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Hakamata T, Muroi D, Kodama K, Kondo Y, Higuchi T. Haptic feedback intervention decreases the spatial margin when older adults walk through a narrow space. J Physiol Anthropol 2022; 41:41. [PMID: 36514087 PMCID: PMC9746091 DOI: 10.1186/s40101-022-00315-y] [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: 09/08/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The ability to avoid obstacles efficiently and safely is important for older adults to prevent injuries from tripping and falling. It is important to find an optimal spatial margin between the body and an obstacle considering both safety and efficiency. One side of finding the optimal margin is to decrease the margin in terms of motor efficiency. In this study, we tested whether fingertip-contact intervention to obtain haptic feedback information to perceive the relationship between body and the environment could immediately improve spatial perception and collision avoidance behavior (an instantaneous effect). METHODS Twenty-seven older adults (12 males and 15 females) participated in the experiment. In the intervention of the fingertip-contact group, they lightly touched the edge of a door with both fingertips while walking. The test task before and after the intervention involved grasping a horizontal bar and passing through a narrow opening. As dependent variables, we measured the spatial margin and the collision rate. RESULTS The fingertip-contact group showed a significant decrease in the spatial margin after the intervention. On the other hand, there was no significant improvement in the collision rate after the intervention but rather a decrease only in the control group. CONCLUSION The results obtained in this study indicate that touching obstacles with the fingertips had an instantaneous effect, leading to efficient movement learning, although a possible side effect of an increased collision rated was also found. The proposed intervention might promote an efficiency-based strategy due to learning the spatial relationship between the body and the environment, and it may suppress the excessive avoidance of older adults.
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Affiliation(s)
- T. Hakamata
- grid.265074.20000 0001 1090 2030Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan ,Department of Rehabilitation, Kasai Central Hospital, Tokyo, Japan
| | - D. Muroi
- grid.448846.20000 0001 0565 8272Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - K. Kodama
- grid.265074.20000 0001 1090 2030University Education Center, Tokyo Metropolitan University, Tokyo, Japan
| | - Y. Kondo
- grid.412769.f0000 0001 0672 0015Tokushima Bunri University, Tokushima, Japan
| | - T. Higuchi
- grid.265074.20000 0001 1090 2030Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
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French MA, Cohen ML, Pohlig RT, Reisman DS. Fluid Cognition Relates to Locomotor Switching in Neurotypical Adults, Not Individuals After Stroke. J Neurol Phys Ther 2022; 46:3-10. [PMID: 34507340 PMCID: PMC8692381 DOI: 10.1097/npt.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The ability to switch between walking patterns (ie, locomotor switching) is vital for successful community navigation and may be impacted by poststroke impairments. Thus, the purpose of this work was to examine locomotor switching and the relationship between locomotor switching and fluid cognition in individuals after stroke compared with neurotypical adults. METHODS Twenty-nine individuals more than 6 months after stroke and 18 neurotypical adults participated in a 2-day study. On day 1, participants were taught a new walking pattern on the treadmill and then locomotor switching was assessed by instructing participants to switch between the new walking pattern and their usual walking pattern. The change between these 2 patterns was calculated as the switching index. On day 2, the NIH Toolbox Cognition Battery was administered to obtain the Fluid Cognition Composite Score (FCCS), which reflected fluid cognition. The switching index was compared between groups using an analysis of covariance, and the relationship between locomotor switching and fluid cognition was assessed with regression. RESULTS Individuals after stroke had significantly lower switching indexes compared with neurotypical adults (P = 0.03). The regression showed a significant interaction between group and FCCS (P = 0.002), with the FCCS predicting the switching index in neurotypical adults but not in individuals after stroke. DISCUSSION AND CONCLUSIONS Individuals after stroke appear to have deficits in locomotor switching compared with neurotypical adults. The relationship between fluid cognition and locomotor switching was significant in neurotypical adults but not in individuals after stroke. Future work to understand the relationship between specific cognitive domains and locomotor switching is needed (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A361).
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Affiliation(s)
- Margaret A French
- Departments of Physical Therapy (M.A.F., D.S.R.) and Communication Sciences and Disorders (M.L.C.), University of Delaware, Newark; Biomechanics and Movement Science Program, University of Delaware, Newark (M.A.F., D.S.R.); and College of Health Sciences Biostatistics Core Facility, University of Delaware, Newark (R.T.P.)
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Obstacle avoidance movement-related motor cortical activity with cognitive task. Exp Brain Res 2021; 240:421-428. [PMID: 34775531 DOI: 10.1007/s00221-021-06268-5] [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: 07/25/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Lack of attention to obstacles on the floor or walking path may cause trip and fall accidents. The preparatory activity in the motor cortex to the perturbation associated with obstacle avoidance movements with cognitive task is still unclear. The purpose of this study was to investigate the motor cortical activity involved in the preparation and execution of concurrent obstacle avoidance movement and cognitive task. Twenty young adults were required to step over obstacles that were projected on the floor while performing a cognitive task. The electroencephalogram was recorded, and the movement-related cortical potentials (MRCP) aligned by foot dorsiflexion were evaluated. There was no significant difference in the number of contacts between the toe and the obstacle between the obstacle avoidance task and obstacle avoidance with cognitive task; however, the distance between the toe and the obstacle just before obstacle avoidance movement was significantly extended in the latter task. The amplitude and the onset of MRCP during the dual task were decreased and delayed, respectively, compared with the simple obstacle avoidance movement task. These results suggest that the young participants changed their clearance strategy to stepping over the obstacle during the concurrent motor and cognitive dual task to reduce motor cortical activity.
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Akinlosotu RY, Alissa N, Waldstein SR, Creath RA, Wittenberg GF, Westlake KP. Examining the influence of mental stress on balance perturbation responses in older adults. Exp Gerontol 2021; 153:111495. [PMID: 34314843 DOI: 10.1016/j.exger.2021.111495] [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: 04/08/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reach-to-grasp responses following balance perturbations are important to fall prevention but are often ineffective in older adults. The ability to shift attention from an ongoing cognitive task to balance related processes has been shown to influence reach-to-grasp effectiveness in older adults. However, the added influence of stress and anxiety - known to negatively affect attention shifting ability - has not yet been explored in relation to recovery from balance perturbations. Given that fear and anxiety over falling is a key fall risk factor, an understanding of how such a negative mental state may affect postural reactions is important. This study aimed to investigate the effect of varied induced emotional states on reach-to-grasp balance responses in older adults. METHODS Healthy older adults (mean age 70.5 ± 5.38 years) stood laterally between 2 handrails with contact sensors. A safety harness with an integrated loadcell was worn to prevent falls and measure the amount of harness assistance (expressed as percent body weight). With instructions to grasp one rail to restore balance, participants' balance was laterally disturbed using surface translations under three randomized conditions: no cognitive task, neutral (verb generation) task, and mental stress task with negative prompts (paced auditory serial addition). The primary outcome was frequency of protective grasps. Secondary outcomes included frequency of harness assistance during trials with grasp errors as well as wrist movement time, trajectory distance, and peak velocity. RESULTS Perceived level of distress was highest for the mental stress task compared to no task (p < 0.001) and neutral task conditions (p = 0.008). The mental stress task resulted in the lowest percentage of protective grasps (p < 0.001) in response to balance perturbations. Closer examination of trials that resulted in grasp errors (i.e., collisions or overshoots), revealed increased harness assistance and reduced peak velocity of wrist movement (p < 0.001) under the mental stress condition compared to grasp errors that occurred under the no task or neutral task condition. DISCUSSION AND CONCLUSION Distressing mental thoughts immediately prior to a balance perturbation lead to reduced effectiveness in reach-to-grasp balance responses compared to no or neutral cognitive tasks and should be considered as a possible fall risk factor.
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Affiliation(s)
- Ruth Y Akinlosotu
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore, MD 21201, USA.
| | - Nesreen Alissa
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore, MD 21201, USA.
| | - Shari R Waldstein
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD 21250, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Robert A Creath
- Department of Exercise Science, Lebanon Valley College, Annville, PA 17003, USA.
| | - George F Wittenberg
- Geriatric Research, Education, and Clinical Center, Human Engineering Research Laboratory, VA Pittsburgh Healthcare System, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Kelly P Westlake
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore, MD 21201, USA.
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Kondo Y, Fukuhara K, Suda Y, Higuchi T. Training older adults with virtual reality use to improve collision-avoidance behavior when walking through an aperture. Arch Gerontol Geriatr 2020; 92:104265. [PMID: 33011429 DOI: 10.1016/j.archger.2020.104265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Abstract
Many older adults perform collision-avoidance behavior either insufficiently (i.e., frequent collision) or inefficiently (i.e., exaggerated behavior to ensure collision-avoidance). The present study examined whether a training system using virtual reality (VR) simulation enhanced older adults' collision-avoidance behavior in response to a VR image of an aperture during real walking. Twenty-five (n = 13 intervention group and n = 12 control group) older individuals participated. During training, a VR image of walking through an aperture was projected onto a large screen. Participants in the intervention group tried to avoid virtual collision with the minimum body rotation required to walk on the spot through a variety of narrow apertures. Participants in the control group remained without body rotation while walking on the spot through a wide aperture. A comparison between pre-test and post-test performances in the real environment indicated that after the training, significantly smaller body rotation angles were observed in the intervention group. This suggests that the training led participants to modify their behavior to try to move efficiently during real walking. However, although not significant, collision rates also tended to be greater, suggesting that, at least for some participants, the modification required to avoid collision was too difficult. Transfer of the learned behavior using the VR environment to real walking is discussed.
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Affiliation(s)
- Yuki Kondo
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan; Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazunobu Fukuhara
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuki Suda
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan.
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Zukowski LA, Iyigün G, Giuliani CA, Plummer P. Effect of the environment on gait and gaze behavior in older adult fallers compared to older adult non-fallers. PLoS One 2020; 15:e0230479. [PMID: 32196529 PMCID: PMC7083306 DOI: 10.1371/journal.pone.0230479] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Compared to controlled laboratory settings, the real world is highly distracting with constant demands on visual attention to avoid hazards and falling. Fall-risk assessments do not adequately take into account the potential role of everyday distractions and environmental hazards. The purpose of this project was to identify the effect of the environment on gait and gaze behavior during walking in older adult fallers relative to non-fallers. METHODS Thirteen older adult fallers (76.8±9.4 years, 3.2±2.3 falls in last year) and 13 age-matched non-fallers (78.3±7.3 years, 0 falls in last year) participated. Participants walked in a real-world and lab setting while gait and gaze were recorded. Gait variables were stride length variability, stride duration variability, and stride velocity. Gaze was analyzed for percentage of time fixating and average fixation duration coded across 6 areas of interest (AOIs) in the visual surroundings. RESULTS Non-fallers walked faster than fallers, but there were no other group or environment effects on gait. For gaze behavior, fallers had shorter fixation durations on the near environment than non-fallers, but only in the real world. In the real world relative to the lab, fallers decreased fixation durations on the near environment but increased durations on near people. In the real world, participants spent a greater proportion of time fixating on people than on the walking path or the near environment compared to the lab. After adjusting for baseline gait speed, fallers had shorter fixation durations than non-fallers in both environments. CONCLUSIONS Our results indicate that in a busy environment, older adults concentrate most of their overt visual attention on people when navigating their walking path. Fallers in particular focus longer on people near to them and have overall shorter fixations than non-fallers. Visual focus while walking in a busy environment should be further explored as a fall-risk factor.
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Affiliation(s)
- Lisa A. Zukowski
- Department of Physical Therapy, High Point University, High Point, North Carolina, United States of America
- * E-mail:
| | - Gözde Iyigün
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus, Turkey
| | - Carol A. Giuliani
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Prudence Plummer
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Golubić A, Šarabon N, Marković G. Association between trunk muscle strength and static balance in older women. J Women Aging 2019; 33:288-297. [PMID: 31739776 DOI: 10.1080/08952841.2019.1692628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to determine the relationship between trunk muscle strength and balance ability in both simple and dual-task conditions in older women. Sixty-seven older women (age: 67.2 ± 1.1 years) volunteered in this study. Each participant performed isometric trunk muscle strength testing in standing position (extension, flexion, and lateral flexion) and balance testing in semitandem stance for 30 seconds in two conditions: with and without an additional cognitive task (counting down by 3 from 300). Balance was quantified via force plate as a mean velocity of center of pressure (CoP) displacement over 30 seconds. We found a statistically significant correlation between the trunk extensor strength and mean velocity of CoP displacement, both without (r = 0.5, p < .05) and with an additional cognitive task (r = 0.4, p < .05). There were no statistically significant correlations between trunk flexor and lateral flexors strength and balance measures (r < 0.2; p > .05). These results indicate that trunk extensor muscle strength is related to balance ability of healthy older women. Although additional studies are needed, our findings suggest that trunk strength training could be of importance in prevention of falls and fall-related injuries in seniors.
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Affiliation(s)
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Koper, Slovenia
| | - Goran Marković
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia.,Research Unit, Motus Melior Ltd., Zagreb, Croatia
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Liebherr M, Schubert P, Averbeck H, Brand M. Simultaneous motor demands affect decision making under objective risk. JOURNAL OF COGNITIVE PSYCHOLOGY 2018. [DOI: 10.1080/20445911.2018.1470182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Magnus Liebherr
- Department of General Psychology: Cognition, University of Duisburg-Essen, Duisburg, Germany
| | - Patric Schubert
- Faculty of Health and Social Sciences, Hochschule Fresenius, University of Applied Sciences, Idstein, Germany
| | - Heike Averbeck
- Department of General Psychology: Cognition, University of Duisburg-Essen, Duisburg, Germany
| | - Matthias Brand
- Department of General Psychology: Cognition, University of Duisburg-Essen, Duisburg, Germany
- Center for Behavioral Addictions Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
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Doniger GM, Beeri MS, Bahar-Fuchs A, Gottlieb A, Tkachov A, Kenan H, Livny A, Bahat Y, Sharon H, Ben-Gal O, Cohen M, Zeilig G, Plotnik M. Virtual reality-based cognitive-motor training for middle-aged adults at high Alzheimer's disease risk: A randomized controlled trial. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:118-129. [PMID: 29955655 PMCID: PMC6021455 DOI: 10.1016/j.trci.2018.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction Ubiquity of Alzheimer's disease (AD) coupled with relatively ineffectual pharmacologic treatments has spurred interest in nonpharmacologic lifestyle interventions for prevention or risk reduction. However, evidence of neuroplasticity notwithstanding, there are few scientifically rigorous, ecologically relevant brain training studies focused on building cognitive reserve in middle age to protect against cognitive decline. This pilot study will examine the ability of virtual reality (VR) cognitive training to improve cognition and cerebral blood flow (CBF) in middle-aged individuals at high AD risk due to parental history. Methods The design is an assessor-blind, parallel group, randomized controlled trial of VR cognitive-motor training in middle-aged adults with AD family history. The experimental group will be trained with adaptive “real-world” VR tasks targeting sustained and selective attention, working memory, covert rule deduction, and planning, while walking on a treadmill. One active control group will perform the VR tasks without treadmill walking; another will walk on a treadmill while watching scientific documentaries (nonspecific cognitive stimulation). A passive (waitlist) control group will not receive training. Training sessions will be 45 minutes, twice/week for 12 weeks. Primary outcomes are global cognition and CBF (from arterial spin labeling [ASL]) at baseline, immediately after training (training gain), and 3 months post-training (maintenance gain). We aim to recruit 125 participants, including 20 passive controls and 35 in the other groups. Discussion Current pharmacologic therapies are for symptomatic AD patients, whereas nonpharmacologic training is administrable before symptom onset. Emerging evidence suggests that cognitive training improves cognitive function. However, a more ecologically valid cognitive-motor VR setting that better mimics complex daily activities may augment transfer of trained skills. VR training has benefited clinical cohorts, but benefit in asymptomatic high-risk individuals is unknown. If effective, this trial may help define a prophylactic regimen for AD, adaptable for home-based application in high-risk individuals.
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Affiliation(s)
- Glen M. Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Corresponding author. Tel.: +97235304874; Fax: +97235307572.
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Bahar-Fuchs
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Center for Research on Aging, Health, and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- The Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Amihai Gottlieb
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Anastasia Tkachov
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hagar Kenan
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Abigail Livny
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Hadar Sharon
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Oran Ben-Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Maya Cohen
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Gabi Zeilig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Caetano MJD, Menant JC, Schoene D, Pelicioni PHS, Sturnieks DL, Lord SR. Sensorimotor and Cognitive Predictors of Impaired Gait Adaptability in Older People. J Gerontol A Biol Sci Med Sci 2017; 72:1257-1263. [PMID: 27573810 DOI: 10.1093/gerona/glw171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This study investigated whether impaired gait adaptability in a task including obstacle and stepping targets is associated with cognitive and sensorimotor capacities in older adults. Methods Fifty healthy older adults (74±7 years) were instructed to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. Participants also completed cognitive and sensorimotor function assessments. Results Stroop test and reaction time performance significantly discriminated between participants who did and did not make stepping errors, and poorer Trail-Making test performance predicted shorter penultimate step length in the obstacle avoidance condition. Slower reaction time predicted poorer stepping accuracy; increased postural sway, weaker quadriceps strength, and poorer Stroop and Trail-Making test performances predicted increased number of steps taken to approach the target/obstacle and shorter step length; and increased postural sway and higher concern about falling predicted slower step velocity. Conclusions Superior executive function, fast processing speed, and good muscle strength and balance were all associated with successful gait adaptability. Processing speed appears particularly important for precise foot placements; cognitive capacity for step length adjustments; and early and/or additional cognitive processing involving the inhibition of a stepping pattern for obstacle avoidance. This information may facilitate fall risk assessments and fall prevention strategies.
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Affiliation(s)
- Maria Joana D Caetano
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Paulo H S Pelicioni
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Daina L Sturnieks
- Neuroscience Research Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Song W, Woon FL, Doong A, Persad C, Tijerina L, Pandit P, Cline C, Giordani B. Fatigue in Younger and Older Drivers: Effectiveness of an Alertness-Maintaining Task. HUMAN FACTORS 2017; 59:995-1008. [PMID: 28510495 DOI: 10.1177/0018720817706811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to examine the effects of an alertness-maintaining task (AMT) in older, fatigued drivers. BACKGROUND Fatigue during driving increases crash risk, and previous research suggests that alertness and driving in younger adults may be improved using a secondary AMT during boring, fatigue-eliciting drives. However, the potential impact of an AMT on driving has not been investigated in older drivers whose ability to complete dual tasks has been shown to decline and therefore may be negatively affected with an AMT in driving. METHOD Younger ( n = 29) and older drivers ( n = 39) participated in a 50-minute simulated drive designed to induce fatigue, followed by four 10-minute sessions alternating between driving with and without an AMT. RESULTS Younger drivers were significantly more affected by fatigue on driving performance than were older drivers but benefitted significantly from the AMT. Older drivers did not demonstrate increased driver errors with fatigue, and driving did not deteriorate significantly during participation in the AMT condition, although their speed was significantly more variable with the AMT. CONCLUSION Consistent with earlier research, an AMT applied during fatiguing driving is effective in improving alertness and reducing driving errors in younger drivers. Importantly, older drivers were relatively unaffected by fatigue, and use of an AMT did not detrimentally affect their driving performance. APPLICATION These results support the potential use of an AMT as a new automotive technology to improve fatigue and promote driver safety, though the benefits of such technology may differ between different age groups.
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Synchrony of gaze and stepping patterns in people with Parkinson’s disease. Behav Brain Res 2016; 307:159-64. [DOI: 10.1016/j.bbr.2016.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/09/2016] [Accepted: 04/05/2016] [Indexed: 11/20/2022]
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Kovacs CR. Age-Related Changes in Gait and Obstacle Avoidance Capabilities in Older Adults: A Review. J Appl Gerontol 2016. [DOI: 10.1177/0733464804271279] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Walking is a fundamental motor skill that significantly affects the level of independence in older adults today. Changes in gait and obstacle avoidance strategies have been well documented in the literature, and falling has been shown to be one of the most significant health care concerns in the elderly population today. Falls are a major contributor to the increasing morbidity rates seen in the older population, and in many cases, alterations in gait or stepping ability have played a significant role. This reviewexamines the specific changes seen in gait and obstacle avoidance in the elderly population and some of the underlying changes seen in sensory capability that play a role in safe and efficient ambulation in older adults. Normal gait (unassisted ambulation) will be presented, followed by an examination of the literature that has examined changes in performance factors associated with gait and obstacle avoidance strategies.
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Caetano MJD, Lord SR, Schoene D, Pelicioni PHS, Sturnieks DL, Menant JC. Age-related changes in gait adaptability in response to unpredictable obstacles and stepping targets. Gait Posture 2016; 46:35-41. [PMID: 27131174 DOI: 10.1016/j.gaitpost.2016.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND A large proportion of falls in older people occur when walking. Limitations in gait adaptability might contribute to tripping; a frequently reported cause of falls in this group. OBJECTIVE To evaluate age-related changes in gait adaptability in response to obstacles or stepping targets presented at short notice, i.e.: approximately two steps ahead. METHODS Fifty older adults (aged 74±7 years; 34 females) and 21 young adults (aged 26±4 years; 12 females) completed 3 usual gait speed (baseline) trials. They then completed the following randomly presented gait adaptability trials: obstacle avoidance, short stepping target, long stepping target and no target/obstacle (3 trials of each). RESULTS Compared with the young, the older adults slowed significantly in no target/obstacle trials compared with the baseline trials. They took more steps and spent more time in double support while approaching the obstacle and stepping targets, demonstrated poorer stepping accuracy and made more stepping errors (failed to hit the stepping targets/avoid the obstacle). The older adults also reduced velocity of the two preceding steps and shortened the previous step in the long stepping target condition and in the obstacle avoidance condition. CONCLUSION Compared with their younger counterparts, the older adults exhibited a more conservative adaptation strategy characterised by slow, short and multiple steps with longer time in double support. Even so, they demonstrated poorer stepping accuracy and made more stepping errors. This reduced gait adaptability may place older adults at increased risk of falling when negotiating unexpected hazards.
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Affiliation(s)
- Maria Joana D Caetano
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Daniel Schoene
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Paulo H S Pelicioni
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; UNESP Univ Estadual Paulista, Instituto de Biociências de Rio Claro, Departamento de Educação Física, Posture and Gait Studies Laboratory, Rio Claro, Brazil
| | - Daina L Sturnieks
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia.
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Wollesen B, Voelcker-Rehage C, Regenbrecht T, Mattes K. Influence of a visual–verbal Stroop test on standing and walking performance of older adults. Neuroscience 2016; 318:166-77. [DOI: 10.1016/j.neuroscience.2016.01.031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 11/29/2022]
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Westlake KP, Johnson BP, Creath RA, Neff RM, Rogers MW. Influence of non-spatial working memory demands on reach-grasp responses to loss of balance: Effects of age and fall risk. Gait Posture 2016; 45:51-5. [PMID: 26979883 PMCID: PMC4794637 DOI: 10.1016/j.gaitpost.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/18/2015] [Accepted: 01/05/2016] [Indexed: 02/02/2023]
Abstract
Reactive balance recovery strategies following an unexpected loss of balance are crucial to the prevention of falls, head trauma and other major injuries in older adults. While a longstanding focus has been on understanding lower limb recovery responses, the upper limbs also play a critical role. However, when a fall occurs, little is known about the role of memory and attention shifting on the reach to grasp recovery strategy and what factors determine the speed and precision of this response beyond simple reaction time. The objective of this study was to compare response time and accuracy of a stabilizing grasp following a balance perturbation in older adult fallers compared to non-fallers and younger adults while loading the processing demands of non-spatial, verbal working memory. Working memory was engaged with a progressively challenging verb-generation task that was interrupted by an unexpected sideways platform perturbation and a pre-instructed reach to grasp response. Results revealed that the older adults, particularly those at high fall risk, demonstrated significantly increased movement time to handrail contact and grasping errors during conditions in which non-spatial memory was actively engaged. These findings provide preliminary evidence of the cognitive deficit in attention shifting away from an ongoing working memory task that underlies delayed and inaccurate protective reach to grasp responses in older adult fallers.
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Affiliation(s)
- Kelly P Westlake
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States.
| | - Brian P Johnson
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
| | - Robert A Creath
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
| | - Rachel M Neff
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
| | - Mark W Rogers
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
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Uiga L, Cheng KC, Wilson MR, Masters RSW, Capio CM. Acquiring visual information for locomotion by older adults: a systematic review. Ageing Res Rev 2015; 20:24-34. [PMID: 25576650 DOI: 10.1016/j.arr.2014.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022]
Abstract
Developments in technology have facilitated quantitative examination of gaze behavior in relation to locomotion. The objective of this systematic review is to provide a critical evaluation of available evidence and to explore the role of gaze behavior among older adults during different forms of locomotion. Database searches were conducted to identify research papers that met the inclusion criteria of (1) study variables that included direct measurement of gaze and at least one form of locomotion, (2) participants who were older adults aged 60 years and above, and (3) reporting original research. Twenty-five papers related to walking on a straight path and turning (n=4), stair navigation (n=3), target negotiation and obstacle circumvention (n=13) and perturbation-evoked sudden loss of balance (n=5) were identified for the final quality assessment. The reviewed articles were found to have acceptable quality, with scores ranging from 47.06% to 94.12%. Overall, the current literature suggests that differences in gaze behavior during locomotion appear to change in late adulthood, especially with respect to transfer of gaze to and from a target, saccade-step latency, fixation durations on targets and viewing patterns. These changes appear to be particularly pronounced for older adults with high risk of falling and impaired executive functioning.
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Affiliation(s)
- Liis Uiga
- Institute of Human Performance, The University of Hong Kong, Hong Kong
| | - Kenneth C Cheng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong
| | | | - Rich S W Masters
- Institute of Human Performance, The University of Hong Kong, Hong Kong; Department of Sport and Leisure Studies, University of Waikato, New Zealand
| | - Catherine M Capio
- Institute of Human Performance, The University of Hong Kong, Hong Kong.
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Yamada M, Higuchi T, Nishiguchi S, Yoshimura K, Kajiwara Y, Aoyama T. Multitarget Stepping Program in Combination with a Standardized Multicomponent Exercise Program Can Prevent Falls in Community-Dwelling Older Adults: A Randomized, Controlled Trial. J Am Geriatr Soc 2013; 61:1669-75. [DOI: 10.1111/jgs.12453] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Minoru Yamada
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science; Graduate School of Human Health Science; Tokyo Metropolitan University; Tokyo Japan
| | - Shu Nishiguchi
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Kazuya Yoshimura
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yuu Kajiwara
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tomoki Aoyama
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
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Wellmon R, Barr-Gillespie AE, Newton R, Ruchinskas RA, Stephens J. The effects of aging on the attentional demands of walking toward and stepping up onto a curb. Gait Posture 2013; 38:198-202. [PMID: 23219782 DOI: 10.1016/j.gaitpost.2012.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/30/2012] [Accepted: 11/10/2012] [Indexed: 02/02/2023]
Abstract
Community ambulation requires the capacity to alter gait in response to obstacles within the path of travel that appear at a known location. Acquiring information from the environment to safely negotiate a curb may increase the cognitive demands of walking. The purpose of this study was to examine the attentional demands of walking toward and stepping up onto a curb in young, middle-age and older adults. Single and dual-task voice reaction time (VRT) was measured in community-dwelling young (n = 24), middle-age (n = 24), and older adults (n = 24) across 5 conditions: sitting in a chair, standing, level walking, and walking toward and while stepping up onto a curb. A 3 (group) by 5 (task condition) ANOVA was used to examine VRT. The interaction of group with task revealed statistically significant within group increases in VRT when comparing either sitting and/or standing to walking on a level surface and walking toward the curb and stepping up onto the curb. When compared to the other groups, older adults had significantly longer VRT for all walking tasks. Stepping onto the curb significantly increased the attentional requirements of walking for all of the groups when compared to level walking. The pattern of statistically significant between group and within group differences during the walking tasks indicate the effects of a curb located at a predictable place in the environment on attentional allocation.
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Affiliation(s)
- Robert Wellmon
- Widener University, Institute for Physical Therapy Education, Chester, PA 19013, United States.
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Sakurai R, Fujiwara Y, Ishihara M, Higuchi T, Uchida H, Imanaka K. Age-related self-overestimation of step-over ability in healthy older adults and its relationship to fall risk. BMC Geriatr 2013; 13:44. [PMID: 23651772 PMCID: PMC3660311 DOI: 10.1186/1471-2318-13-44] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background Older adults could not safely step over an obstacle unless they correctly estimated their physical ability to be capable of a successful step over action. Thus, incorrect estimation (overestimation) of ability to step over an obstacle could result in severe accident such as falls in older adults. We investigated whether older adults tended to overestimate step-over ability compared with young adults and whether such overestimation in stepping over obstacles was associated with falls. Methods Three groups of adults, young-old (age, 60–74 years; n, 343), old-old (age, >74 years; n, 151), and young (age, 18–35 years; n, 71), performed our original step-over test (SOT). In the SOT, participants observed a horizontal bar at a 7-m distance and estimated the maximum height (EH) that they could step over. After estimation, they performed real SOT trials to measure the actual maximum height (AH). We also identified participants who had experienced falls in the 1 year period before the study. Results Thirty-nine young-old adults (11.4%) and 49 old-old adults (32.5%) failed to step over the bar at EH (overestimation), whereas all young adults succeeded (underestimation). There was a significant negative correlation between actual performance (AH) and self-estimation error (difference between EH and AH) in the older adults, indicating that older adults with lower AH (SOT ability) tended to overestimate actual ability (EH > AH) and vice versa. Furthermore, the percentage of participants who overestimated SOT ability in the fallers (28%) was almost double larger than that in the non-fallers (16%), with the fallers showing significantly lower SOT ability than the non-fallers. Conclusions Older adults appear unaware of age-related physical decline and tended to overestimate step-over ability. Both age-related decline in step-over ability, and more importantly, overestimation or decreased underestimation of this ability may raise potential risk of falls.
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Affiliation(s)
- Ryota Sakurai
- Health Promotion Science, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo 192-0397, Japan.
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Pilot study into impaired judgement, self-toileting behaviour in fallers and non-fallers. Eur J Ageing 2013; 10:257-260. [PMID: 28804301 DOI: 10.1007/s10433-013-0264-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Falls are a significant cause of morbidity and mortality in older people. There is an increased frequency of falls in older adults with cognitive impairment and dementia which may be due to impaired judgement of self capability to mobilise safely. This case control study assessed 53 Aged Care subjects aged 75+ years that were hospitalised post fall, from January 2008-December 2009, and compared these subjects' responses to those of 26 non-fallers to a standard question: 'While you are in the hospital, what would you do if you need to go to the toilet later?' This hypothetical scenario question was designed to assess judgement based on self-toileting behaviour and mobility. The study group and control group were similar in age (83.9 ± 4.7 vs. 82.0 ± 4.6 years respectively, p = 0.081) but the study group had statistically lower MMSE results when compared to controls (median 23 vs. 26.5 respectively, p = 0.031). Impaired judgement, defined as an unsafe/inappropriate response to the scenario question, was significantly more prevalent in the study group (fallers) compared to the control group (non-fallers) (41.5 vs. 15.4 %, p = 0.020). Impaired judgement was also more common with lower MMSE scores with 80.9 % of unsafe/inappropriate responses given by participants with MMSE of ≤20. The authors suggest there may be an association between impaired judgement, evidenced by responses to a standardised question, and falls history in older subjects, particularly in those with cognitive impairment or dementia. Ultimately, this may lead to identification of people at increased risk of falls and possibly effective falls prevention strategies in this population.
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Nagamatsu LS, Voss M, Neider MB, Gaspar JG, Handy TC, Kramer AF, Liu-Ambrose TYL. Increased cognitive load leads to impaired mobility decisions in seniors at risk for falls. Psychol Aging 2011; 26:253-9. [PMID: 21463063 DOI: 10.1037/a0022929] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Successful mobility requires appropriate decision-making. Seniors with reduced executive functioning-such as senior fallers-may be prone to poor mobility judgments, especially under dual-task conditions. We classified participants as "At-Risk" and "Not-At-Risk" for falls using a validated physiological falls-risk assessment. Dual-task performance was assessed in a virtual reality environment where participants crossed a simulated street by walking on a manual treadmill while listening to music or conversing on a phone. Those "At-Risk" experienced more collisions with oncoming cars and had longer crossing times in the Phone condition compared to controls. We conclude that poor mobility judgments during a dual-task leads to unsafe mobility for those at-risk for falls.
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Nagamatsu LS, Hsu CL, Handy TC, Liu-Ambrose T. Functional neural correlates of reduced physiological falls risk. Behav Brain Funct 2011; 7:37. [PMID: 21846395 PMCID: PMC3178476 DOI: 10.1186/1744-9081-7-37] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 08/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background It is currently unclear whether the function of brain regions associated with executive cognitive processing are independently associated with reduced physiological falls risk. If these are related, it would suggest that the development of interventions targeted at improving executive neurocognitive function would be an effective new approach for reducing physiological falls risk in seniors. Methods We performed a secondary analysis of 73 community-dwelling senior women aged 65 to 75 years old who participated in a 12-month randomized controlled trial of resistance training. Functional MRI data were acquired while participants performed a modified Eriksen Flanker Task - a task of selective attention and conflict resolution. Brain volumes were obtained using MRI. Falls risk was assessed using the Physiological Profile Assessment (PPA). Results After accounting for baseline age, experimental group, baseline PPA score, and total baseline white matter brain volume, baseline activation in the left frontal orbital cortex extending towards the insula was negatively associated with reduced physiological falls risk over the 12-month period. In contrast, baseline activation in the paracingulate gyrus extending towards the anterior cingulate gyrus was positively associated with reduced physiological falls risk. Conclusions Baseline activation levels of brain regions underlying response inhibition and selective attention were independently associated with reduced physiological falls risk. This suggests that falls prevention strategies may be facilitated by incorporating intervention components - such as aerobic exercise - that are specifically designed to induce neurocognitive plasticity. Trial Registration ClinicalTrials.gov Identifier: NCT00426881
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Affiliation(s)
- Lindsay S Nagamatsu
- Department of Psychology, University of British Columbia, Vancouver BC, Canada
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Yamada M, Tanaka H, Mori S, Nagai K, Uemura K, Tanaka B, Aoyama T, Ichihashi N. Fallers choose an early transfer gaze strategy during obstacle avoidance in dual-task condition. Aging Clin Exp Res 2011; 23:316-9. [PMID: 20834203 DOI: 10.1007/bf03337757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS The aim of the present study is to compare the gaze behavior between fallers and non-fallers during obstacle avoidance in dual-task conditions. METHODS Nine older adults who had no experience of falling (mean age 79.9 ± 5.4) and 9 older adults with known experience of falling (83.4 ± 3.6) participated in the study. We examined their gaze behavior during obstacle avoidance in singletask (ST) and dual-task (DT) conditions. RESULTS In the ST condition, compared with the faller group, the non-faller group showed no significant difference in timing of gaze transfer from the obstacle (faller: gaze transfer from obstacle when 1.6 ± 1.1 steps before; non-faller: 1.9 ± 0.7 steps before, p=0.493). In the DT condition, the faller group chose a transfer of gaze strategy significantly earlier than the non-faller group (faller: 2.7 ± 1.4 steps before; non-faller: 1.6 ± 0.5 steps before, p=0.008). CONCLUSION Our findings suggest that fallers chose an early transfer of gaze strategy when challenged with an obstacle in DT conditions.
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Greany JF, Di Fabio RP. Models to Predict Fall History and Fall Risk for Community-Dwelling Elderly. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2010. [DOI: 10.3109/02703181003775128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Di Fabio RP, Greany JF, Zampieri C. Saccade-Stepping Interactions Revise the Motor Plan for Obstacle Avoidance. J Mot Behav 2010; 35:383-97. [PMID: 14607775 DOI: 10.1080/00222890309603158] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors used a stimulus-response compatibility paradigm to assess the effect of changing the estimated time to obstacle contact. A limb-selection cue was presented in different phases of gait to young (n = 5) and to older (n = 4) adults while they were moving toward a foam obstacle in the walking path. A downward saccade was initiated after the cue; the saccade typically occurred during the stance phase of the target limb (the foot cued to lead the step over the obstacle). The mean saccade-step latency after the cue was on the order of -500 ms in both young and elderly participants. On reaching the obstacle, both groups generated an upward saccade approximately -300 ms before target footlift in both groups. Saccades following the limb-selection cue appeared to direct the gaze toward footfall targets just beyond the obstacle, whereas saccades generated just before obstacle footlift moved the gaze to the forward-looking direction. The elderly had significantly longer saccade-trailing-footlift latencies and prolonged gaze-fixation times than did the younger adults. Transient disruptions in optical flow appeared to be necessary for successful obstacle-avoidance behavior when there was an unexpected change in the estimated time to obstacle contact.
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Affiliation(s)
- Richard P Di Fabio
- Department of Physical Medicine & Rehabilitation, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA.
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Lord SE, Weatherall M, Rochester L. Community Ambulation in Older Adults: Which Internal Characteristics Are Important? Arch Phys Med Rehabil 2010; 91:378-83. [DOI: 10.1016/j.apmr.2009.11.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 10/28/2009] [Accepted: 11/09/2009] [Indexed: 11/17/2022]
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Riolo L. Attention Contributes to Functional Reach Test Scores in Older Adults with History of Falling. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v22n02_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PRIMARY OBJECTIVE To review of studies that focus on the assessment of driving competence among the elderly who are at increased risk of being involved in automobile crashes. The current status of neuropsychological testing as a predictor of driving safety in this population is critically evaluated. MAIN OUTCOMES AND RESULTS Several domains of neuropsychological assessment have been shown to be related to safe driving in older age groups, including vision-based testing, attention-based testing, and testing of executive functions. Use of a driving simulator to investigate crash risk has been particularly effective. CONCLUSIONS The argument is made that a combination of test approaches be used to develop an algorithm for efficient screening of elderly drivers on a regular basis and that use of a driving simulator to measure driving performance under challenge should be incorporated as part of this evaluation.
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Affiliation(s)
- Linas A Bieliauskas
- VA Medical Center/University of Michigan Health System, Ann Arbor, Michigan 48105, USA.
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Siu KC, Chou LS, Mayr U, Donkelaar PV, Woollacott MH. Does inability to allocate attention contribute to balance constraints during gait in older adults? J Gerontol A Biol Sci Med Sci 2009; 63:1364-9. [PMID: 19126850 DOI: 10.1093/gerona/63.12.1364] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent research has explored dual-task deficits during locomotion in older adults, yet the mechanisms underlying these deficits are poorly understood. In the current study, we examined one possible factor contributing to these deficits, the inability to flexibly allocate attention between two tasks. METHODS Twelve healthy young adults and 12 healthy elderly adults performed obstacle avoidance while walking and an auditory Stroop task either alone or simultaneously. RESULTS Using an attentional allocation index (AAI) to compare performance of healthy young and older adults and to measure the flexibility of allocation of attention, results showed a tendency in older adults toward a decreased ability to flexibly allocate their attention between the two tasks, with small AAI values. The decreased ability to allocate attention in older adults was found to be more prominent in the auditory Stroop task performance than in the obstacle avoidance task. CONCLUSION This study suggests that an important factor contributing to decreased dual-task performance in older adults when simultaneously performing a postural and secondary cognitive task is a reduced ability to flexibly allocate attention between the two tasks, with the general ability to switch attention flexibly being predictive of the ability to adhere to a prioritized focus.
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Affiliation(s)
- Ka-Chun Siu
- University of Nebraska at Omaha, Omaha, NE 68182, USA.
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Hausdorff JM, Schweiger A, Herman T, Yogev-Seligmann G, Giladi N. Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci 2009; 63:1335-43. [PMID: 19126846 DOI: 10.1093/gerona/63.12.1335] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The factors that contribute to the dual tasking (DT) changes in performance that occur when older adults walk while simultaneously performing other tasks are not well known. We hypothesized that cognitive and motor reserve (e.g., executive function [EF], postural control, and walking abilities) and affect (e.g., anxiety, depressive symptoms) influence the DT decrements (DTDs) in gait. METHODS Two hundred twenty-eight community-living, healthy older adults (mean: 76.2 +/- 4.2 years; 59% women) walked with and without DT, for example, subtracting 7s and phoneme monitoring. Mobility (e.g., the Dynamic Gait Index), cognitive function (e.g., memory, EF), and affect (e.g., Geriatric Depression Scale) were quantified. Bivariate and multivariate analyses identified factors associated with the DTD in gait speed (a general measure of locomotor function), swing time, (reflecting balance during gait), and swing time variability (a measure of stride-to-stride consistency). RESULTS Gait speed and swing time decreased (p <.001) and swing time variability increased (became worse) (p <.001) during all DTs. The DTD in gait speed was correlated with comfortable walking gait speed, but not with tests of mobility or cognitive function. The DTD in swing time variability was correlated with EF, mobility, and affect (e.g., depressive symptoms). Much of the variance in the DTDs was unexplained. CONCLUSIONS Usual walking abilities and cognitive function contribute to the DT effects on gait, but these relationships depend on specifics of the DT, the gait feature being studied, and the particulars of the cognitive domain. Meeting the everyday challenges of walking while dual tasking apparently relies on multiple factors including a consistent gait pattern and EF.
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Persad CC, Jones JL, Ashton-Miller JA, Alexander NB, Giordani B. Executive function and gait in older adults with cognitive impairment. J Gerontol A Biol Sci Med Sci 2009; 63:1350-5. [PMID: 19126848 DOI: 10.1093/gerona/63.12.1350] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cognitive impairment has been shown to predict falls risk in older adults. The ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. However, it is unclear how well persons with cognitive impairment can step accurately to avoid such hazards and what specific aspects of cognition predict stepping ability in different patient populations. METHODS Healthy older adults (NC), patients with Mild Cognitive Impairment with only memory impairment (MCI-EF) or memory and executive function impairments (MCI+EF) and early Alzheimer's patients (AD) were timed as they performed a stepping accuracy test with increasing cognitive demand (Walking Trail-Making Test; W-TMT), which required stepping on instrumented targets with either increasing sequential numbers (W-TMT A) or alternating sequential numbers and letters (W-TMT B). RESULTS After accounting for age and baseline walking speed, the AD and MCI+EF groups were significantly slower than the NC and MCI-EF groups on the task with the highest cognitive demand, W-TMT B (interaction effect F = 6.781, p <.0001). No group differences were noted on the W-TMT A task that was less cognitively demanding. Neuropsychological measures of executive functioning were associated with slower W-TMT B performance, whereas memory, visual attention and visual spatial skills were not (adjusted R(2) = 0.42). CONCLUSIONS Executive function is important for stepping performance, particularly under more complex environmental conditions.
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Affiliation(s)
- Carol C Persad
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA.
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van Iersel MB, Kessels RPC, Bloem BR, Verbeek ALM, Olde Rikkert MGM. Executive functions are associated with gait and balance in community-living elderly people. J Gerontol A Biol Sci Med Sci 2009; 63:1344-9. [PMID: 19126847 DOI: 10.1093/gerona/63.12.1344] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognition influences gait and balance in elderly people. Executive functions seem to play a key role in this mechanism. Previous studies used only a single test to probe executive functions, and outcome measures were restricted to gait variables. We extend this prior work by examining the association between two different executive functions and measures of both gait and balance, with and without two different cognitive dual tasks. METHODS This is a cross-sectional study with randomly selected community-living elderly people. Executive functions were tested with the Trail Making Test Parts A and B and the Stroop Color Word Test; memory with Cambridge Neuropsychological Test Automated Battery (CANTAB) subtests. Patients walked without and with two dual tasks (subtracting serial sevens and animal naming). Main outcomes focused on gait (velocity, stride length, and stride time variability), measured on an electronic walkway, and balance, measured as trunk movements during walking. Associations were assessed with multiple regression models. RESULTS One hundred elderly people, with a mean age 80.6 years (range 75-93 years) participated. Both dual tasks decreased gait velocity and increased variability and trunk sway. Executive functions were associated with only stride length variability and mediolateral trunk sway during performance of animal naming as the dual task. Memory was not associated with the gait and balance variables. CONCLUSIONS In community-living elderly people, executive functions are associated with gait and balance impairment during a challenging dual-task condition that also depends on executive integrity. Next steps will be to explore the value of executive functions in defining fall-risk profiles and in fall-prevention interventions for frail patients.
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Affiliation(s)
- Marianne B van Iersel
- Radboud University Nijmegen Medical Centre, Department of Geriatrics, 6500 HB Nijmegen, the Netherlands.
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Alexander NB, Hausdorff JM. Guest editorial: linking thinking, walking, and falling. J Gerontol A Biol Sci Med Sci 2009; 63:1325-8. [PMID: 19126844 DOI: 10.1093/gerona/63.12.1325] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND Falls are a major health care problem for older people and are associated with cognitive dysfunction. Mild cognitive impairment (MCI) is an increasingly recognized clinical problem. No study has comprehensively compared people with and without MCI for fall risk factors in both the physiological and cognitive domains. OBJECTIVE The purpose of this cross-sectional study was to comprehensively compare fall risk factors in community-dwelling older women with and without MCI. DESIGN A cross-sectional design was used in the study. METHODS Community-dwelling women (N=158) with Folstein Mini Mental State Examination scores of >or=24 participated in the study. The Montreal Cognitive Assessment (MoCA) was used to categorize participants as either having or not having MCI. Each participant's fall risk profile was assessed with the Physiological Profile Assessment (PPA). Three central executive functions were assessed: (1) set shifting was assessed with the Trail Making Test (part B), (2) updating (ie, working memory) was assessed with the Verbal Digits Backward Test, and (3) response inhibition was assessed with the Stroop Colour-Word Test. RESULTS Both the composite PPA score and its subcomponent, postural sway performance, were significantly different between the 2 groups; participants with MCI had higher composite PPA scores and greater postural sway compared with participants without MCI. Participants with MCI performed significantly worse on all 3 central executive function tests compared with participants without MCI. LIMITATIONS A screening tool was used to categorize participants as having MCI, and fall risk factors were compared rather than the actual incidence of falls. CONCLUSIONS Fall risk screening may be prudent in older adults with MCI.
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Attentional mechanisms contributing to balance constraints during gait: the effects of balance impairments. Brain Res 2008; 1248:59-67. [PMID: 19028462 DOI: 10.1016/j.brainres.2008.10.078] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recent research has begun to explore the ability of older adults to perform balance tasks while simultaneously performing a secondary cognitive task; however, it has suffered from limitations regarding the mechanisms underlying the problems that cause dual-task deficits in older adults with balance impairments. Two possible attentional mechanisms (reduced general attentional capacity vs. a true dual-task performance deficit and inability to allocate attention between two tasks) contributing to balance constraints were examined. METHODS Twelve healthy elderly adults and 12 elderly adults with balance impairments (BIOA) were asked to perform obstacle avoidance while walking, either alone or simultaneously with an auditory Stroop task. Two experiments were designed to examine attentional mechanisms that may contribute to reduce performance in the dual-task situations for the BIOA. RESULTS Experiment 1 determined whether for BIOA, single vs. dual-task performance conditions led to similar effects as a single-task difficulty (congruent vs. incongruent) manipulation. Results indicated that dual-task performance reduction did not exceed that of the difficult single task, suggesting that neither older adult group showed a true dual-task performance deficit, but rather BIOA showed a reduced attentional capacity. Experiment 2 showed that BIOA also showed deficits in flexibly focusing their attention between two tasks according to instructions. CONCLUSION Our study confirmed that the ability to allocate attention between a postural task and a secondary cognitive task was impaired in BIOA; it is suggested that inability to flexibly allocate attention could be one important factor among many factors that contribute to balance constraints during gait in fallers.
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Liu-Ambrose T, Donaldson MG, Ahamed Y, Graf P, Cook WL, Close J, Lord SR, Khan KM. Otago Home-Based Strength and Balance Retraining Improves Executive Functioning in Older Fallers: A Randomized Controlled Trial. J Am Geriatr Soc 2008; 56:1821-30. [PMID: 18795987 DOI: 10.1111/j.1532-5415.2008.01931.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Teresa Liu-Ambrose
- Centre for Hip Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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Liu-Ambrose T, Ahamed Y, Graf P, Feldman F, Robinovitch SN. Older fallers with poor working memory overestimate their postural limits. Arch Phys Med Rehabil 2008; 89:1335-40. [PMID: 18586136 DOI: 10.1016/j.apmr.2007.11.052] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 11/07/2007] [Accepted: 11/15/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the accuracy of perceived postural limits between older fallers with good working memory and those with poor working memory. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Thirty-three community-dwelling older adults with a history of falls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We measured the accuracy of perceived postural limits by using the perceived reach test in 33 fallers. The difference between the verbal digits forward test score and the verbal digits backward test score was used to provide an index of the central executive component of working memory. Participants were then allocated into 2 groups: (1) good working memory or (2) poor working memory. Comparisons of group characteristics and scores were undertaken by using Student independent-sample t tests for differences in means between those with good working memory and those with poor memory. One hierarchical linear regression model was constructed to determine the independent association of the central executive component of working memory with the accuracy of older fallers' perceived reach capacity. RESULTS There was a significant difference in the mean percentage error in perceived reach between older fallers with good working memory and those with poor working memory (P=.01). The verbal digit span difference score was independently associated with the percentage error in perceived reach. The verbal digit span difference score resulted in an R(2) change of 18.2% and significantly improved the regression model (F(1,26) change, 7.45; P=.01). CONCLUSIONS Our novel results suggest that impaired executive functioning may increase falls risk by impairing older adults' judgment in motor planning for daily activities. However, future studies with larger sample sizes are needed to confirm our current results.
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Affiliation(s)
- Teresa Liu-Ambrose
- Centre for Hip Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
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Wong WL, Masters RSW, Maxwell JP, Abernethy AB. Reinvestment and falls in community-dwelling older adults. Neurorehabil Neural Repair 2008; 22:410-4. [PMID: 18334603 DOI: 10.1177/1545968307313510] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Falls are common in older adults and have many adverse consequences. In an attempt to prevent further incidents, elder fallers may consciously monitor and control their movements. Ironically, conscious movement control may be one factor that contributes to disruption of automaticity of walking, increasing the likelihood of subsequent falls. OBJECTIVE The Movement Specific Reinvestment Scale (MSRS), which aims to measure the propensity for movement-related self-consciousness and for conscious processing of movement, was used to try to discriminate elder fallers from non-fallers. METHODS Fifty-two volunteer older adults, aged 65 or above, participated. In addition to the 10-item MSRS, participants completed the Mini-Mental State Examination questionnaire, Timed "Up & Go" test, and Four Word Short-Term Memory test. Demographics including age, gender, and history of falling were collected. RESULTS Elder fallers scored significantly higher than non-fallers on both the movement self-consciousness and conscious motor processing components of the MSRS. Logistic regression revealed a significant association between the MSRS (conscious motor processing component) and "faller or non-faller" status. CONCLUSIONS Elder fallers may have a higher propensity to consciously control their movements. The MSRS shows potential as a clinical tool with which to predict falls in the elderly, as well as to gain insight into the perception of safety during walking in any impaired patient.
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Affiliation(s)
- W L Wong
- Institute of Human Performance, The University of Hong Kong, Hong Kong, China.
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Holtzer R, Friedman R, Lipton RB, Katz M, Xue X, Verghese J. The relationship between specific cognitive functions and falls in aging. Neuropsychology 2007; 21:540-8. [PMID: 17784802 PMCID: PMC3476056 DOI: 10.1037/0894-4105.21.5.540] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The current study examined the relationship between cognitive function and falls in older people who did not meet criteria for dementia or mild cognitive impairment (N = 172). To address limitations of previous research, the authors controlled for the confounding effects of gait measures and other risk factors by means of associations between cognitive function and falls. A neuropsychological test battery was submitted to factor analysis, yielding 3 orthogonal factors (Verbal IQ, Speed/Executive Attention, Memory). Single and recurrent falls within the last 12 months were evaluated. The authors hypothesized that Speed/Executive Attention would be associated with falls. Additionally, the authors assessed whether associations between different cognitive functions and falls varied depending on whether single or recurrent falls were examined. Multivariate logistic regressions showed that lower scores on Speed/Executive Attention were associated with increased risk of single and recurrent falls. Lower scores on Verbal IQ were related only to increased risk of recurrent falls. Memory was not associated with either single or recurrent falls. These findings are relevant to risk assessment and prevention of falls and point to possible shared neural substrates of cognitive and motor function.
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Affiliation(s)
- Roee Holtzer
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, Yeshiva University, NY 10461, USA.
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Chapman GJ, Hollands MA. Evidence that older adult fallers prioritise the planning of future stepping actions over the accurate execution of ongoing steps during complex locomotor tasks. Gait Posture 2007; 26:59-67. [PMID: 16939711 DOI: 10.1016/j.gaitpost.2006.07.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 05/24/2006] [Accepted: 07/27/2006] [Indexed: 02/02/2023]
Abstract
Previous research has highlighted differences between older adults determined to be at a low-risk of falling (low-risk) and older adults prone to falling (high-risk) in both where and when they look at stepping targets and the precision with which they subsequently step. On the basis of these findings, we proposed that high-risk older adults prioritise the planning of future stepping actions over the accurate execution of ongoing movements and that adoption of this strategy contributes to increased likelihood of falls. The present experiment was designed to test this hypothesis by manipulating the complexity of the required walking conditions and comparing gaze and stepping performance between young, high-risk and low-risk older adults. Participants walked at a self-selected pace along a 7-m pathway and encountered one of three obstacle conditions: (1) a single stepping target, (2) two stepping targets, (3) two stepping targets separated by a raised obstacle. On average, when there was a single target (Target 1) in the travel path, all groups fixated the target until after heel contact. However, when challenged with additional impending stepping constraints, high-risk older adults transferred their gaze significantly sooner from Target 1 prior to heel contact. On average, low-risk older adults and younger adults maintained gaze on Target 1 until after heel contact, irrespective of future constraints. Premature gaze transfer was associated with decline in stepping accuracy and precision. Our findings suggest that high-risk older adults choose a potentially hazardous gaze strategy when challenged with multiple obstacles. Putative mechanisms underlying this behaviour are discussed.
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Affiliation(s)
- G J Chapman
- Human Movement Laboratory, School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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Eriksson S, Gustafson Y, Lundin-Olsson L. Characteristics associated with falls in patients with dementia in a psychogeriatric ward. Aging Clin Exp Res 2007; 19:97-103. [PMID: 17446719 DOI: 10.1007/bf03324674] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Few studies have reported fall-risk factors for persons with dementia, and no successful randomized fall prevention studies have been published. The aim of this study was to identify characteristics associated with falls in patients with dementia in a psychogeriatric ward. METHODS This prospective study comprised 204 patients with any diagnosis of dementia. It was carried out in a psychogeriatric ward specializing in the assessment and treatment of behavioral and psychological symptoms in patients with dementia (BPSD). Baseline patient data were collected from medical records, and covered physical, behavioral and cognitive areas. Falls were recorded during time spent in the ward and median follow-up time was 52.5 days. RESULTS Eighty-two patients fell a total of 251 times. Factors significantly and independently associated with an increased risk of falling were male sex (IRR 3.36, 95% CI 2.02-5.61), failed "copy design" activity (decreased visual perception) (IRR 2.37, 95% CI 1.24-4.52), and any walking difficulty on level ground (IRR 1.84, 95% CI 1.10-3.08). Statins were associated with a decreased risk of falling (IRR 0.29, 95% CI 0.10-0.86). Twenty-seven percent of the variation in falls was explained. CONCLUSIONS Male sex, decreased visual perception, and walking difficulties were all associated with an increased number of falls, and the model explained 1/4 of the variation in falls. Well-planned furnishing and use of color to achieve a plain, clearly defined environment, as well as training in walking ability, may decrease the risk of falling in people with dementia.
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Affiliation(s)
- Staffan Eriksson
- Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, SE-901 87, Umeå, Sweden.
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Verghese J, Kuslansky G, Holtzer R, Katz M, Xue X, Buschke H, Pahor M. Walking while talking: effect of task prioritization in the elderly. Arch Phys Med Rehabil 2007; 88:50-3. [PMID: 17207675 PMCID: PMC1894901 DOI: 10.1016/j.apmr.2006.10.007] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the effect of 2 instructions on the same walking while talking (WWT) task on task prioritization by nondisabled subjects. DESIGN Cross-sectional survey with within subject comparisons. SETTING Community-based sample. PARTICIPANTS Older adults (N=189; mean age, 80.2+/-4.9y), who did not meet criteria from the Diagnostic and Statistical Manual, Fourth Edition, for dementia and were able to independently perform activities of daily living. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Verbal and gait measures on the same WWT task with 2 different instructions: paying attention to both talking and walking (WWT-C) and paying attention only to talking (WWT-T). RESULTS Task prioritization effects were seen on walking but not on talking. Compared with their baseline normal walking velocity (without talking), subjects slowed down more on WWT-T (median change, 28.3%) than WWT-C (median change, 26.4%). Comparing the 2 WWT conditions, velocity and cadence was slower during WWT-T compared with WWT-C, with longer stride length. Verbal output was not significantly different on the 2 conditions. CONCLUSIONS Changing instructions while maintaining the same cognitive and motor tasks on WWT in older adults result in task prioritization effects.
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Affiliation(s)
- Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
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Liu-Ambrose T, Pang MYC, Eng JJ. Executive function is independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention. Cerebrovasc Dis 2006; 23:203-10. [PMID: 17143004 PMCID: PMC4492718 DOI: 10.1159/000097642] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 09/11/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke survivors have a high incidence of falls. Impaired executive-controlled processes are frequent in stroke survivors and are associated with falls in this population. Better understanding of the independent association between executive-controlled processes and physiological fall risk (i.e. performances of balance and mobility) could enhance future interventions that aim to prevent falls and to promote an independent lifestyle among stroke survivors. METHODS Cross-sectional analysis of 63 adults who suffered a mild stroke >1 year prior to the study, aged > or =50 years. RESULTS Cognitive flexibility was independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke, after accounting for age, quadriceps strength of the paretic side and current physical activity level. CONCLUSIONS Clinicians may need to consider cognitive function when assessing and treating impaired balance and mobility in community-dwelling older adults after mild stroke.
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Affiliation(s)
- Teresa Liu-Ambrose
- UBC Bone Health Research Group, Center for Hip Health, BC Women's Hospital and Health Center Osteoporosis Program, Faculty of Medicine, Vancouver, Canada.
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Lord SE, Rochester L, Weatherall M, McPherson KM, McNaughton HK. The effect of environment and task on gait parameters after stroke: A randomized comparison of measurement conditions. Arch Phys Med Rehabil 2006; 87:967-73. [PMID: 16813785 DOI: 10.1016/j.apmr.2006.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess the effect of environment and a secondary task on gait parameters in community ambulant stroke survivors and to assess the contribution of clinical symptoms to gait performance. DESIGN A 2x3 randomized factorial design with 2 main factors: task (no task, motor task, cognitive task) and environment (clinic, suburban street, shopping mall). SETTING Subjects were assessed in 1 of 3 settings: 2 in the community (a suburban street and shopping mall) and 1 clinical environment. PARTICIPANTS Twenty-seven people with stroke (mean age, 61+/-11.6y; mean time since stroke onset, 45.8+/-34.2mo), living at home, were recruited from community stroke groups and from a local rehabilitation unit. Selection criteria included the following: ability to give informed consent, unilateral first ever or recurrent stroke at least 6 months previously, walking independently in the community, a gait speed between 24 and 50 m/min, Mini-Mental State Examination score of 24 or higher, and no severe comorbidity. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait speed (in m/min), cadence, and step length were assessed by using an accelerometer with adjustable thresholds. Clinical measures hypothesized to influence gait parameters in community environments were also assessed including fatigue, anxiety and depression, and attentional deficit. RESULTS Twenty-seven people with a mean baseline gait speed of 42.2+/-5.9 m/min were randomly allocated to 1 of 9 conditions in which the setting and distraction were manipulated. Analysis of variance showed a significant main effect for environment (P = .046) but not for task (P = .37). The interaction between task and environment was not significant (P = .73). Adjusting for baseline gait speed, people walked on average 8.8m/min faster in the clinic (95% confidence interval, 0.3-17.3m/min) than in the mall. Scores for fatigue, anxiety and depression, and attentional deficit were higher than normative values but did not influence gait performance. CONCLUSIONS This study suggests that people with chronic stroke cope well with the challenges of varied environments and can maintain their gait speed while performing a secondary task. Despite moderate levels of gait impairment, gait automaticity may be restored over time to a functional level.
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Affiliation(s)
- Susan E Lord
- Department of Medicine (Rehabilitation), Wellington School of Medicine and Health Sciences, University of Otago, Wellington South, New Zealand.
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Alexander NB, Ashton-Miller JA, Giordani B, Guire K, Schultz AB. Age differences in timed accurate stepping with increasing cognitive and visual demand: a walking trail making test. J Gerontol A Biol Sci Med Sci 2006; 60:1558-62. [PMID: 16424288 DOI: 10.1093/gerona/60.12.1558] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Impaired vision, cognition, and divided attention performance predict falls. Requiring both visual and cognitive input, the ability to step accurately is necessary to safely traverse challenging terrain conditions such as uneven or slippery surfaces. We compared healthy young and older adults in the time taken to step accurately under conditions of increasing cognitive and visual demand. METHODS Healthy Young (n = 42, mean age 21) and Older (n = 37, mean age 70) participants were required to step accurately on an instrumented walkway under conditions of increasing visual and cognitive demand. Based on the paper-and-pencil neuropsychological test, the Trail Making Test (P-TMT) A and B, participants stepped on instrumented targets with increasing sequential numbers (Walking Trail Making Test A [W-TMT A]) and increasing sequential numbers and letters (Walking Trail Making Test B [W-TMT B]), under conditions of Low as well as Normal lighting. RESULTS W-TMT performance time increased with increased age (Older vs Young), decreased light (Low vs Normal), and increased cognitive demand (Trails B vs Trails A). W-TMT performance time was disproportionately increased in Low light and in the Older group under the highest cognitive demand (W-TMT B) conditions. Paired W-TMT A-B differences were three times higher in the Older group than in the Young group. In the Older group, the correlation between W-TMT results and P-TMT B was particularly strong (p <.001). CONCLUSIONS The time to perform a stepping accuracy task, such as may be required to avoid environmental hazards, increases under reduced lighting and with increased cognitive demand, the latter disproportionately so in older adults.
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Affiliation(s)
- Neil B Alexander
- Department of Internal Medicine, The University of Michigan, Ann Arbor, USA
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Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM. Dual-tasking effects on gait variability: The role of aging, falls, and executive function. Mov Disord 2006; 21:950-7. [PMID: 16541455 DOI: 10.1002/mds.20848] [Citation(s) in RCA: 455] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objectives of the present study were to test the hypothesis that the dual-tasking effect on gait variability is larger in healthy older adults than it is in healthy young adults; that this effect is larger in idiopathic elderly fallers than it is in healthy older adults; and that the dual-tasking effects on gait variability are correlated with executive function (EF). Young adults and older adults who were classified as fallers and nonfallers were studied. Gait speed, swing time, and swing time variability, a marker of fall risk, were measured during usual walking and during three different dual-tasking conditions. EF and memory were evaluated. When performing dual tasks, all three groups significantly decreased their gait speed. Dual tasking did not affect swing time variability in the young adults and in the nonfallers. Conversely, dual tasking markedly increased swing time variability in the fallers. While memory was similar in fallers and nonfallers, EF was different. The faller-specific response to dual tasking was significantly correlated with tests of EF. These findings demonstrate that dual tasking does not affect the gait variability of elderly nonfallers or young adults. In contrast, dual tasking destabilizes the gait of idiopathic elderly fallers, an effect that appears to be mediated in part by a decline in EF.
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Affiliation(s)
- Shmuel Springer
- Movement Disorders Unit, Neurology Department, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Gauchard GC, Deviterne D, Guillemin F, Sanchez J, Perrin PP, Mur JM, Ravaud JF, Chau N. Prevalence of sensory and cognitive disabilities and falls, and their relationships: a community-based study. Neuroepidemiology 2005; 26:108-18. [PMID: 16374036 DOI: 10.1159/000090445] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study assessed the prevalence of sensory and cognitive disabilities and falls for various age groups, sexes, and socio-occupational categories, and their associations in the Lorraine population. The sample included 6,159 subjects, aged 15 years or more, randomly selected from the Lorraine population. They filled in a mailed questionnaire including socio-demographic characteristics, job, falls with physical injuries at the time of the survey, and sensory and cognitive disabilities. Data analysis was made via the adjusted odds ratios. The prevalences of sensory and cognitive disabilities were 3.0 and 4.7%, respectively, that of falls with physical injuries 2.4%: 1.2% for falls on the same level and 1.2% for falls to a lower level. Subjects aged over 70 were markedly affected, but the other age groups had relatively high prevalences as well; the workmen had the highest prevalence, followed by the foremen, farmers, craftsmen and tradesmen, and employees. A twofold risk independently of age, sex and job was found for the subjects with sensory or cognitive disabilities for all falls combined. These findings show the high prevalences of sensory and cognitive disabilities and falls with physical injuries, and their strong associations in the general population. Preventive measures are needed to detect and follow up the persons with these disabilities, limit their risk of falls and reduce occupational hazards.
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Affiliation(s)
- Gérome C Gauchard
- Inserm, U420, IFR25-RFRH, Faculty of Medicine, Vandoeuvre-lès-Nancy, France
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Di Fabio RP, Zampieri C, Henke J, Olson K, Rickheim D, Russell M. Influence of elderly executive cognitive function on attention in the lower visual field during step initiation. Gerontology 2005; 51:94-107. [PMID: 15711076 DOI: 10.1159/000082194] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2004] [Accepted: 06/28/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a well-established relationship between poor executive cognitive abilities and elderly fall risk, but the precise mechanism underlying this relationship is unknown. Older persons frequently fall or trip on objects below eye level, and it was hypothesized that the pathological mechanism linking low executive function and fall risk is a selective impairment in the resolution of visual attention in the lower visual fields. OBJECTIVE To determine if normally sighted older persons living in the community with deficits in executive cognitive abilities have a reduced resolution of visual attention in the lower visual fields compared to elderly and younger subjects with high executive abilities. METHODS Eye and head angulations were monitored as subjects fixated on a point rear-projected at eye level at the end of a 3- meter walkway. Visual stimuli were briefly presented (<300 ms) in the peripheral visual field (with and without distractors) to directly cue the selection of the right or left foot to lead a step over a foam obstacle resting at the subject's feet. No saccades were allowed until the stimulus was extinguished, at which time a down-saccade-step sequence moved the foot over the obstacle. The resolution of visual attention (tested with gratings) and the influence of target eccentricity in the upper and lower visual fields were evaluated. The primary outcome measures were step error and obstacle contact rate, saccade occurrence after extinguished stimulus and the log of cue-saccade latency (limb-independent reaction time). RESULTS All groups experienced greater stepping errors than expected by chance when stimuli were presented in the lower versus upper visual field and with increasing eccentricity. However, the obstacle contact rate was greater, cue-saccade latency was prolonged, and fewer down-saccades were generated in the elderly group with poor executive abilities compared to those with high executive function and younger subjects. CONCLUSIONS Loss of visual attention in the lower visual fields was not unique to elderly subjects with poor executive function. However, slowed processing time and reduction in the frequency of down-saccades associated with a low level of executive function potentially account for the mechanism linking executive abilities and fall risk.
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Affiliation(s)
- Richard P Di Fabio
- Department of Physical Medicine and Rehabilitation, Doctoral Program in Physical Therapy, University of Minnesota, Minneapolis, Minn. 55455, USA.
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Hausdorff JM, Yogev G, Springer S, Simon ES, Giladi N. Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp Brain Res 2005; 164:541-8. [PMID: 15864565 DOI: 10.1007/s00221-005-2280-3] [Citation(s) in RCA: 321] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 01/11/2005] [Indexed: 10/25/2022]
Abstract
Walking is generally viewed as an automated, over-learned, rhythmic motor task and may even be considered the lower-limb analog of rhythmic finger tapping, another automated motor task. Thus, one might hypothesize that walking would be associated with a simple rhythmic task like tapping rather than with a complex motor task like catching. Surprisingly, however, we find that among older adults, routine walking has more in common with complex motor tasks, like catching a moving object, than it does with tapping. Tapping performance, including both the average tapping interval and the variability of tapping interval, was not significantly associated with any gait parameter (gait speed, average stride time and stride time variability). In contrast, catch game performance was significantly associated with measures of walking, suggesting that walking is more like catching than it is like tapping. For example, participants with a higher gait speed tended to have lower times to first move when catching, better catching accuracy, and less catching errors. Stride time variability was significantly associated with each of the measures of catching. Participants with a lower stride time variability (a more steady gait) had better catching accuracy, lower time to first move, fewer direction changes when moving the cursor to catch the falling object, and less catching errors. To understand this association, we compared walking performance to performance on the Stroop test, a classic measure of executive function, and tests of memory. Walking was associated with higher-level cognitive resources, specifically, executive function, but not with memory or cognitive function in general. For example, a lower (better) stride time variability was significantly associated with higher (better) scores on the Stroop test, but not with tests of memory. Similarly, when participants were stratified based on their performance on the Stroop test and tests of memory, stride time variability was dependent on the former, but not the latter. These findings underscore the interconnectedness of gait and cognitive function, indicate that even routine walking is a complex cognitive task that is associated with higher-level cognitive function, and suggest an alternative approach to the treatment of gait and fall risk in the elderly.
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Affiliation(s)
- Jeffrey M Hausdorff
- Movement Disorders Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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