; however, little is known about these associations in the elderly population with CVD. In this study, we aimed to clarify the possible associations of physical capacity and functional and cognitive outcomes with the incidence of falls in older adults with CVD. In this comparative study, 72 elderly patients were divided into fallers (n = 24 cases) and non-fallers (n = 48 controls) according to the occurrence of falls within one year. Machine learning techniques were adopted to formulate a classification model and identify the most important variables associated with the risk of falls. Participants with the worst cardiac health classification, older age, the worst cognitive and functional performance, balance and aerobic capacity were prevalent in the case group. The variables of most importance for the machine learning model were VO2max, dual-task in seconds and the Berg Scale. There was a significant association between cognitive-motor performance and the incidence of falls. Dual-task performance, balance, and aerobic capacity levels were associated with an increased risk of falls, in older adults with CVD, during a year of observation.
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Affiliation(s)
- Heitor Silveira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Juliana Lima
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Jessica Plácido
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - José Vinícius Ferreira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Renan Ferreira
- Instituto Nacional de Tecnologia, Rio de Janeiro 20081-312, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Clínica da Gávea, Rio de Janeiro 22451-262, Brazil
| | - Andrea Deslandes
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
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Cao K, Bay AA, Hajjar I, Wharton W, Goldstein F, Qiu D, Prusin T, McKay JL, Perkins MM, Hackney ME. Rationale and Design of the PARTNER Trial: Partnered Rhythmic Rehabilitation for Enhanced Motor-Cognition in Prodromal Alzheimer's Disease. J Alzheimers Dis 2023; 91:1019-1033. [PMID: 36530084 PMCID: PMC10105523 DOI: 10.3233/jad-220783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Functional decline in Alzheimer's disease (AD) is impacted by impaired ability to integrate and modulate complex cognitive and motor abilities, commonly known as motor-cognitive integration. Impaired motor-cognitive integration occurs in the early stages of AD, prodromal AD (pAD), and may precede other symptoms. Combined motor and cognitive training have been recommended for people with pAD and need to be better researched. Our data suggest that partnered rhythmic rehabilitation (PRR) improves motor-cognitive integration in older adults with cognitive impairment. PRR is an ideal intervention to simultaneously target cardiovascular, social, and motor-cognitive domains important to AD. OBJECTIVE/METHODS We propose to conduct a 1-year Phase II, single-blind randomized controlled trial using PRR in 66 patients with pAD. Participants will be assigned to three months of biweekly sessions, followed by nine months of weekly sessions of PRR or group walking (WALK) with 1 : 1 allocation. Group walking in the control group will allow us to compare physical exercise alone versus the added benefit of the cognitively engaging elements of PRR. RESULTS/CONCLUSION Using an intent-to-treat approach, this innovative pilot study will 1) Determine acceptability, safety, tolerability, and satisfaction with PRR; 2) Compare efficacy of PRR versus WALK for improving motor-cognitive integration and identify the most sensitive endpoint for a Phase III trial from a set of motor-cognitive, volumetric MRI, and cognitive measures. The study will additionally explore potential neural, vascular, and inflammatory mechanisms by which PRR affects pAD to derive effect size of these intermediary measures and aid us in estimating sample size for a future trial.
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Affiliation(s)
- Ke Cao
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Allison A Bay
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ihab Hajjar
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | | | - Felicia Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Deqiang Qiu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Todd Prusin
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - J Lucas McKay
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Bioinformatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA
| | - Madeleine E Hackney
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Decatur, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center (GRECC), Atlanta, GA, USA
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Spina S, Facciorusso S, D'Ascanio MC, Morone G, Baricich A, Fiore P, Santamato A. Sensor based assessment of turning during instrumented Timed Up and Go Test for quantifying mobility in chronic stroke patients. Eur J Phys Rehabil Med 2023; 59:6-13. [PMID: 36511168 PMCID: PMC10035361 DOI: 10.23736/s1973-9087.22.07647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Turning may be particularly challenging for stroke patients leading to decreased mobility and increased functional restriction. Timed up and go instrumentation using a simple technology in the clinical context could allow for the collection of both traditional and potentially more discriminatory variables in turning ability. AIM Determine whether the speed turning metrics obtained by a single inertial sensor are suitable for differentiating between stroke patients with varying levels of mobility and disability. DESIGN Cross-sectional study. SETTING Outpatients setting. POPULATION Chronic stroke patients. METHODS A total of 48 chronic stroke patients and 23 healthy controls were included. Stroke patients were divided in two groups based on the total iTUG score: an impaired mobility (> 20 seconds) and an available mobility (<20 seconds) group. All subjects performed an instrumented Timed Up and Go (iTUG) wearing a single IMU sensor on the lower back. Time of subcomponents of the timed up and go test and kinematic parameters of turning were quantified. Other clinical outcomes were: 10 meters walk test, Functional Ambulation Categories Scale (FAC), the Rivermead Mobility Index (RMI), Modified Rankin Scale and the Saltin-Grimby Physical Activity Level Scale (SGPALS). RESULTS There were significant differences (P<0.01) in iTUG phases and turning speeds among groups. Low to strong significant correlations were found between measures derived from the turning speeds and clinical measures. The area under the curve (AUC) of Receiver Operating Characteristic (ROC) turning speeds was demonstrated to be able to discriminate (AUC: 0.742-0.912) from available to impaired stroke patients. CONCLUSIONS This study provides evidence that turning speeds during timed up and go test are accurate measures of mobility and capable of discriminating stroke patients with impaired mobility from those with normal mobility. CLINICAL REHABILITATION IMPACT The turning metrics are related to impairment and mobility in chronic stroke patients; hence they are important to include during clinical evaluation and may assist in creating a customized strategy, assess potential treatments, and effectively organize recovery.
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Affiliation(s)
- Stefania Spina
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Salvatore Facciorusso
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy -
| | - Milena C D'Ascanio
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, L'Aquila, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, University Hospital "Maggiore della Carità", Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Santamato
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
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6
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Bianchini E, Warmerdam E, Romijnders R, Stürner KH, Baron R, Heinzel S, Pontieri FE, Hansen C, Maetzler W. Turning when using a smartphone in persons with and without neurologic conditions: an observational study (Preprint). J Med Internet Res 2022; 25:e41082. [PMID: 36995756 PMCID: PMC10131647 DOI: 10.2196/41082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. OBJECTIVE This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. METHODS Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. RESULTS In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. CONCLUSIONS Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. TRIAL REGISTRATION German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998.
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Affiliation(s)
- Edoardo Bianchini
- Department of Neurology, Kiel University, Kiel, Germany
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Elke Warmerdam
- Department of Neurology, Kiel University, Kiel, Germany
- Division of Surgery, Saarland University, Homburg, Germany
| | - Robbin Romijnders
- Department of Neurology, Kiel University, Kiel, Germany
- Faculty of Engineering, Kiel University, Kiel, Germany
| | | | - Ralf Baron
- Department of Neurology, Kiel University, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Kiel University, Kiel, Germany
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Francesco Ernesto Pontieri
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Santa Lucia Foundation, Rome, Italy
| | - Clint Hansen
- Department of Neurology, Kiel University, Kiel, Germany
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Kuan YC, Lin LF, Wang CY, Hu CC, Liang PJ, Lee SC. Association Between Turning Mobility and Cognitive Function in Chronic Poststroke. Front Neurol 2022; 13:772377. [PMID: 35280264 PMCID: PMC8904417 DOI: 10.3389/fneur.2022.772377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Turning difficulties are common in patients with stroke. The detrimental effects of dual tasks on turning indicate a correlation between turning and cognition. Cognitive impairment is prevalent after stroke, and stroke patients with mild cognitive impairment had a poorer turning performance than did stroke patients with intact cognitive abilities. Therefore, we investigated the association between turning mobility and cognitive function in patients with chronic poststroke. Ninety patients with chronic stroke (>6 months post-stroke) were recruited. Angular velocity was assessed using wearable sensors during 180° walking turns and 360° turning on the spot from both sides. Global cognition and distinct cognitive domains were assessed using the Mini-Mental State Examination. In patients with stroke, turning mobility was significantly associated with global cognitive function and distinct cognitive domains, such as visuospatial ability and language. The balance function and lower limbs strength were mediators of the association between cognition and turning. The association highlights the complexity of the turning movement and dynamic motor and cognitive coordination necessary to safely complete a turn. However, our findings should be regarded as preliminary, and a thorough neuropsychological assessment to provide a valid description of distinct cognitive domains is required.
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Affiliation(s)
- Yi-Chun Kuan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Li-Fong Lin
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang-Ho Hospital, New Taipei City, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Chia-Chen Hu
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shu-Chun Lee
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study. J Aging Phys Act 2022; 31:303-310. [PMID: 36216335 DOI: 10.1123/japa.2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.
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An HS, Kim DJ. Effects of activities of daily living-based dual-task training on upper extremity function, cognitive function, and quality of life in stroke patients. Osong Public Health Res Perspect 2021; 12:304-313. [PMID: 34719222 PMCID: PMC8561019 DOI: 10.24171/j.phrp.2021.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of this study was to investigate the effect of daily living dual-task training focused on improving attention and executive function of the upper extremities, cognitive function, and quality of life in stroke patients. Methods We included 30 stroke patients who were hospitalized between July 2020 and October 2020. They were divided into experimental and control groups through randomization. The experimental group performed 20 minutes of dual-task training and received 10 minutes of conventional occupational therapy, while the control group performed 20 minutes of single-task training and received 10 minutes of conventional occupational therapy. Both groups underwent their respective rehabilitation for 30 minutes per session, 5 times per week for 5 weeks. Results Both groups showed significant improvements in upper extremity function, cognitive function, and quality of life; the experimental group showed higher results for all items. A significant between-group difference was observed in the magnitude of the changes. Conclusion In stroke patients, dual-task training that combined attention and executive function with daily living activities was found to be meaningful, as it encouraged active participation and motivation. This study is expected to be used as a foundation for future interventions for stroke patients.
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Affiliation(s)
- Hee-Su An
- Department of Occupational Therapy, Hana General Hospital, Cheongju, Korea
| | - Deok-Ju Kim
- Department of Occupational Therapy, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
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10
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Brauner FO, Balbinot G, Figueiredo AI, Hausen DO, Schiavo A, Mestriner RG. The Performance Index Identifies Changes Across the Dual Task Timed Up and Go Test Phases and Impacts Task-Cost Estimation in the Oldest-Old. Front Hum Neurosci 2021; 15:720719. [PMID: 34658817 PMCID: PMC8514992 DOI: 10.3389/fnhum.2021.720719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Dual tasking is common in activities of daily living (ADLs) and the ability to perform them usually declines with age. While cognitive aspects influence dual task (DT) performance, most DT-cost (DT-C) related metrics include only time- or speed- delta without weighting the accuracy of cognitive replies involved in the task. Objectives: The primary study goal was to weight the accuracy of cognitive replies as a contributing factor when estimating DT-C using a new index of DT-C that considers the accuracy of cognitive replies (P-index) in the instrumented timed up and go test (iTUG). Secondarily, to correlate the novel P-index with domains of the Mini-Mental State Examination (MMSE). Methods: Sixty-three participants (≥85 years old) took part in this study. The single task (ST) and DT iTUG tests were performed in a semi-random order. Both the time taken to complete the task measured utilizing an inertial measurement unit (IMU), and the accuracy of the cognitive replies were used to create the novel P-index. Clinical and sociodemographic data were collected. Results: The accuracy of the cognitive replies changed across the iTUG phases, particularly between the walk 1 and walk 2 phases. Moreover, weighting 0.6 for delta-time (W1) and 0.4 for cognitive replies (W2) into the P-index enhanced the prediction of the MMSE score. The novel P-index was able to explain 37% of the scores obtained by the fallers in the “spatial orientation” and “attention” domains of the MMSE. The ability of the P-index to predict MMSE scores was not significantly influenced by age, schooling, and number of medicines in use. The Bland-Altman analysis indicated a substantial difference between the time-delta-based DT-C and P-index methods, which was within the limits of agreement. Conclusions: The P-index incorporates the accuracy of cognitive replies when calculating the DT-C and better reflects the variance of the MMSE in comparison with the traditional time- or speed-delta approaches, thus providing an improved method to estimate the DT-C.
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Affiliation(s)
- Fabiane Oliveira Brauner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Gustavo Balbinot
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anelise Ineu Figueiredo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Daiane Oliveira Hausen
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Régis Gemerasca Mestriner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
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11
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Figueiredo AI, Balbinot G, Brauner FO, Schiavo A, Baptista RR, Pagnussat AS, Hollands K, Mestriner RG. SPARC Metrics Provide Mobility Smoothness Assessment in Oldest-Old With and Without a History of Falls: A Case Control Study. Front Physiol 2020; 11:540. [PMID: 32587523 PMCID: PMC7298141 DOI: 10.3389/fphys.2020.00540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ −13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs.
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Affiliation(s)
- Anelise Ineu Figueiredo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Balbinot
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Fabiane Oliveira Brauner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Reimann Baptista
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Souza Pagnussat
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Kristen Hollands
- School of Health Sciences, University of Salford Manchester, Salford, United Kingdom
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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12
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Zou TE, Liang PJ, Lee SC. Turning duration and steps predict future falls in poststroke hemiplegic individuals: A preliminary cohort study. Top Stroke Rehabil 2020; 28:33-41. [PMID: 32397952 DOI: 10.1080/10749357.2020.1760644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Turning was reported as one of the activities that most frequently leads to falling among stroke patients. This study investigated whether the duration and steps of a 180° turn while walking can distinguish retrospective fallers from non-fallers and predict future falls in a 1-year period in patients with poststroke hemiplegia. Methods: Thirty stroke patients were recruited. They were instructed to get up from a chair, walk straight 3 m, turn around, and return to seated position to assess the 180° walking-turn task. Turning performance was measured by two inertial sensor units of Physilog. Turn duration and steps were recorded for analysis. The numbers of retrospective and prospective falls were also obtained. Results: No significant difference was observed between retrospective stroke fallers and non-fallers in turn duration and steps. Turn duration and steps were significantly greater in prospective stroke fallers than in non-fallers. The cutoff turn duration of 4 s (area under the curve 0.75, 95% CI: 0.56-0.93, sensitivity 67%, specificity 80%, p =.04) and turn step of 7 steps (area under the curve 0.73, 95% CI: 0.51-0.94, sensitivity 56%, specificity 85%, p =.05) were found to most accurately predict prospective stroke fallers from non-fallers. Conclusions: Turn duration and steps were unable to discriminate between retrospective fallers and non-fallers but could predict prospective falls in patients with stroke. More than 4 s or 7 steps to complete a 180° turn while walking can be a predictor for patients with stroke at an increased risk of falling.
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Affiliation(s)
- Tian-En Zou
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , New Taipei City, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , New Taipei City, Taiwan
| | - Shu-Chun Lee
- School of Gerontology Health Management, College of Nursing, Taipei Medical University , Taipei City, Taiwan
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13
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Turn Characteristics During Gait Differ With and Without a Cognitive Demand Among College Athletes. J Sport Rehabil 2020; 29:448-453. [PMID: 30860425 DOI: 10.1123/jsr.2018-0129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 12/26/2018] [Accepted: 02/12/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Sports often involve complex movement patterns, such as turning. Although cognitive load effects on gait patterns are well known, little is known on how it affects biomechanics of turning gait among athletes. Such information could help evaluate how concussion affects turning gait required for daily living and sports. OBJECTIVE To determine the effect of a dual task on biomechanics of turning while walking among college athletes. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Fifty-three participants performed 5 trials of a 20-m walk under single- and dual-task conditions at self-selected speed with a 180° turn at 10-m mark. The cognitive load included subtraction, spelling words backward, or reciting the months backward. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Turn duration, turning velocity, number of steps, SD of turn duration and velocity, and coefficient of variation of turn duration and velocity. RESULTS Participants turned significantly slower (155.99 [3.71] cm/s vs 183.52 [4.17] cm/s; P < .001) and took longer time to complete the turn (2.63 [0.05] s vs 2.33 [0.04] s; P < .001) while dual tasking, albeit taking similar number of steps to complete the turn. Participants also showed more variability in turning time under the dual-task condition (SD of turn duration = 0.39 vs 0.31 s; P = .004). CONCLUSIONS Overall, college athletes turned slower and showed more variability during turning gait while performing a concurrent cognitive dual-task turning compared with single-task turning. The slower velocity increased variability may be representative of specific strategy of turning gait while dual tasking, which may be a result of the split attention to perform the cognitive task. The current study provides descriptive values of absolute and variability turning gait parameters for sports medicine personnel to use while they perform their concussion assessments on their college athletes.
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14
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Swanson CW, Fling BW. Associations between Turning Characteristics and Corticospinal Inhibition in Young and Older Adults. Neuroscience 2019; 425:59-67. [PMID: 31765624 DOI: 10.1016/j.neuroscience.2019.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023]
Abstract
The effects of aging are multifaceted including deleterious changes to the structure and function of the nervous system which often results in reduced mobility and quality of life. Turning while walking (dynamic) and in-place (stable) are ubiquitous aspects of mobility and have substantial consequences if performed poorly. Further, turning is thought to require higher cortical control compared to bouts of straight-ahead walking. This study sought to understand how relative amounts of corticospinal inhibition as measured by transcranial magnetic stimulation and the cortical silent period within the primary motor cortices are associated with various turning characteristics in neurotypical young (YA) and older adults (OA). In the current study, OA had reduced peak turn velocity and increased turn duration for both dynamic and stable turns. Further, OA demonstrated significantly reduced corticospinal inhibition within the right motor cortex. Finally, all associations between corticospinal inhibition and turning performance were specific to the right hemisphere, reflecting that those OA who maintained high levels of inhibition performed turning similar to their younger counterparts. These results compliment the right hemisphere model of aging and lateralization specification of cortically regulated temporal measures of dynamic movement. While additional investigations are required, these pilot findings provide an additional understanding as to the neural control of dynamic movements.
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Affiliation(s)
- Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA.
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15
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Nakamura T, Higuchi T, Kikumoto T, Takeda T, Tashiro H, Hoshi F. Slower Reorientation of Trunk for Reactive Turning while Walking in Hemiparesis Stroke Patients. J Mot Behav 2019; 51:640-646. [PMID: 30600784 DOI: 10.1080/00222895.2018.1547894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We examined the behavioral characteristics of reactive turning in hemiplegic stroke patients when they were informed of the turning direction just before turning was required at an unpredictable time. Eleven stroke patients and 20 healthy elderly control people were asked to initiate a turn as soon as a visual cue to inform them of the turning direction was activated unpredictably using a foot switch. Both the segmental reorientation and stepping type when turning 90° while walking were measured. The results indicated preserved segmental reorientation of the head and pelvis in stroke patients. Stroke patients showed delays in pelvic turning but not in head turning. Their delayed pelvic movement might be due to motor dysfunction and the time taken to ensure stability when deciding when to turn.
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Affiliation(s)
- Takahito Nakamura
- Department of Rehabilitation, Rehabilitation Amakusa Hospital , Saitama , Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University , Tokyo , Japan
| | - Toyo Kikumoto
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University , Saitama , Japan
| | - Takanori Takeda
- Department of Rehabilitation Technique, Ageo Central General Hospital , Saitama , Japan
| | - Hideyuki Tashiro
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University , Hokkaido , Japan
| | - Fumihiko Hoshi
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University , Saitama , Japan
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16
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Chan WN, Tsang WWN. The effect of Tai Chi training on the dual-tasking performance of stroke survivors: a randomized controlled trial. Clin Rehabil 2018; 32:1076-1085. [DOI: 10.1177/0269215518777872] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effect of Tai Chi training with conventional exercise on dual-tasking performance among stroke survivors. Design: An assessor-blinded, randomized controlled trial. Subjects: Community-dwelling stroke survivors. Setting: Community centers and university. Interventions: Subjects in the Tai Chi group and the conventional exercise group were trained with the corresponding exercises for 12 weeks (1 hour/session, 2/week). No training was given to the controls. Main measures: An auditory Stroop test, a turning-while-walking test, and a dual-tasking condition that combined the two tests were conducted at baseline, after the intervention, and one month later. Results: Forty-seven subjects were randomized into Tai Chi group ( n = 15), conventional exercise group ( n = 17), or control group ( n = 15). There was no significant difference in the outcome measures among the three groups after the intervention and at the one month follow-up assessment. Within-group comparisons showed improvements in dual-tasking performance after Tai Chi training and further improvement during the follow-up period (composite score on the auditory Stroop test: pre-assessment: 73.1 ± 27.6, post-assessment: 89.9 ± 23.4, follow-up assessment: 91.7 ± 26.9; completion time of the turning-while-walking test: pre-assessment: 17.7 ± 6.9 seconds, post-assessment: 15.6 ± 5.2 seconds, follow-up assessment: 14.9 ± 4.9 seconds). Conclusion: Tai Chi training does not have superior effect on dual-tasking performance compared with conventional exercise among stroke survivors. Further studies with larger sample size, longer training, and follow-up periods are needed.
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Affiliation(s)
- Wing Nga Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - William Wai-Nam Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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17
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Abstract
Although turning has been reported as one of the leading activities performed during a fall, and falls during turning result in 8-times more hip fractures than falls during linear gait, the quantity and quality of turns resulting in falls remain unknown since turns are rarely assessed during activities of daily living. 160 community-dwelling older adults were monitored for one week using smartphone technology. Turn measures and activity rates were quantified. Fall incidence within 12 months from continuous monitoring defined fall status, with 7/153 prospective fallers/non-fallers. Based on the analysis of 718,582 turns, prospective fallers turned less frequently, took longer to turn, and were less consistent in turn angle (p = 0.007, 0.025, and 0.038, respectively). Prospective fallers also walked slower and spent less time walking and turning and more time engaged in sedentary behavior (p = 0.043, 0.012, and 0.015, respectively). Individuals experiencing decline in the control of gait and/or turning may attempt to reduce their risk of falling by limiting their exposure and implementing cautionary movement strategies while turning. Since there was no difference in the overall active rate between prospective fallers and non-fallers, impaired gait and turning ability, specifically, may attribute to elevated fall risk within this cohort.
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18
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Medeiros FM, de Carvalho Myskiw J, Baptista PPA, Neves LT, Martins LA, Furini CRG, Izquierdo I, Xavier LL, Hollands K, Mestriner RG. Can an aversive, extinction-resistant memory trigger impairments in walking adaptability? An experimental study using adult rats. Neurosci Lett 2018; 665:224-228. [PMID: 29229398 DOI: 10.1016/j.neulet.2017.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
Abstract
Cognitive demands can influence the adaptation of walking, a crucial skill to maintain body stability and prevent falls. Whilst previous research has shown emotional load tunes goal-directed movements, little attention has been given to this finding. This study sought to assess the effects of suffering an extinction-resistant memory on skilled walking performance in adult rats, as an indicator of walking adaptability. Thus, 36 Wistar rats were divided in a two-part experiment. In the first part (n=16), the aversive, extinction-resistance memory paradigm was established using a fear-conditioning chamber. In the second, rats (n=20) were assessed in a neutral room using the ladder rung walking test before and tree days after inducing an extinction-resistance memory. In addition, the elevated plus-maze test was used to control the influence of the anxiety-like status on gait adaptability. Our results revealed the shock group exhibited worse walking adaptability (lower skilled walking score), when compared to the sham group. Moreover, the immobility time in the ladder rung walking test was similar to the controls, suggesting that gait adaptability performance was not a consequence of the fear generalization. No anxiety-like behavior was observed in the plus maze test. Finally, correlation coefficients also showed the skilled walking performance score was positively correlated with the number of gait cycles and trial time in the ladder rung walking test and the total crossings in the plus maze. Overall, these preliminary findings provide evidence to hypothesize an aversive, extinction-resistant experience might change the emotional load, affecting the ability to adapt walking.
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Affiliation(s)
- Filipe Mello Medeiros
- Cell and Tissue Laboratory, Biosciences College, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Neuroplasticity and Rehabilitation Research Group, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Graduate Program in Cellular and Molecular Biology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | - Jociane de Carvalho Myskiw
- Memory Center, Brain Institute of Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | - Pedro Porto Alegre Baptista
- Cell and Tissue Laboratory, Biosciences College, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | - Laura Tartari Neves
- Cell and Tissue Laboratory, Biosciences College, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Graduate Program in Cellular and Molecular Biology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | - Lucas Athaydes Martins
- Cell and Tissue Laboratory, Biosciences College, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Neuroplasticity and Rehabilitation Research Group, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | | | - Iván Izquierdo
- Memory Center, Brain Institute of Rio Grande do Sul, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | - Léder Leal Xavier
- Cell and Tissue Laboratory, Biosciences College, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Neuroplasticity and Rehabilitation Research Group, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Graduate Program in Cellular and Molecular Biology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | - Kristen Hollands
- Health Sciences College, University of Salford, Manchester, United Kingdom
| | - Régis Gemerasca Mestriner
- Cell and Tissue Laboratory, Biosciences College, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Neuroplasticity and Rehabilitation Research Group, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil; Graduate Program in Cellular and Molecular Biology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil.
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19
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The performance of stroke survivors in turning-while-walking while carrying out a concurrent cognitive task compared with controls. PLoS One 2017; 12:e0189800. [PMID: 29272276 PMCID: PMC5741217 DOI: 10.1371/journal.pone.0189800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/02/2017] [Indexed: 01/09/2023] Open
Abstract
Background Turning-while-walking is one of the commonest causes of falls in stroke survivors. It involves cognitive processing and may be challenging when performed concurrently with a cognitive task. Previous studies of dual-tasking involving turning-while-walking in stroke survivors show that the performance of physical tasks is compromised. However, the design of those studies did not address the response of stroke survivors under dual-tasking condition without specifying the task-preference and its effect on the performance of the cognitive task. Objective First, to compare the performance of single-tasking and dual-tasking in stroke survivors. Second, to compare the performance of stroke survivors with non-stroke controls. Methods Fifty-nine stroke survivors and 45 controls were assessed with an auditory Stroop test, a turning-while-walking test, and a combination of the two single tasks. The outcome of the cognitive task was measured by the reaction time and accuracy of the task. The physical task was evaluated by measuring the turning duration, number of steps to turn, and time to complete the turning-while-walking test. Results Stroke survivors showed a significantly reduced accuracy in the auditory Stroop test when dual-tasking, but there was no change in the reaction time. Their performance in the turning-while-walking task was similar under both single-tasking and dual-tasking condition. Additionally, stroke survivors demonstrated a significantly longer reaction time and lower accuracy than the controls both when single-tasking and dual-tasking. They took longer to turn, with more steps, and needed more time to complete the turning-while-walking task in both tasking conditions. Conclusions The results show that stroke survivors with high mobility function performed the auditory Stroop test less accurately while preserving simultaneous turning-while-walking performance. They also demonstrated poorer performance in both single-tasking and dual-tasking as compared with controls.
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20
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An SH, Jee YJ, Shin HH, Lee GC. Validity of the Original and Short Versions of the Dynamic Gait Index in Predicting Falls in Stroke Survivors. Rehabil Nurs 2017; 42:325-332. [DOI: 10.1002/rnj.280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Barrois RPM, Ricard D, Oudre L, Tlili L, Provost C, Vienne A, Vidal PP, Buffat S, Yelnik AP. Observational Study of 180° Turning Strategies Using Inertial Measurement Units and Fall Risk in Poststroke Hemiparetic Patients. Front Neurol 2017; 8:194. [PMID: 28555124 PMCID: PMC5431013 DOI: 10.3389/fneur.2017.00194] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/21/2017] [Indexed: 11/13/2022] Open
Abstract
Objective We analyzed spontaneous 180° turning strategies in poststroke hemiparetic patients by using inertial measurement units (IMUs) and the association of turning strategies with risk of falls. Methods We included right paretic (RP) and left paretic (LP) post-stroke patients, and healthy controls (HCs) from a physical and rehabilitation department in France between July 2015 and October 2015. All subjects were right-handed and right-footed for mobilization tasks. Participants were instructed to turn 180° in a self-selected direction after a 10-m walk while wearing three IMUs on their trunk and both feet. We defined three turning patterns based on the number of external steps (pattern I = 1; II = 2–4 steps; and III ≥ 5) and four turning strategies based on the side chosen to turn (healthy or paretic) and the stance limb used during the first step of the turn (healthy or paretic). Falls in the 6 months after measurement were investigated. Results We included 17 RP [mean (SD) age 57.5 (9.5) years (range 43–73)], 20 LP patients [mean age 60.7 (8.8) years (range 43–63)], and 15 HCs [mean age 56.7 (16.1) years (range 36–83)]. The LP and RP groups behaved similarly in turning patterns, but 90% of LP patients turned spontaneously to the paretic side versus 59% of RP patients. This difference increased with turning strategies: 85% of LP versus 29% of RP patients used strategy 4 (paretic turn side with paretic limb). Patients using strategy 4 had the highest rate of falls. Conclusion We propose to consider spontaneous turning strategies as new indicators to evaluate the risk of fall after stroke. IMU could be routinely used to identify this risk and guide balance rehabilitation programs.
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Affiliation(s)
- Rémi Pierre-Marie Barrois
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France
| | - Damien Ricard
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France.,Service de Neurologie, Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, France.,École d'application du Val-de-Grâce, Service de Santé des Armée, Paris, France
| | - Laurent Oudre
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France.,Institut Galilée, Université Paris 13, Villetaneuse, France
| | - Leila Tlili
- PRM Department, GH St Louis Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France
| | - Clément Provost
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France.,PRM Department, GH St Louis Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France
| | - Aliénor Vienne
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France
| | - Pierre-Paul Vidal
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France
| | - Stéphane Buffat
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France.,École d'application du Val-de-Grâce, Service de Santé des Armée, Paris, France.,Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France
| | - Alain P Yelnik
- Cognition and Action Group, Cognac-G, CNRS UMR 8257, Université Paris Descartes, Service de Santé des Armées, Paris, France.,PRM Department, GH St Louis Lariboisière F. Widal, AP-HP, Paris Diderot University, Paris, France
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22
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Xu R, Wang X, Yang J, He F, Zhao X, Qi H, Zhou P, Ming D. Comparison of the COM-FCP inclination angle and other mediolateral stability indicators for turning. Biomed Eng Online 2017; 16:37. [PMID: 28340588 PMCID: PMC5364651 DOI: 10.1186/s12938-017-0325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that turning is associated with more instability than straight walking and instability increases with turning angles. However, the precise relationship of changes in stability with the curvature and step length of turning is not clear. The traditional center of mass (COM)-center of pressure (COP) inclination angle requires the use of force plates. A COM-foot contact point (FCP) inclination angle derived from kinematic data is proposed in this study as a measure of the stability of turning. METHODS In order to generate different degrees of stability, we designed an experiment of walking with different curvatures and step lengths. Simultaneously, a novel method was proposed to calculate the COM-FCP inclination angles of different walking trajectories with different step lengths for 10 healthy subjects. The COM-FCP inclination angle, the COM acceleration, the step width and the COM-ankle inclination angles were statistically analyzed. RESULTS The statistical results showed that the mediolateral (ML) COM-FCP inclination angles increased significantly as the curvature of the walking trajectories or the step length in circular walking increased. Changes in the ML COM acceleration, the step width and the ML COM-ankle inclination angle verified the feasibility and reliability of the proposed method. Additionally, the ML COM-FCP inclination angle was more sensitive to the ML stability than the ML COM-ankle inclination angle. CONCLUSIONS The work suggests that it is more difficult to keep balance when walking in a circular trajectory with a larger curvature or in a larger step length. Essentially, turning with a larger angle in one step leads to a lower ML stability. A novel COM-FCP inclination angle was validated to indicate ML stability. This method can be applied to complicated walking tasks, where the force plate is not applicable, and it accounts for the variability of the base of support (BOS) compared to the COM-ankle inclination angle.
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Affiliation(s)
- Rui Xu
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Xin Wang
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Jiajia Yang
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Feng He
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Xin Zhao
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Hongzhi Qi
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Peng Zhou
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China.,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
| | - Dong Ming
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China. .,Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China.
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23
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Bhatt T, Subramaniam S, Varghese R. Examining interference of different cognitive tasks on voluntary balance control in aging and stroke. Exp Brain Res 2016; 234:2575-84. [PMID: 27302401 DOI: 10.1007/s00221-016-4662-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/26/2016] [Indexed: 11/26/2022]
Abstract
This study compared the effect of semantic and working memory tasks when each was concurrently performed with a voluntary balance task to evaluate the differences in the resulting cognitive-motor interference (CMI) between healthy aging and aging with stroke. Older stroke survivors (n = 10), older healthy (n = 10) and young adults (n = 10) performed the limits of stability, balance test under single task (ST) and dual task (DT) with two different cognitive tasks, word list generation (WLG) and counting backwards (CB). Cognitive ability was evaluated by recording the number of words and digits counted while sitting (ST) and during balance tasks (DT). The balance and cognitive costs were computed using [(ST-DT)/ST] × 100 for all the variables. Across groups, the balance cost was significantly higher for the older stroke survivors group in the CB condition than older healthy (p < 0.05) and young adult groups (p < 0.05) but was similar between these two groups for the WLG task. Similarly, the cognitive cost was significantly higher in older stroke survivors than in older healthy (p < 0.05) and young adults (p < 0.01) for both the cognitive tasks. The working memory task resulted in greater CMI than the semantic one, and this difference seemed to be most apparent in older stroke survivors. Young adults showed the least CMI, with a similar performance on the two memory tasks. On the other hand, healthy aging and stroke impact both semantic and working memory. Stroke-related cognitive deficits may further significantly decrease working memory function.
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Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA.
| | - Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA
| | - Rini Varghese
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA
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24
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Zaferiou AM, Wilcox RR, McNitt-Gray JL. Modification of impulse generation during piqué turns with increased rotational demands. Hum Mov Sci 2016; 47:220-230. [PMID: 27038006 DOI: 10.1016/j.humov.2016.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
During initiation of a piqué turn, a dancer generates impulse to achieve the desired lateral translation and whole-body rotation. The goal of this study was to determine how individuals regulate impulse generation when initiating piqué turns with increased rotational demands. Skilled dancers (n=10) performed single (∼360°) and double (∼720°) piqué turns from a stationary position. Linear and angular impulse generated by the push and turn legs were quantified using ground reaction forces and compared across turn conditions as a group and within a dancer using probability-based statistical methods. The results indicate that as the rotation demands of the piqué turn increased, the net angular impulse generated increased whereas net lateral impulse decreased. Early during turn initiation, the free moment contributed to angular impulse generation. Later during turn initiation, horizontal reaction forces were controlled to generate angular impulse. As rotational demands increased, the moment applied increased primarily from redirection of the horizontal reaction force (RFh) at the push leg and a combination of RFh magnitude and moment arm increases at the turn leg. RFh at each leg were coordinated to limit unwanted net linear impulse. Knowledge of observed subject-specific mechanisms is important to inform the design of turning performance training tools.
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Affiliation(s)
- Antonia M Zaferiou
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Rand R Wilcox
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jill L McNitt-Gray
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA; Department of Biological Sciences, University of Southern California, Los Angeles, CA, USA
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25
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Hollands KL, Pelton TA, van der Veen S, Alharbi S, Hollands MA. A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors. Gait Posture 2016; 43:170-5. [PMID: 26455475 DOI: 10.1016/j.gaitpost.2015.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 09/03/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although there is evidence that stroke survivors have reduced gait adaptability, the underlying mechanisms and the relationship to functional recovery are largely unknown. We explored the relationships between walking adaptability and clinical measures of balance, motor recovery and functional ability in stroke survivors. METHODS Stroke survivors (n=42) stepped to targets, on a 6m walkway, placed to elicit step lengthening, shortening and narrowing on paretic and non-paretic sides. The number of targets missed during six walks and target stepping speed was recorded. Fugl-Meyer (FM), Berg Balance Scale (BBS), self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (using GaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was used to model the relationships between: total targets missed, number missed with paretic and non-paretic legs, target stepping speed, and each clinical measure. RESULTS Regression revealed a significant model for each outcome variable that included only one independent variable. Targets missed by the paretic limb, was a significant predictor of FM (F(1,40)=6.54, p=0.014,). Speed of target stepping was a significant predictor of each of BBS (F(1,40)=26.36, p<0.0001), SSWS (F(1,40)=37.00, p<0.0001). No variables were significant predictors of SL or SS asymmetry. DISCUSSION Speed of target stepping was significantly predictive of BBS and SSWS and paretic targets missed predicted FM, suggesting that fast target stepping requires good balance and accurate stepping demands good paretic leg function. The relationships between these parameters indicate gait adaptability is a clinically meaningful target for measurement and treatment of functionally adaptive walking ability in stroke survivors.
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Affiliation(s)
- K L Hollands
- School of Health Sciences, University of Salford, Manchester, UK.
| | - T A Pelton
- School of Psychology, University of Birmingham, Birmingham, UK
| | - S van der Veen
- School of Health Sciences, University of Salford, Manchester, UK
| | - S Alharbi
- School of Health Sciences, University of Salford, Manchester, UK
| | - M A Hollands
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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