Increased Time Difference between Imagined and Physical Walking in Older Adults at a High Risk of Falling

Factors associated with proximal femoral fractures in older adults during hospital stay: a cross-sectional study

BACKGROUND

Proximal femoral fractures in older adults affect prognosis, quality of life and medical expenses. Therefore, identifying patients with an elevated risk for proximal femoral fractures and implementing preventive measures to mitigate their occurrence are crucial.

OBJECTIVE

This study aimed to develop an accurate in-hospital fracture prediction model that considers patients' daily conditions and medical procedure status. Additionally, it investigated the changes in their conditions associated with fractures during hospital stays.

DESIGN

A retrospective observational study.

SETTINGS

Acute care hospitals in Japan.

PARTICIPANTS

Participants were 8 514 551 patients from 1321 medical facilities who had been discharged between April 2018 and March 2021 with hip and proximal femoral fractures.

METHODS

Logistic regression analysis determined the association between patients' changes in their ability to transfer at admission and the day before fracture, and proximal femoral fracture during hospital stays.

RESULTS

Patients were classified into fracture and non-fracture groups. The mean ages were 77.4 (SD: 7.7) and 82.6 (SD: 7.8), and the percentages of women were 42.7% and 65.3% in the non-fracture and fracture groups (p<0.01), respectively. Model 4 showed that even if a patient required partial assistance with transfer on the day before the fracture, the fracture risk increased in each category of change in ability to transfer in the following order: 'declined', 'improved' and 'no change'.

CONCLUSIONS

Patients showing improved ability to transfer during their hospitalisation are at a higher risk for fractures. Monitoring patients' daily conditions and tracking changes can help prevent fractures during their hospital stays.

Association between individual differences in gait motor imagery and visuo-spatial working memory after stroke

Motor imagery is a mental process in which an individual internally simulates movements without actual motor execution. Gait motor imagery is associated with visuospatial working memory (VSWM) among young adults. This study investigates how individual differences in gait motor imagery ability among stroke patients are related to VSWM. Gait motor imagery of 12 S patients with right hemisphere damage and 12 healthy older adults were evaluated and compared in this study. Gait motor imagery ability was evaluated by comparing actual and mental walking times while manipulating path width, whereas VSWM ability was evaluated using the Corsi Block-Tapping task. The results revealed that VSWM ability could predict the accuracy of gait motor imagery for both stroke patients and healthy controls; those with higher VSWM ability exhibited more overestimation of mental walking time over actual walking time. Additionally, based on the results of dividing stroke participants into two groups depending on whether they had right prefrontal cortex (PFC) damage, stroke patients with right PFC damage had decreased VSWM, and underestimated mental walking over actual walking for all path widths compared to those with non-right PFC damage. These results suggest that gait motor imagery accuracy is associated with individual differences in VSWM ability, particularly in patients affected by right PFC damage.

Older adults do not consistently overestimate their action opportunities across different settings

Am I still able to climb the ladder? Aging accompanies changes in physical constitution and a higher risk of injuries. At the same time, the judgment of action opportunities needs to be highly adaptive to the given task setting. We examined older adults' (n = 40) judgment tendencies in four different tasks by use of a detection theory approach. The tasks' setting differed in their boundaries' proximity to the actor with either proximal (e.g., judging one's hand fit into an opening) or distal boundaries (e.g., judging the reachability of a distant object). The older participants showed significantly more liberal judgments in tasks with distal boundaries. Body awareness and alertness were associated with the extent of judgment disparity between setting types. Subsequently, we compared a gender- and education-matched subsample of the group (n = 24) to a younger sample (n = 24). Older participants' judgment tendencies were significantly more extreme, with stronger under- or overestimations depending on the type of setting. We discuss potential links between more extreme judgments in older adults and higher reliance on learned patterns. Future research is needed to further unravel these setting-dependent behavioral differences and the factors contributing to more extreme judgment tendencies with growing age.

Motor imagery does not effectively improve walking-related performance in older adults: A randomised controlled trial

BACKGROUND

Inaccurate perception of one's physical abilities is potentially related to age-related declines in motor planning and can lead to changes in walking. Motor imagery training is effective at improving balance and walking in older adults, but most research has been conducted on older adults following surgery or in those with a history of falls. Deficits in motor imagery ability are associated with reduced executive function in older adults with cognitive impairment.

OBJECTIVES

To determine whether walking-specific motor imagery training could improve walking performance (physical and imagined) in healthy older adults, and identify the relationship between actual and imagined movement, motor imagery accuracy and executive function across 5 different walking tasks in healthy older adults.

METHODS

A cohort of 53 community dwelling older adults took part in a 4-wk randomized controlled trial to assess the effect of motor imagery training on the physical and imagined performance of 5 walking-related tasks (3 narrow path walking tasks, Timed-up and go and step-over test), together with motor imagery clarity using the kinesthetic and visual imagery questionnaire (KVIQ-10). The association between physical performance, motor imagery accuracy and executive function were identified at baseline.

RESULTS

Four weeks of motor imagery training did not improve walking-specific performance (imagined or physical) compared to no-training. Motor imagery training did improve the visual clarity of imagined non-walking tasks. Executive function was significantly correlated with 2 out of 5 imagined walking tasks and 4 out of 5 physical walking tasks but was not associated with motor imagery accuracy.

CONCLUSION

Four weeks of motor imagery training is not effective at improving performance in walking-related tasks in healthy older adults. This lack of improvement may be due in part to the high functional ability of the cohort. Future research should assess the relationship between motor planning and executive function with more complex walking tasks.

TRIAL REGISTRATION

ANZCTR registration (ACTRN12619001784101).

Cross-Sectional Analysis of Fall-Related Factors with a Focus on Fall Prevention Self-Efficacy and Self-Cognition of Physical Performance among Community-Dwelling Older Adults

This study aimed to determine how fall prevention self-efficacy and degree of deviation in self-cognition of physical performance, which have recently received attention for their potential to explain falls in combination with a wide variety of fall-related factors, as well as affect falls. Older adults using day-care services (n = 27 with six men, mean age: 81.41 ± 7.43 years) were included in this study. Fall history in the past year, the modified fall efficacy scale (MFES), and physical performance and cognition errors were examined by evaluating the functional reach test (FRT), the stepping over test, and the timed up and go test (TUG), along with a questionnaire. In the fall (n = 14) and non-fall (n = 13) groups, logistic regression analysis using Bayesian statistical methods was used to identify factors associated with falls. The odds ratios for the MFES ranged from 0.97 to 1.0, while those of cognition-error items ranged from 3.1 to 170.72. These findings suggested that deviation in self-cognition of physical performance, particularly overestimation of timed cognitive ability, was a factor with more explanatory power for fall history. Future studies should analyze differences by disease and age group, which were not clarified in this study, to identify more detailed fall risk factors.

Using crutches during walking possibly reduces gait imagery accuracy among healthy young and older adults

[Purpose] Although crutches are widely used in the field of rehabilitation to improve gait performance, patients usually have difficulties using them, and this may increase their risks for falls. This study aimed to define the accuracy of gait imagery during walking with and without crutches, in healthy young and older adults, using the mental chronometry method. [Participants and Methods] Overall, 99 healthy young (mean age, 20.2 ± 1.0 years) and 39 healthy older adults (mean age, 71.3 ± 2.9 years) performed the imagery and execution tasks, which involved walking through a distance of 10 meters both with and without crutches. Using the mental chronometry method, the accuracy of the motor imagery was defined as the difference between the imagery time and the actual execution time. Two-way analysis of variance and one-sample t-tests were performed to evaluate the accuracy of the gait imagery. [Results] Both the young and older adults significantly overestimated their gait speeds when using crutches; the overestimation was larger among the older adults. [Conclusion] The overestimations indicate that participants estimated their gait speeds with crutches to be faster than their actual speeds. Therefore, using crutches decreased the accuracy of gait imagery and might therefore increase an individual’s risk of falling during walking.

Motor Imagery of Walking in People Living with and without Multiple Sclerosis: A Cross-Sectional Comparison of Mental Chronometry

Motor imagery represents the ability to simulate anticipated movements mentally prior to their actual execution and has been proposed as a tool to assess both individuals’ perception of task difficulty as well as their perception of their own abilities. People with multiple sclerosis (pwMS) often present with motor and cognitive dysfunction, which may negatively affect motor imagery. In this cross-sectional study, we explored differences in motor imagery of walking performance between pwMS (n = 20, age = 57.1 (SD = 8.6) years, 55% female) and age- and sex-matched healthy controls (n = 20, age = 58.1 (SD = 7.0) years, 60% female). Participants underwent mental chronometry assessments, a subset of motor imagery, which evaluated the difference between imagined and actual walking times across four walking tasks of increasing difficulty (i.e., large/narrow-width walkway with/without obstacles). Raw and absolute mental chronometry (A-MC) measures were recorded in single- (ST) and dual-task (DT) conditions. In ST conditions, pwMS had higher A-MC scores across all walking conditions (p ≤ 0.031, η² ≥ 0.119), indicating lower motor imagery ability compared to healthy controls. During DT, all participants tended to underestimate their walking ability (3.38 ± 6.72 to 5.63 ± 9.17 s). However, after physical practice, pwMS were less able to adjust their imagined walking performance compared to healthy controls. In pwMS, A-MC scores were correlated with measures of balance confidence (ρ = −0.629, p < 0.01) and the self-reported expanded disability status scale (ρ = 0.747, p < 0.01). While the current study revealed that pwMS have lower motor imagery of walking performance compared to healthy individuals, further work is necessary to examine how the disassociation between mental chronometry and actual performance relates to quality of life and well-being.