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Peters J, Lauinger A, Mayr M, Ginell K, Abou L. Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review. Am J Phys Med Rehabil 2024; 103:554-560. [PMID: 38466165 DOI: 10.1097/phm.0000000000002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT This review investigated the ability of dual-task tests to predict falls in people with neurological disorders. Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with neurological disorders. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. Eighteen studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances were predictive of future falls in people with Huntington's disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, 37% of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer's or Parkinson's disease. Complex dual tasks seemed to be more predictive of fall risk than simpler dual tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in neurological disorders. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions.
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Affiliation(s)
- Joseph Peters
- From the Kansas City University College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri (JP, MM); Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (AL); and Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (KG, LA)
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Petros FE, Santos AM, Adeniyi A, Teruya S, De Los Santos J, Maurer MS, Agrawal SK. Gait abnormalities in older adults with transthyretin cardiac amyloidosis. Amyloid 2024; 31:116-123. [PMID: 38433466 PMCID: PMC11116048 DOI: 10.1080/13506129.2024.2319133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/10/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Transthyretin cardiac amyloidosis (ATTR cardiac amyloidosis) is caused by variant (ATTRv) or wild type (ATTRwt) transthyretin. While gait abnormalities have been studied in younger patients with ATTRv amyloidosis, research on gait in older adults with ATTR cardiac amyloidosis is lacking. Given ATTR cardiac amyloidosis' association with neuropathy and orthopedic manifestations, we explore the gait in this population. METHODS Twenty-eight older male ATTR cardiac amyloidosis patients and 11 healthy older male controls walked overground with and without a dual cognitive task. Gait parameters: stride width, length, velocity and stance time percentage were measured using an instrumented mat. ATTR amyloidosis patients were further categorized based on clinical and functional assessments. RESULTS We found significant gait differences between ATTR cardiac amyloidosis patients and healthy controls; patients had more variable, slower, narrower and shorter strides, with their feet spending more time in contact with the ground as opposed to in swing. However, the observed gait differences did not correlate with clinical and functional measures of ATTR cardiac amyloidosis severity. CONCLUSIONS Our results suggest that gait analysis could be a complementary tool for characterizing ATTR cardiac amyloidosis patients and may inform clinical care as it relates to falls, management of anticoagulation, and functional independence.
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Affiliation(s)
- Fitsum E Petros
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | | | - Adedeji Adeniyi
- Vagelos College of Physicians & Surgeons, Irvine Medical Center, Columbia University, New York, NY, USA
| | - Sergio Teruya
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - Jeffeny De Los Santos
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - Mathew S Maurer
- Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
- Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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Harrison EC, Haussler AM, Tueth LE, Baudendistel ST, Earhart GM. Graceful gait: virtual ballet classes improve mobility and reduce falls more than wellness classes for older women. Front Aging Neurosci 2024; 16:1289368. [PMID: 38327499 PMCID: PMC10847569 DOI: 10.3389/fnagi.2024.1289368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Dance is an effective and motivating form of exercise for older women, but few studies have quantified the benefits of virtual dance classes nor, specifically, ballet. This study tested the effectiveness of virtual ballet compared to virtual wellness classes, with the goal of reaching underserved populations. It is among the first to explore the effects of virtual classical ballet on functional gait mobility, balance, and quality of life measures in older women. Methods Older women were recruited in two waves and randomized to two groups: a ballet class modified for older adults and a wellness-based control class. Both groups received 12 weeks of online classes, meeting twice per week for 45-min sessions. Classes were taught by a local company that offers community-based ballet classes. The same instructor led both the ballet and the wellness classes. Pre- and post-intervention assessments include gait and balance testing using wearable inertial sensors and self-report outcomes including quality of life and mood questionnaires. Results Forty-four older women completed the study: Ballet group (n = 21, 67.81 ± 7.3 years); Wellness group (n = 23, 69.96 ± 6.7 years). Pre- to post-intervention, both groups increased velocity on the two-minute walk test (F1,42 = 25.36, p < 0.001) and improved their time on the Timed Up and Go (F1,42 = 4.744, p = 0.035). Both groups improved balance on the Mini-BESTest (F1,42 = 38.154, p < 0.001), increased their scores on the Activities-Specific Balance Confidence Scale (F1,42 = 10.688, p < 0.001), and increased quality of life via the Short Form Health Survey (F1,42 = 7.663, p = 0.008). The ballet group improved gait variability in the backward direction (F1,42 = 14.577, p < 0.001) and reduced fall rates more than the wellness group [χ2(1) = 5.096, p = 0.024]. Discussion Both virtual ballet and wellness classes improve select measures of gait, balance, and quality of life. The benefits seen in both groups highlight the importance of considering social interaction as a key component when developing future interventions to target mobility in older women.
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Affiliation(s)
- Elinor C. Harrison
- Program in Dance, Performing Arts Department, Washington University in St. Louis, St. Louis, MO, United States
- Program in Physical Therapy, Washington University in School of Medicine St. Louis, St. Louis, MO, United States
| | - Allison M. Haussler
- Program in Physical Therapy, Washington University in School of Medicine St. Louis, St. Louis, MO, United States
| | - Lauren E. Tueth
- Program in Physical Therapy, Washington University in School of Medicine St. Louis, St. Louis, MO, United States
| | - Sidney T. Baudendistel
- Program in Physical Therapy, Washington University in School of Medicine St. Louis, St. Louis, MO, United States
| | - Gammon M. Earhart
- Program in Physical Therapy, Washington University in School of Medicine St. Louis, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Neuroscience, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Piche E, Gerus P, Zory R, Jaafar A, Guerin O, Chorin F. Effects of muscular and mental fatigue on spatiotemporal gait parameters in dual task walking in young, non-frail and frail older adults. Aging Clin Exp Res 2023; 35:2109-2118. [PMID: 37535312 DOI: 10.1007/s40520-023-02506-8] [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: 03/31/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Dual-task (DT) walking is of great interest in clinical evaluation to evaluate frailty or cognitive declines in older adults. Frail older adults are known to adopt different walking strategy to overcome fatigue. However, no studies evaluated the effect of muscular or mental fatigue on dual-task walking strategy and the difference between frail and non-frail older adults. AIMS Evaluate the effect of mental and muscular fatigue on spatio-temporal parameters in dual-task walking in young, non-frail and frail older adults. METHODS 59 participants divided into 20 young (Y) (24.9 ± 3 years old), 20 non-frail (NF) (75.8 ± 4.9 years old) and 19 frail older adults (F) (81 ± 4.7 years old) performed single-task (ST) walking, single-task cognitive (serial subtraction of 3), and dual-task (subtraction + walking) for 1 min at their fast pace. Gait speed, step length, step length variability, stance and swing phase time, single and double support time, cadence, gait speed variability were recorded in single- and dual-task walking. The dual-task effect (DTE) was calculated as ((DT - ST)/ST) × 100). Generalized linear mixed models (GLMM) were used to compare the effects of mental and muscular fatigue on gait and cognitive variables between the groups. RESULTS The DTE walking parameters were worse in F compared to NF or Y but no significant effect of fatigue were highlighted except for swing time and single support time DTEs. CONCLUSIONS The results were mitigated but a clear difference in dual-task spatio-temporal parameters was found between F and NF which brings hope into the capacity of DT to better reveal frailty.
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Affiliation(s)
- Elodie Piche
- Université Côte d'Azur, LAMHESS, Nice, France.
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France.
| | | | - Raphaël Zory
- Université Côte d'Azur, LAMHESS, Nice, France
- Institut Universitaire de France, Paris, France
| | - Amyn Jaafar
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Olivier Guerin
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
- Université Côte d'Azur, CNRS UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice (IRCAN), Faculté de médecine, Nice, France
| | - Frédéric Chorin
- Université Côte d'Azur, LAMHESS, Nice, France
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
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Waterval NFJ, Claassen CM, van der Helm FCT, van der Kruk E. Predictability of Fall Risk Assessments in Community-Dwelling Older Adults: A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:7686. [PMID: 37765742 PMCID: PMC10536675 DOI: 10.3390/s23187686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Fall risk increases with age, and one-third of adults over 65 years old experience a fall annually. Due to the aging population, the number of falls and related medical costs will progressively increase. Correct prediction of who will fall in the future is necessary to timely intervene in order to prevent falls. Therefore, the aim of this scoping review is to determine the predictive value of fall risk assessments in community-dwelling older adults using prospective studies. A total of 37 studies were included that evaluated clinical assessments (questionnaires, physical assessments, or a combination), sensor-based clinical assessments, or sensor- based daily life assessments using prospective study designs. The posttest probability of falling or not falling was calculated. In general, fallers were better classified than non-fallers. Questionnaires had a lower predictive capability compared to the other assessment types. Contrary to conclusions drawn in reviews that include retrospective studies, the predictive value of physical tests evaluated in prospective studies varies largely, with only smaller-sampled studies showing good predictive capabilities. Sensor-based fall risk assessments are promising and improve with task complexity, although they have only been evaluated in relatively small samples. In conclusion, fall risk prediction using sensor data seems to outperform conventional tests, but the method's validity needs to be confirmed by large prospective studies.
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Affiliation(s)
- N. F. J. Waterval
- Department of Rehabilitation Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - C. M. Claassen
- Biomechatronics & Human-Machine Control, Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - F. C. T. van der Helm
- Biomechatronics & Human-Machine Control, Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - E. van der Kruk
- Biomechatronics & Human-Machine Control, Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
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Suri A, VanSwearingen J, Rosano C, Brach JS, Redfern MS, Sejdić E, Rosso AL. Uneven surface and cognitive dual-task independently affect gait quality in older adults. Gait Posture 2023; 106:34-41. [PMID: 37647710 PMCID: PMC10591986 DOI: 10.1016/j.gaitpost.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 07/07/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Real-world mobility involves walking in challenging conditions. Assessing gait during simultaneous physical and cognitive challenges provides insights on cognitive health. RESEARCH QUESTION How does uneven surface, cognitive task, and their combination affect gait quality and does this gait performance relate to cognitive functioning? METHODS Community-dwelling older adults (N = 104, age=75 ± 6 years, 60 % females) performed dual-task walking paradigms (even and uneven surface; with and without alphabeting cognitive task (ABC)) to mimic real-world demands. Gait quality measures [speed(m/s), rhythmicity(steps/minute), stride time variability (%), adaptability (m/s2), similarity, smoothness, power (Hz) and regularity] were calculated from an accelerometer worn on the lower back. Linear-mixed modelling and Tukey analysis were used to analyze independent effects of surface and cognitive task and their interaction on gait quality. Partial Spearman correlations compared gait quality with global cognition and executive function. RESULTS No interaction effects between surface and cognitive task were found. Uneven surface reduced gait speed(m/s) (β = -0.07). Adjusted for speed, uneven surface reduced gait smoothness (β = -0.27) and increased regularity (β = 0.09), Tukey p < .05, for even vs uneven and even-ABC vs uneven-ABC. Cognitive task reduced gait speed(m/s) (β = -0.12). Adjusted for speed, cognitive task increased variability (β = 7.60), reduced rhythmicity (β = -6.68) and increased regularity (β = 0.05), Tukey p < .05, for even vs even-ABC and uneven vs uneven-ABC. With demographics as covariates, gait speed was not associated with cognition. Gait quality [lower variability during even-ABC (ρp =-.31) and uneven-ABC (ρp =-.28); greater rhythmicity (ρp between.22 and.29) and greater signal-adaptability AP (ρp between.22 and.26) during all walking tasks] was associated with better global cognition. Gait adaptability during even (ρp =-0.21, p = 0.03) and uneven(ρp =-0.19, p = 0.04) walking was associated with executive function. SIGNIFICANCE Surface and cognitive walking tasks independently affected gait quality. Our study with high-functioning older adults suggests that task-related changes in gait quality are related to subtle changes in cognitive functioning.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, PA, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, PA, USA
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, PA, USA; The Edward S. Rogers Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada; North York General Hospital, Toronto, ON, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA.
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Lino TB, Scarmagnan GS, Sobrinho-Junior SA, Tessari GMF, Gonçalves GH, Pereira HM, Christofoletti G. Impact of Using Smartphone While Walking or Standing: A Study Focused on Age and Cognition. Brain Sci 2023; 13:987. [PMID: 37508919 PMCID: PMC10376959 DOI: 10.3390/brainsci13070987] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Using smartphones during a task that requires upright posture is suggested to be detrimental for the overall motor performance. The aim of this study was to determine the role of age and specific aspects of cognitive function on walking and standing tasks in the presence of smartphone use. METHODS 51 older (36 women) and 50 young (35 women), mean age: 66.5 ± 6.3 and 22.3 ± 1.7 years, respectively, were enrolled in this study. The impact of using a smartphone was assessed during a dynamic (timed up and go, TUG) and a static balance test (performed on a force platform). Multivariate analyses of variance were applied to verify main effects of age, task, estimates of cognitive function and interactions. RESULTS Compared to young, older individuals exhibited a poorer performance on the dynamic and on the static test (age effect: p = 0.001 for both variables). Dual-tasking with a smartphone had a negative impact on both groups (task effect: p = 0.001 for both variables). The negative impact, however, was greater in the older group (age × task effect: p = 0.001 for both variables). Executive function and verbal fluency partially explained results of the dynamic and static tests, respectively. CONCLUSIONS The negative impact of using a smartphone while performing tasks similar to daily activities is higher in older compared to young people. Subclinical deficits in distinct aspects of cognitive function partially explain the decreased performance when dual-tasking.
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Affiliation(s)
- Tayla B Lino
- School of Medicine, Institute of Health, Federal University of Mato Grosso do Sul, UFMS, Campo Grande 79060-900, Brazil
| | - Gabriella S Scarmagnan
- School of Medicine, Institute of Health, Federal University of Mato Grosso do Sul, UFMS, Campo Grande 79060-900, Brazil
| | - Sidney A Sobrinho-Junior
- School of Medicine, Institute of Health, Federal University of Mato Grosso do Sul, UFMS, Campo Grande 79060-900, Brazil
| | - Giovanna M F Tessari
- School of Medicine, Institute of Health, Federal University of Mato Grosso do Sul, UFMS, Campo Grande 79060-900, Brazil
| | - Glaucia H Gonçalves
- School of Medicine, Institute of Health, Federal University of Mato Grosso do Sul, UFMS, Campo Grande 79060-900, Brazil
| | - Hugo M Pereira
- Department of Health and Exercise Science, University of Oklahoma, Norman, OU 73019, USA
| | - Gustavo Christofoletti
- School of Medicine, Institute of Health, Federal University of Mato Grosso do Sul, UFMS, Campo Grande 79060-900, Brazil
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Nascimento MDM, Maduro PA, Rios PMB, Nascimento LDS, Silva CN, Kliegel M, Ihle A. The Effects of 12-Week Dual-Task Physical-Cognitive Training on Gait, Balance, Lower Extremity Muscle Strength, and Cognition in Older Adult Women: A Randomized Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085498. [PMID: 37107780 PMCID: PMC10139030 DOI: 10.3390/ijerph20085498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
This study aims to investigate the effects of dual-task physical-cognitive the training on body balance (BB), gait performance (GP), lower limb muscle strength (LEMS), and cognitive performance (CP) in a group of cognitively normal older adult women (n = 44; 66.20 ± 4.05 years). Of these, 22 were randomly allocated to the dual-task training (DT) group, and 22 participated in the control group (CG). Assessments were performed at baseline, after 12 weeks of intervention, and at the end of 12 weeks of follow-up, using the following instruments: Timed Up & Go (TUG), Timed Up & Go manual (TUGm), Timed Up & Go cognitive (TUGc), Balance Test (TEC), sit-to-stand test (STS), and verbal fluency test (VF). After 12 weeks of DT training, participants showed a significant time × group interaction in all motor assessments (BB, GP, LEMS), as well as in three cognitive tests (VF-grouping, VF-exchange, VF-total). No time-group interaction effect was indicated for the VF-category test. At all evaluation times, CG members maintained constant physical and cognitive performance. We conclude that 12 weeks of physical-cognitive DT training was effective in promoting BB, GP, and LEMS, as well as CP in cognitively normal older adult women, with lasting effects up to 12 weeks after the intervention.
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Affiliation(s)
- Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
- Correspondence: ; Tel.: +55-(87)-21016856
| | - Paula Andreatta Maduro
- University Hospital of the Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Pâmala Morais Bagano Rios
- Department of Psychology, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Lara dos Santos Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Carolina Nascimento Silva
- Department of Psychology, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Matthias Kliegel
- Department of Psychology, University of Geneva, 1205 Geneva, Switzerland (A.I.)
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland
| | - Andreas Ihle
- Department of Psychology, University of Geneva, 1205 Geneva, Switzerland (A.I.)
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland
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Dual-Task Interference Slows Down Proprioception. Motor Control 2023:1-15. [PMID: 36599354 DOI: 10.1123/mc.2022-0075] [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: 06/09/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 01/05/2023]
Abstract
It is well-known that multitasking impairs the performance of one or both of the concomitant ongoing tasks. Previous studies have mainly focused on how a secondary task can compromise visual or auditory information processing. However, despite dual tasking being critical to motor performance, the effects of dual-task performance on proprioceptive information processing have not been studied yet. The purpose of the present study was, therefore, to investigate whether sensorimotor task performance would be affected by the dual task and if so, in which phase of the sensorimotor task performance would this negative effect occur. The kinematic variables of passive and active knee movements elicited by the leg drop test were analyzed. Thirteen young adults participated in the study. The dual task consisted of performing serial subtractions. The results showed that the dual task increased both the reaction time to counteract passive knee-joint movements in the leg drop test and the threshold to detect those movements. The dual task did not affect the speed and time during the active knee movement and the absolute angle error between the final and the target knee angles. Furthermore, the results showed that the time to complete the sensorimotor task was prolonged in dual tasking. Our findings suggest that dual tasking reduces motor performance due to slowing down proprioceptive information processing without affecting movement execution.
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Effects of age, sex, frailty and falls on cognitive and motor performance during dual-task walking in older adults. Exp Gerontol 2023; 171:112022. [PMID: 36371049 DOI: 10.1016/j.exger.2022.112022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/26/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dual-task (DT) walking is of great interest in clinical evaluation to evaluate the risk of falling or cognitive declines in older adults. However, it appears necessary to investigate deeply the confounding factors to better understand their impact on dual-task performance. OBJECTIVE To evaluate the effect of age, sex, falls and frailty on cognitive and motor parameters in dual-task walking. SUBJECTS 66 older participants (mean age = 75.5 ± 6.3; mean height = 165.8 ± 8.4 cm; mean weight = 68.4 ± 14 kgs) were split into groups based on their age, sex, fall and frailty status. METHODS Participants performed single-task walking, single-task cognitive (serial subtraction of 3), and dual-task walking (subtraction + walking) for 1 min at their fast pace. Gait speed, step length, step length variability, stance and swing phase time, single and double support, cadence, step time variability and gait speed variability were recorded in single- and dual-task walking and used to calculate the dual-task effect (DTE) as ((DT - ST) / ST) ∗ 100). The cognitive score (DTEcog) was calculated as the number of correct responses minus errors. Generalized linear mixed models (GLMM) were used to compare the effects of falls, frailty, age and sex on gait and cognitive variables. RESULTS The interaction frailty*sex and frailty*age were the major effect on the DTEs. Specifically, the DTE was higher in women than men and in the frail group compared to non-frail. CONCLUSIONS The present findings provide a better understanding on the confounding factors explaining the behavior in DT that could be used to develop more effective dual-task clinical programs for community-living older adults.
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iPhone Accelerometry Provides a Sensitive In-Home Assessment of Age-Related Changes in Standing Balance. J Aging Phys Act 2022; 31:489-496. [PMID: 36640781 DOI: 10.1123/japa.2022-0214] [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: 06/11/2022] [Revised: 08/23/2022] [Accepted: 09/23/2022] [Indexed: 12/25/2022]
Abstract
Remote health monitoring has become increasingly important, especially in aging populations. We aimed to identify tasks that are sensitive to age-related changes in balance during fully remote, at-home balance assessment. Participants were 12 healthy young adults (mean age = 26.08 years, range: 18-33) and 12 healthy older adults (mean age = 67.33 years, range: 60-75). Participants performed standing tasks monitored via video conference while their balance was quantified using a custom iPhone application measuring mediolateral center of mass acceleration. We included three stances (feet together, tandem, and single leg) with eyes open or closed, with or without a concurrent cognitive task. Older adults demonstrated significantly more variable center of mass accelerations in tandem (p = .04, ηp2=.25) and significantly higher (p < .01, ηp2=.45) and more variable (p < .01, ηp2=.44) center of mass accelerations in single leg compared with young adults. We also observed that as task challenge increased, balance dual-task cost diminished for older, but not young, adults.
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12
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Beck Jepsen D, Robinson K, Ogliari G, Montero-Odasso M, Kamkar N, Ryg J, Freiberger E, Tahir M. Predicting falls in older adults: an umbrella review of instruments assessing gait, balance, and functional mobility. BMC Geriatr 2022; 22:615. [PMID: 35879666 PMCID: PMC9310405 DOI: 10.1186/s12877-022-03271-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background To review the validated instruments that assess gait, balance, and functional mobility to predict falls in older adults across different settings. Methods Umbrella review of narrative- and systematic reviews with or without meta-analyses of all study types. Reviews that focused on older adults in any settings and included validated instruments assessing gait, balance, and functional mobility were included. Medical and allied health professional databases (MEDLINE, PsychINFO, Embase, and Cochrane) were searched from inception to April 2022. Two reviewers undertook title, abstract, and full text screening independently. Review quality was assessed through the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS). Data extraction was completed in duplicate using a standardised spreadsheet and a narrative synthesis presented for each assessment tool. Results Among 2736 articles initially identified, 31 reviews were included; 11 were meta-analyses. Reviews were primarily of low quality, thus at high risk of potential bias. The most frequently reported assessments were: Timed Up and Go, Berg Balance Scale, gait speed, dual task assessments, single leg stance, functional Reach Test, tandem gait and stance and the chair stand test. Findings on the predictive ability of these tests were inconsistent across the reviews. Conclusions In conclusion, we found that no single gait, balance or functional mobility assessment in isolation can be used to predict fall risk in older adults with high certainty. Moderate evidence suggests gait speed can be useful in predicting falls and might be included as part of a comprehensive evaluation for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03271-5.
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Affiliation(s)
- D Beck Jepsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - K Robinson
- Department of Health Care for Older People (HCOP), Research and Innovation, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK. .,School of Medicine, University of Nottingham, Nottingham, UK.
| | - G Ogliari
- Department of Health Care for Older People (HCOP), Research and Innovation, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, SLawson Health Research Institute, London, ON, Canada.,Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario London, London, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - N Kamkar
- Gait and Brain Lab, Parkwood Institute, SLawson Health Research Institute, London, ON, Canada
| | - J Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - E Freiberger
- Institute for Biomedicine of Aging, FAU Erlangen-Nürnberg, Nuremberg, Germany
| | - Masud Tahir
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Health Care for Older People (HCOP), Research and Innovation, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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13
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Wang J, Hong JT, Xiang Y, Zhang C. Do the dual-task "8-foot up and go" tests provide additional predictive value for early detection of cognitive decline in community-dwelling older women? Aging Clin Exp Res 2022; 34:2431-2439. [PMID: 35838984 DOI: 10.1007/s40520-022-02193-x] [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: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The 8-Foot Up and Go (8UG) test is a widely used mobility assessment. Some dual-task mobility assessments have been developed to help detect cognitive decline. AIMS This study developed a dual-task version of 8UG test to investigate the dual-task 8UG performance and to evaluate the ability of dual-task 8UG test in detecting cognitive decline. METHODS A total of 101 eligible community-dwelling women aged 60-74 years were grouped into the mild cognitive impairment group (MCI, n = 49) and the non-cognitive impairment group (NCI, n = 52). The 8UG tests under single-task (ST), manual dual-task (MT), and cognitive dual-task (CT) conditions were performed respectively. The dual-task cost (DTC) and the correct response rate (CRR) were calculated to quantify the dual-task interference. RESULTS Participants spent more time in performing the 8UG test under dual-task conditions. No differences were observed between NCI and MCI groups for 8UG parameters under ST and MT conditions (p > 0.05). When executing CT, significant differences were found in the number of correct answers and CRR (p < 0.05). CRR showed the strongest ability to predict MCI with a cut-off point of 0.50 (71.2% sensitivity and 61.2% specificity). DISCUSSION Both manual and cognitive dual-task were found to interfere with the 8UG performance. CRR with cutoff point of 0.50 could be a potential predictor of MCI in community-dwelling older women. CONCLUSIONS The CRR of the cognitive dual-task 8UG test could be recommended as a potential predictor for the early detection of MCI in community-dwelling older women.
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Affiliation(s)
- Jingjing Wang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.,Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Jin-Tao Hong
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, 200030, China
| | - Yun Xiang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.,School of Physical Education, Hubei Engineering University, Xiaogan, 432000, Hubei, China
| | - Chunhua Zhang
- School of Exercise and Health, Shanghai University of Sport, Yangpu District, 650 Qing Yuan Huan Rd, Shanghai, 200438, China.
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14
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Parati M, Ambrosini E, DE Maria B, Gallotta M, Dalla Vecchia LA, Ferriero G, Ferrante S. The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:363-377. [PMID: 34985239 PMCID: PMC9987464 DOI: 10.23736/s1973-9087.22.07037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups. EVIDENCE ACQUISITION A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the Consensus-Based Standards for the Selection of Health Measurement Instruments Checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values. EVIDENCE SYNTHESIS A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in single-and cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction). CONCLUSIONS Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy -
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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15
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Piche E, Gerus P, Chorin F, Jaafar A, Guerin O, Zory R. The effect of different dual tasks conditions on gait kinematics and spatio-temporal walking parameters in older adults. Gait Posture 2022; 95:63-69. [PMID: 35453085 DOI: 10.1016/j.gaitpost.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dual-task (DT) walking has increasingly been investigated over the last decade because of its valuable role as a clinical marker of both cognitive impairment and fall risk in older adults based on cognitive and motor performance (DTEcog, DTEmotor). However, there is still a lack of information on what type of dual task to choose and which is the most adapted to the population of interest. RESEARCH QUESTION To evaluate the effect of different dual-tasks (DT3, DT7, FLU, STROOP) on the spatiotemporal and kinematic parameters of hip, knee, and ankle joints. METHODS Thirty-eight older adults were recruited (9 men, 29 women, mean age = 77.5 +/- 6.5 years, mean height = 163.6 +/- 8.6 cm, mean weight = 67.5 +/- 15.3 kg). They performed a single and dual-task walk with the 4 types of tasks during 1 min, equipped with an inertial system. Dual-task effect (DTE) on spatiotemporal and kinematic variables as well as cognitive score and speed were calculated. RESULTS An alteration in most of the spatiotemporal parameters was observed in each DT condition (p < 0.05), especially in arithmetic tasks (DT3, DT7), while no DT effect was noticed on kinematic parameters (RMSE<3°) except on hip and knee angular velocities (RMSE>15°). Arithmetic tasks seemed to alter more spatiotemporal and kinematic parameters than the verbal fluency or STROOP test. However, DT7 appeared to be too difficult for the population of interest. SIGNIFICANCE Arithmetic tasks seemed to be very pertinent as a clinical dual-task protocol for older adults. The use of an inertial system to retrieve kinematic variables is an improvement in these dual-task protocols.
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Affiliation(s)
- Elodie Piche
- Université Côte d'Azur, LAMHESS, Nice, France; Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France.
| | | | - Fréderic Chorin
- Université Côte d'Azur, LAMHESS, Nice, France; Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Amyn Jaafar
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France
| | - Olivier Guerin
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique du Cerveau et du Mouvement, Nice, France; Université Côte d'Azur, CNRS UMR 7284/INSERM U108, Institute for Research on Cancer and Aging Nice (IRCAN), Faculté de médecine, Nice, France
| | - Raphaël Zory
- Université Côte d'Azur, LAMHESS, Nice, France; Institut Universitaire de France, France
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16
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Pallavi P, Jariwala N, Patel N, Kanetkar M, Diwan S, Lahiri U. The Implication of Pathway Turn and Task Condition on Gait Quantified Using SmartWalk: Changes With Age and Parkinson's Disease With Relevance to Postural Strategy and Risk of Fall. Front Neurosci 2022; 16:804397. [PMID: 35573308 PMCID: PMC9098993 DOI: 10.3389/fnins.2022.804397] [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: 10/29/2021] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
One's gait can be affected by aging, pathway with turns, task demands, etc., causing changes in gait-related indices and knee flexion (influencing posture). Walking on pathways with turns threatens stability, affecting one's gait-related indices and posture. The ability to overcome such deficits is compromised with age and neurological disorders, e.g., Parkinson's Disease (PD) leading to falls. Also, task demands imposed by single and dual-task (e.g., counting backward while walking) conditions affect the gait of individuals using different postural strategies varying with age and neurological disorder. Existing research has investigated either the effect of the pathway with turn or task condition on one's gait. However, none (to our knowledge) have explored the differentiated implications of the pathway with turn and task conditions on one's gait-related indices and knee flexion while walking. Our study had two phases with 30 participants. Phase 1 had healthy adults (young and old) and Phase 2 had age and gender-matched healthy elderly and individuals with Parkinson's disease (PD) who walked on pathways having turns under single and dual-task conditions. We analysed gait in terms of (i) gait-related indices (Phases 1 and 2) and (ii) knee flexion (Phase 2). Also, we analysed one's counting performance during dual task. One's gait-related indices and knee flexion were measured using a portable gait quantifier. The aim was to (i)understand whether both pathways with turn and task conditions are equally effective in affecting the gait of (a)individuals of varying ages and (b) gender-matched healthy older adults and individuals with PD, (ii)study variations of knee joint angles while walking on pathways having turns (under different task conditions) in terms of its clinical relevance, and (iii) explore the implication of pathway with turn on counting performance (with relevance to postural strategy) with varying age and PD. Results indicated that for the younger group, the task condition caused statistical variations in gait-related indices. For the older group, both pathways with turn and task conditions had statistical implications on gait-related indices. Additionally, individuals with PD demonstrated a higher variation in knee flexion than their healthy counterparts. Again, pathways with varying turns elicited variations in counting performance indicating different postural strategies being employed by the three groups.
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Affiliation(s)
- Priya Pallavi
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | | | - Niravkumar Patel
- Design and Innovation Centre, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | - Manasi Kanetkar
- Design and Innovation Centre, Indian Institute of Technology Gandhinagar, Gandhinagar, India
| | | | - Uttama Lahiri
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, India
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17
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Kirshner D, Spiegelhalder K, Shahar RT, Shochat T, Agmon M. The association between objective measurements of sleep quality and postural control in adults: A systematic review. Sleep Med Rev 2022; 63:101633. [DOI: 10.1016/j.smrv.2022.101633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/18/2022] [Accepted: 04/03/2022] [Indexed: 01/31/2023]
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18
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Hupfeld KE, Geraghty JM, McGregor HR, Hass CJ, Pasternak O, Seidler RD. Differential Relationships Between Brain Structure and Dual Task Walking in Young and Older Adults. Front Aging Neurosci 2022; 14:809281. [PMID: 35360214 PMCID: PMC8963788 DOI: 10.3389/fnagi.2022.809281] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Almost 25% of all older adults experience difficulty walking. Mobility difficulties for older adults are more pronounced when they perform a simultaneous cognitive task while walking (i.e., dual task walking). Although it is known that aging results in widespread brain atrophy, few studies have integrated across more than one neuroimaging modality to comprehensively examine the structural neural correlates that may underlie dual task walking in older age. We collected spatiotemporal gait data during single and dual task walking for 37 young (18–34 years) and 23 older adults (66–86 years). We also collected T1-weighted and diffusion-weighted MRI scans to determine how brain structure differs in older age and relates to dual task walking. We addressed two aims: (1) to characterize age differences in brain structure across a range of metrics including volumetric, surface, and white matter microstructure; and (2) to test for age group differences in the relationship between brain structure and the dual task cost (DTcost) of gait speed and variability. Key findings included widespread brain atrophy for the older adults, with the most pronounced age differences in brain regions related to sensorimotor processing. We also found multiple associations between regional brain atrophy and greater DTcost of gait speed and variability for the older adults. The older adults showed a relationship of both thinner temporal cortex and shallower sulcal depth in the frontal, sensorimotor, and parietal cortices with greater DTcost of gait. Additionally, the older adults showed a relationship of ventricular volume and superior longitudinal fasciculus free-water corrected axial and radial diffusivity with greater DTcost of gait. These relationships were not present for the young adults. Stepwise multiple regression found sulcal depth in the left precentral gyrus, axial diffusivity in the superior longitudinal fasciculus, and sex to best predict DTcost of gait speed, and cortical thickness in the superior temporal gyrus to best predict DTcost of gait variability for older adults. These results contribute to scientific understanding of how individual variations in brain structure are associated with mobility function in aging. This has implications for uncovering mechanisms of brain aging and for identifying target regions for mobility interventions for aging populations.
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Affiliation(s)
- Kathleen E. Hupfeld
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Justin M. Geraghty
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Heather R. McGregor
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - C. J. Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachael D. Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
- University of Florida Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
- *Correspondence: Rachael D. Seidler
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19
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Tsang CSL, Miller T, Pang MYC. Association between fall risk and assessments of single-task and dual-task walking among community-dwelling individuals with chronic stroke: A prospective cohort study. Gait Posture 2022; 93:113-118. [PMID: 35134650 DOI: 10.1016/j.gaitpost.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falling and fall-related injuries are common among community-dwelling individuals with chronic stroke. Falls often occur during dual-task walking scenarios. Accurate fall prediction is critical for formulating effective fall prevention strategies. RESEARCH QUESTIONS Can dual-task walking tests and corresponding single-task tests predict falls among individuals with chronic stroke? Are dual-task walking tests involving visuospatial cognition more effective in predicting falls than those involving other cognitive domains? METHODS Ninety-three individuals with stroke (age: 62.4 ± 6.7 years; stroke duration: 5.6 ± 4.5 years) participated in this prospective cohort study. Two mobility tasks (level-ground walking and obstacle-crossing) were performed with and without two cognitive tasks (auditory clock test and auditory Stroop test). Demographic information and clinical measures of depression, motor function, walking speed and balance were collected. Monthly telephone interviews were conducted to collect data on fall incidence, related circumstances and injuries incurred during a 12-month follow-up period. Multivariate logistic regression analysis was performed to identify predictive factors associated with future risk of falls. RESULTS Thirty-six participants (39%) reported one or more falls during the follow-up period. The regression model including reaction time during the auditory clock task performance while negotiating obstacles correctly classified the fall status of 80% of the participants (72% future fallers and 84% non-fallers). Performance did not differ between fallers and non-fallers on any other measures tested. SIGNIFICANCE Dual-task assessment combining an auditory clock task with an obstacle-crossing task has potential clinical utility for identifying future fall risk among people with chronic stroke.
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Affiliation(s)
- Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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20
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Altorfer P, Adcock M, de Bruin ED, Graf F, Giannouli E. Feasibility of Cognitive-Motor Exergames in Geriatric Inpatient Rehabilitation: A Pilot Randomized Controlled Study. Front Aging Neurosci 2021; 13:739948. [PMID: 34912206 PMCID: PMC8667343 DOI: 10.3389/fnagi.2021.739948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: The aim of this pilot randomized clinical trial was to test the feasibility and efficacy of an exergame-based cognitive-motor training program in geriatric inpatients. Methods: The study participants were randomly allocated to either the exergame intervention group or the control group. The control group received the standard rehabilitation treatment offered in the clinic. In addition to the standard rehabilitation program, the intervention group conducted supervised exergame training on 5 days per week using the Dividat Senso, an exergame system specifically designed for older adults. The primary outcome was feasibility, as measured by e.g., adherence rate, attrition rate, occurrence of adverse events, System Usability Scale (SUS) and NASA-TLX score. Secondary outcomes included measures of physical and cognitive functioning such as comfortable walking speed, maximal walking speed, dual task walking speed, Short Physical Performance Battery (SPPB), Timed Up and Go test (TUG), Color-Word Interference test (D-KEFS), Trail Making test A and B (TMT), Go/No-Go test and Step Reaction Time test (SRTT). All secondary outcome measures were assessed pre- and post-intervention. Results: Thirty-nine persons were included in the study. Average adherence rate was 99%, there were no intervention-related dropouts and no adverse events. The mean System Usability Scale (SUS) score was 83.6 and the mean NASA-TLX score 45.5. Significant time-group interaction effects were found for the dual task walking speed, the Go/No-Go test and Step Reaction Time test (SRTT). Conclusion: Exergaming is a feasible, safe and effective cognitive-motor training approach in inpatient rehabilitation of geriatric patients. Incorporating exergaming in the rehabilitation program of geriatric patients offers potential to reduce fall risk factors and to increase patients' exercise motivation and rehabilitation success.
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Affiliation(s)
- Patrizia Altorfer
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
| | - Manuela Adcock
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
| | - Florian Graf
- VAMED Rehaklinik Dussnang, Clinic for Geriatric and Orthopedic Rehabilitation, Dussnang, Switzerland
| | - Eleftheria Giannouli
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zürich, Zurich, Switzerland
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, University of Basel, Basel, Switzerland
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21
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Saccadic eye movement performance reduces visual manipulation influence and center of pressure displacements in older fallers. Exp Brain Res 2021; 240:395-406. [PMID: 34741190 DOI: 10.1007/s00221-021-06256-9] [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: 03/25/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
This study examined changes in postural control and gaze performance of faller and non-faller older adults under conditions of visual tasks and optical flow manipulations. Fifteen older non-fallers (69.8 years, ± 3.2) and fifteen older fallers (71.1 years, ± 6.4) stood on a force platform inside a moving room wearing an eye tracker. Four tasks were performed: gaze fixation; predictable saccades; unpredictable saccades; and free-viewing. The stimuli appeared at a frequency of 1.1 Hz during conditions of predictable and unpredictable saccades. Sixteen trials were divided into two blocks. In the first block, the room remained stationary. In the second block, the room oscillated, without the participant's awareness, with a 0.6 cm amplitude and 0.2 Hz frequency. Results showed postural sway attenuation in older fallers during the saccadic tasks compared to gaze fixation and free-viewing tasks, in both stationary and moving room conditions. Both groups showed increased center of pressure (CoP) magnitude during the moving room condition and CoP displacements strongly coupled to the room's movement. The influence of the moving room on the postural sway was reduced during the saccadic tasks for both older groups. Older fallers exhibited higher variability compared to older non-fallers. Gaze behavior differences between groups were dependent on the goals of the visual tasks. Therefore, CoP displacements of older adults are reduced during saccadic tasks regardless of their falling history. However, postural and gaze performance of older fallers suggests increased deterioration of postural and oculomotor control which may be used as a predictor of fall risk.
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22
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Rizzato A, Paoli A, Andretta M, Vidorin F, Marcolin G. Are Static and Dynamic Postural Balance Assessments Two Sides of the Same Coin? A Cross-Sectional Study in the Older Adults. Front Physiol 2021; 12:681370. [PMID: 34267673 PMCID: PMC8277194 DOI: 10.3389/fphys.2021.681370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/31/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to investigate if the combination of static and dynamic postural balance assessments gives more accurate indications on balance performance among healthy older adults. We also aimed at studying the effect of a dual-task condition on static and dynamic postural balance control. Fifty-seven healthy older adults (age = 73.2 ± 5.0 year, height = 1.66 ± 0.08 m, and body mass = 72.8 ± 13.8 kg) completed the study. Static and dynamic balance were assessed both in single-task and dual-task conditions through a force plate and an oscillating platform. The dominant handgrip strength was also measured with a dynamometer. Pearson’s correlation revealed non-statistically significant correlations between static and dynamic balance performance. The dual-task worsened the balance performance more in the dynamic (+147.8%) than in the static (+25.10%, +43.45%, and +72.93% for ellipse area, sway path, and AP oscillations, respectively) condition (p < 0.001). A weak correlation was found between dynamic balance performance and handgrip strength both in the single (p < 0.05; r = −0.264) and dual (p < 0.05; r = −0.302) task condition. The absence of correlations between static and dynamic balance performance suggests including both static and dynamic balance tests in the assessment of postural balance alterations among older adults. Since cognitive-interference tasks exacerbated the degradation of the postural control performance, dual-task condition should also be considered in the postural balance assessment.
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Affiliation(s)
- Alex Rizzato
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Marta Andretta
- School of Human Movement Sciences, University of Padova, Padova, Italy
| | - Francesca Vidorin
- School of Human Movement Sciences, University of Padova, Padova, Italy
| | - Giuseppe Marcolin
- Department of Biomedical Sciences, University of Padova, Padova, Italy
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Zancan A, Sozzi S, Schieppati M. Basic Spatiotemporal Gait Variables of Young and Older Healthy Volunteers Walking Along a Novel Figure-of-8 Path. Front Neurol 2021; 12:698160. [PMID: 34168613 PMCID: PMC8217764 DOI: 10.3389/fneur.2021.698160] [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: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Locomotion along curved trajectories requires fine coordination among body segments. Elderly people may adopt a cautious attitude when steering. A simple, expeditious, patient-friendly walking protocol can be a tool to help clinicians. We evaluated the feasibility of a procedure based upon a newly designed Figure-of-eight (nFo8) path and an easy measurement operation. Methods: Sixty healthy volunteers, aged from 20 to 86 years, walked three times at self-selected speed along a 20 m linear (LIN) and the 20 m nFo8 path. Number of steps, mean speed and walk ratio (step length/cadence) were collected. Data were analysed for the entire cohort and for the groups aged 20-45, 46-65, and >65 years. Results: There was no difference in mean LIN walking speed between the two younger groups but the oldest was slower. During nFo8, all groups were slower (about 16%) than during LIN. Cadence was not different across groups but lower during nFo8 in each group. Step length was about 8% shorter in the two younger groups and 14% shorter in the oldest during nFo8 compared to LIN. Walk ratio was the smallest in the oldest group for both LIN and nFo8. Conclusions: A complex nFo8 walking path, with fast and easy measurement of a simple set of variables, detects significant differences with moderate and large effects in gait variables in people >65 years. This challenging trajectory is more revealing than LIN. Further studies are needed to develop a quick clinical tool for assessment of gait conditions or outcome of rehabilitative treatments.
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Affiliation(s)
| | - Stefania Sozzi
- Centro Studi Attività Motorie, Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri SB, Pavia, Italy
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Kirshner D, Kizony R, Gil E, Asraf K, Krasovsky T, Haimov I, Shochat T, Agmon M. Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study. Nat Sci Sleep 2021; 13:329-338. [PMID: 33727875 PMCID: PMC7955755 DOI: 10.2147/nss.s299833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/16/2021] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia. METHODS Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests. RESULTS Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599). CONCLUSION Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.
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Affiliation(s)
- Dani Kirshner
- Clalit Health Services; Faculty of Medicine, Technion, Haifa, Israel
| | - Rachel Kizony
- Occupational Therapy Department, University of Haifa, Haifa, Israel.,Occupational Therapy Department, Sheba Medical Center, Tel- Hashomer, Tel-Aviv, Israel
| | - Efrat Gil
- Clalit Health Services; Faculty of Medicine, Technion, Haifa, Israel
| | - Kfir Asraf
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Tal Krasovsky
- Physical Therapy Department, University of Haifa, Haifa, Israel.,Pediatric Rehabilitation Department, Sheba Medical Center, Tel- Hashomer, Tel-Aviv, Israel
| | - Iris Haimov
- The Center for Psychobiological Research, Department of Psychology, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Tamar Shochat
- School of Nursing, Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
| | - Maayan Agmon
- School of Nursing, Faculty of Health and Social Welfare, University of Haifa, Haifa, Israel
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