The association between oral health status and physical function in elderly patients with acute heart failure

OBJECTIVES

Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the association between oral health status and the decline in physical function during hospitalization in elderly patients with acute heart failure.

MATERIALS AND METHODS

We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Oral health problems were defined as a revised oral assessment guide score ≥9.

RESULTS

Oral health problems were identified in 66.2% of the patients. Patients with oral health problems had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with oral health problems than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate analyses.

CONCLUSIONS

Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients.

Do Sex and Age Influence Scapular and Thoracohumeral Kinematics During a Functional Task Protocol?

There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19-63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P < .001), and less scapular anterior tilt angles in the forward transfer task (6°, P < .001) than males. Age was positively associated with humeral elevation (R2 = .330, P < .001) and scapular rotation (R2 = .299, P < .001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development.

The association of depression and anxiety symptoms to three different types of activities of daily living in persons with and without HIV

Mood disorders are highly prevalent in people living with HIV (PLWH) and represent a potential contributor to functional impairment in activities of daily living. We aimed to determine if (1) Anxiety and depression symptoms were independently associated with impairments in basic self-care, role functioning, and social functioning and (2) PLWH differentially experienced impairments due to mood symptoms compared to those without HIV. Data for this study were obtained from 150 individuals (87 PLWH, 61% male, mean age = 44) via a cross-sectional study on alcohol and HIV-associated brain dysfunction. The Beck Anxiety Inventory (BAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess anxiety and depressive symptoms. Higher anxiety symptoms were associated with role functioning impairment, while higher depressive and anxiety symptoms were each associated with social functioning impairment. As depressive symptoms increased, PLWH were 3x more likely to have impairments in role functioning compared to those without HIV. HIV status did not interact with mood symptoms to affect basic self-care or social functioning. Overall, mood symptoms are associated with different types of functional impairment, and improved management of mood symptoms could lead to improved role and social functioning.

Cognitive assistance to support individuals with traumatic brain injury using a minimal and personalised approach: A conversion mixed methods study using video analysis

INTRODUCTION

Individuals with traumatic brain injury (TBI) frequently need assistance to manage complex everyday activities. However, little is known about the types of cognitive assistance that can be used to facilitate optimal independence. A conversion mixed method study using video analysis was conducted to describe assistance provided by trained occupational therapists during three everyday tasks carried out in the participants' homes and surrounding environments.

METHODS

Forty-five people with moderate and severe TBI were tested by three occupational therapists using the Instrumental Activities of Daily Living Profile, an observation-based assessment that documents independence in complex everyday activities and the minimal assistance required to attain task goals. Using video analysis, difficulties experienced by the people with TBI during a meal preparation and grocery shopping task, and the cognitive assistance provided by the occupational therapists in response to these difficulties, were documented. Statistical analyses were also completed to identify the main difficulties and types of cognitive assistance provided during the evaluation, for the whole group and depending on their level of independence.

RESULTS

Nine types of cognitive assistance were used by occupational therapists, including implicit (stimulating thought processes), and more explicit assistance (cueing), to facilitate task performance. When needed, motivational assistance, which consisted of encouraging participants to think for themselves, was also used. Stimulating thought processes was mostly used to support goal formulation and planning, whereas cueing was used in numerous instances. Participants with lower levels of independence received more assistance of almost all types to support them.

CONCLUSION

Using these findings, training could be developed for caregivers and occupational therapists to support them in providing minimal and personalised cognitive assistance. Further research is needed to examine the extent to which all types of cognitive assistance are effective in helping various cognitive profiles of people with TBI attain optimal independence.

Correlation between trunk function improvement and recovery of activities of daily living after stroke in older adult patients

OBJECTIVES

To examine the impact of improved trunk function on activities of daily living in stroke patients using the Functional Independence Measure (FIM).

METHODS

This retrospective observational study was conducted on patients aged ≥ 65 years who had cerebral infarction. Patients were divided into a group with improved trunk function and a group without trunk function improvement based on the difference between the calculated Functional Assessment for Control of Trunk (FACT) gain at discharge and admission.

RESULTS

Of the 218 patients (mean age, 79.5 ± 7.9 years; 56.9% were men) included, 110 patients had improved FACT scores. Multiple linear regression analysis revealed that the group with improved FACT scores had higher FIM gain (coefficient = 7.562, 95% confidence interval = 3.870-11.253, P < 0.001). Multivariate logistic regression showed that the factors associated with FACT score improvement were the Mini Nutritional Assessment Short-Form score at admission, National Institutes of Health Stroke Scale score at admission, FACT score at admission, length of hospital stay, and period of rehabilitation.

DISCUSSIONS

Improvement in trunk function suggests a positive correlation with the recovery of activities of daily living in patients with cerebral infarction. This relationship should be further validated through prospective observational studies.

Functional evaluation of physical performance, gait, balance and activities of daily living in older individuals with long COVID syndrome

OBJECTIVE

The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS).

METHODS

A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID-19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI).

RESULTS

In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p < .05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p < .05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p > .05).

CONCLUSIONS

It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL.

The effect of urban-rural resident basic medical insurance on physical health of the rural older adult in China

Introduction

Urban-Rural Resident Basic Medical Insurance (URRBMI) is an important system for effectively transferring disease risks to the rural older adult. As China experiences rapid aging, maintaining the physical health of the rural older adult is key to achieving the goal of healthy aging.

Methods

The study explores the impact of URRBMI on physical health of the rural older adult in China using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018. Ordinary least square models were used to analyze the relationship between URRBMI and physical health of the rural older adult, and we used instrumental variable method to address the potential endogenous problem.

Results

We find that URRBMI greatly improves physical health of the rural older adult. The heterogeneity analysis indicates that URRBMI contributes more significantly to the rural older adult in eastern areas and the advanced rural older adult. The results also suggested that URRBMI improves physical health of the rural older adult through increasing life satisfaction and enhancing the timeliness of medical services.

Recommendations

This study implies that we need to further improve the participation rate, increase the actual reimbursement ratio and increase financial subsidies for URRBMI in central and western areas, and further integrate the distribution of medical resources to promote physical health of the rural older adult.

Longitudinal Changes in Iron and Myelination Within Ischemic Lesions Associate With Neurological Outcomes: A Pilot Study

BACKGROUND

Combined quantitative susceptibility mapping and R2* relaxometry can distinguish iron and myelin components in ischemic lesions. We aimed to investigate whether longitudinal changes in magnetic susceptibility and R2* values within ischemic lesions were associated with neurological outcomes.

METHODS

In this single-center prospective study, we included patients, 20 to 90 years of age, who were consecutively admitted to the stroke care unit between August 2020 and March 2022 due to acute ischemic stroke. The participants underwent 2 instances of quantitative susceptibility mapping and R2* relaxometry scanning before and after stroke rehabilitation. We compared the changes in these quantitative measures across different subtypes of acute ischemic stroke. Multiple linear regression models were used to investigate the associations between the National Institutes of Health Stroke Scale scores and the mean magnetic susceptibility and R2* values in ischemic lesions.

RESULTS

Among a total of 112 patients with acute ischemic stroke, 32 participants (aged 73.3±9.4 years; 20 men and 12 women) were evaluated. The median time from stroke onset to the first imaging was 5 days and that to the second imaging was 102 days. The changes in magnetic susceptibility values of branch atheromatous disease were higher than those of cardioembolism (mean difference, 0.018 [95% CI, 0.009-0.027] ppm; P<0.001) and lacunar (mean difference, 0.013 [95% CI, 0.005-0.020] ppm; P=0.004). Across all patients, the changes in National Institutes of Health Stroke Scale scores were associated with those of magnetic susceptibility values (coefficient, 0.311 [95% CI, 0.098-0.520]; P=0.017) but not with R2* values (coefficient, 0.114 [95% CI, -0.127 to 0.345]; P=0.291).

CONCLUSIONS

The longitudinal changes in the magnetic susceptibility values within ischemic lesions were associated with neurological outcomes during the restorative stages poststroke in patients experiencing acute ischemic stroke.

REGISTRATION

URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000050719.

Effectiveness of Different Neurocognitive Intervention Approaches on Functionality in Healthy Older Adults: A Systematic Review

Subtle loss of functionality in healthy older adults is considered one of the most important predictors of cognitive decline. Neurocognitive interventions are increasingly being used, from a preventive maintenance approach to functional capacity. This study evaluates the effectiveness of different neurocognitive approaches on the functionality of healthy older adults. In this systematic review (CRD42023473944), an extensive search was conducted for articles published in the last 10 years (2013-2023) in the following databases: Medline, Scopus, and Web of Science. A total of 809 trials were identified, of which 18 were considered to be eligible for inclusion in the review. The data revealed heterogeneity in sample size, measures of functional assessment, neurocognitive interventions used, number of sessions, session duration, and time. Traditional cognitive stimulation is shown to have no significant functional benefit, while other less commonly used neurocognitive interventions, such as those based on everyday cognition, are associated with more significant benefits. Moreover, it is demonstrated that although the Instrumental Activities of Daily Living scale (IADL) is the most used test in similar studies, it is not sensitive enough to detect changes in functionality in healthy elderly individuals, with other tests such as the Timed Instrumental Activities of Daily Living (TIADL) being more advantageous. Therefore, a new guideline is proposed for its use in clinical practice and research, using homogeneous study protocols and neurocognitive interventions that allow for the transfer and generalization of results in daily life.

Grade-4/5 motor activity log-Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study

PURPOSE

This study examined the clinimetrics of the Brazilian-Portuguese translation of the Grade-4/5 Motor Activity Log (MAL 4/5), which assesses everyday use of the more affected upper-limb (UL) in stroke survivors with moderate/severe or severe motor impairment.

MATERIALS AND METHODS

The translated MAL 4/5 was administered to 47 stroke survivors with moderate/severe or severe UL motor impairment. Accelerometers were worn on participants' wrists for five days on average prior to the first assessment. Test-retest and inter-rater reliabilities were assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach's α, and construct validity was tested with correlations with the accelerometry. The measurement error (SEM) and the minimal detectable change (MDC) were calculated.

RESULTS

MAL4/5-Brazil's test-retest reliability (AOU: ICC = 0.84; QOU: ICC = 0.90), inter-rater reliability (AOU: ICC = 0.83; QOU: ICC = 0.91), internal consistency (Cronbach's α = 0.91 and 0.95 for AOU and QOU scales, respectively), the SEM and MDC were 0.3 and 0.8 points for the AOU subscale and 0.2 and 0.5 points for the QOU subscale, respectively. The construct validity (AOU scale: r = 0.67; QOU scale: r = 0.76) was high.

CONCLUSION

Grade-4/5 Motor Activity Log-Brazil is a reliable and valid instrument for assessing the more-affected UL use of stroke patients with moderate/severe or severe UL motor impairments.

Effects of whole-body vibration training on physical function, activities of daily living, and quality of life in patients with stroke: a systematic review and meta-analysis

Purpose: This systematic review and meta-analysis aimed to evaluate the efficacy of whole-body vibration training (WBVT) in patients with stroke, specifically focusing on its effects on physical function, activities of daily living (ADL), and quality of life (QOL). Additionally, potential moderators influencing WBVT outcomes were explored. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library from inception to September 2022. Eligible studies were randomized controlled trials employing WBVT in patients with stroke. Two investigators independently extracted the data and calculated the standardized mean difference (SMD) using random-effect models. Results: Twenty-five studies involving 991 patients were included in this meta-analysis. WBVT demonstrated significant reductions in spasticity (SMD = -0.33, 95% CI = -0.61 to -0.06, p = 0.02), improvements in motor function (SMD = 0.39, 95% CI = 0.16 to 0.61, p < 0.01), and enhancements in balance function (SMD = 0.28, 95% CI = 0.09 to 0.47, p < 0.01) in patients with stroke. However, no significant effects were observed for gait (SMD = -0.23, 95% CI = -0.50 to 0.04, p = 0.10), ADL (SMD = -0.01, 95% CI = -0.46 to 0.44, p = 0.97), or QOL (SMD = 0.12, 95% CI = -0.30 to 0.53, p = 0.59). Subgroup analyses revealed that variable frequency vibration and side-alternating vibration exhibited significant efficacy in reducing spasticity and improving motor and balance functions, while fixed frequency vibration and vertical vibration did not yield significant therapeutic benefits in these domains. Conclusion: Our findings indicate that WBVT may serve as a viable adjunct therapy for stroke patients to alleviate spasticity and enhance motor and balance functions. Variable frequency and side-alternating vibration appear to be crucial factors influencing the therapeutic effects of WBVT on these dysfunctions. Nonetheless, WBVT did not show significant effects on gait, ADL, or QOL in stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022384319).

Physical Leisure Activities in Adolescents with Disabilities: Data from National Survey of Disabled Persons

The impact of activities of daily living (ADLs) on the life satisfaction of adolescents with disabilities and the potential role of physical leisure activities as a moderator in this context have received attention. However, little is known about the influence of physical leisure activities on the relationship between ADLs and life satisfaction in adolescents with disabilities. This cross-sectional study aimed to investigate the moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction among adolescents with disabilities. Secondary data analysis was conducted by extracting data from 5364 adolescents aged 12-18 years with disabilities from the 2020 National Survey of Disabled Persons of Korea. The potential moderating effect of physical leisure activities on the relationship between ADLs and life satisfaction was investigated using Pearson's correlation analysis and hierarchical multiple regression. Significant positive correlations were found for living, life satisfaction, and physical leisure activities. Physical leisure activities were found to play a moderating role in the relationship between ADLs and life satisfaction. This study concluded that increasing physical leisure activities, even with dependent ADLs, promotes life satisfaction, especially if ADLs are low, highlighting the necessity of increasing leisure activities in adolescents with disabilities.

Continuous monitoring of eating and sleeping behaviors in the home environments of older adults: a case study demonstration

Accurate observation of patient functioning is necessary for rigorous clinical research and for improving the quality of patient care. However, clinic or laboratory environments systematically differ from the contexts of everyday life. Further, assessments that are completed in a single institutional session may not be generalizable. Here, we describe a computer vision methodology that measures human functioning continuously in the environments where patients live, sleep, and eat.

Efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor function outcomes in patients with stroke: a systematic review and meta-analysis

Background

Stroke disrupts the functions carried out by the brain such as the control of movement, sensation, and cognition. Disruption of movement control results in hemiparesis that affects the function of the diaphragm. Impaired function of the diaphragm can in turn affect many outcomes such as respiratory, cognitive, and motor function. The aim of this study is to carry out a systematic review and meta-analysis to determine the efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor outcomes after stroke.

Method

The study was registered in PROSPERO (CRD42023422293). PubMED, Embase, Web of Science (WoS), PEDro, Scopus, and CENTRAL databases were searched until September 2023. Only randomized controlled trials comparing diaphragmatic breathing exercise with a control were included. Information on the study authors, time since stroke, mean age, height, weight, sex, and the protocols of the experimental and control interventions including intensity, mean scores on the outcomes such as respiratory, cognitive, and motor functions were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were used to summarize the results, which were then presented in tables, risk-of-bias graph, and forest plots. The meta-analysis was carried out on respiratory function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF)] and motor function (trunk impairment, and internal and external oblique muscles activity).

Results

Six studies consisting of 151 participants were included. The results of the meta-analyses showed that diaphragmatic breathing exercise is only superior to the control at improving respiratory function, FVC (MD = 0.90, 95% CI = 0.76 to 1.04, P < 0.00001), FEV1 (MD = 0.32, 95% CI = 0.11 to 0.52, P = 0.002), and PEF (MD = 1.48, 95% CI = 1.15 to 1.81, P < 0.00001).

Conclusion

There is limited evidence suggesting that diaphragmatic breathing exercise may help enhance respiratory function, which may help enhance recovery of function post stroke.

Systematic Review Registration

PROSPERO, identifier CRD42023422293.

Effect of cognitive impairment at admission on activities of daily living at discharge in older patients with heart failure

Nonaka Y, Fujii R, Tanaka S, Tabira K. Effect of cognitive impairment at admission on activities of daily living at discharge in older patients with heart failure. Jpn J Compr Rehabil Sci 2023; 14: 78‒83.

Objective

Hasegawa's Dementia Scale-Revised (HDS-R) is widely used as a screening test for cognitive function in older adults. In this study, we examined the effect of cognitive impairment (CI) at admission on activities of daily living (ADL) at discharge in older patients with heart failure (HF).

Methods

This retrospective observational study included 394 patients hospitalized for acute decompensated HF between April 2016 and December 2022. Data on age, sex, body mass index, length of hospital stay, initiation of rehabilitation, New York Heart Association (NYHA) class, Charlson Comorbidity Index, medication, brain natriuretic peptide levels, left ventricular ejection fraction, renal function, hemoglobin level, serum albumin level, Geriatric Nutritional Risk Index (GNRI), Barthel Index (BI), and HDS-R score were analyzed using the χ2 test, unpaired t test, Mann-Whitney U test, and multiple linear regression.

Results

Among 394 patients, 102 who met the final inclusion criteria were included in the study. Based on previous studies, patients were divided into a high BI group (N = 44) and a low BI group (N = 58). Multiple linear regression analysis showed that CI at admission independently affected BI at discharge even after adjusting for confounding effects of age, NYHA class, GNRI, and BI at admission.

Conclusions

Our study showed that the presence or absence of CI may influence ADL improvement in rehabilitation interventions aimed at improving ADL in older patients with HF.

The effects of neighborhood socioeconomic status on ADL/IADL among Chinese older adults-neighborhood environments as mediators

Background

There have been few consistencies in the effects and pathways of neighborhood socioeconomic status (SES) on functional limitations. This study aimed to investigate whether neighborhood socioeconomic status influences ADL/IADL in older residents in China through the neighborhood built environment and social environment.

Methods

Activities of daily living/IADL were assessed in a sample of 5,887 Chinese individuals aged 60 or older, utilizing data obtained from the 2011 China Health and Retirement Longitudinal Study (CHARLS 2011). Neighborhood SES was measured by the neighborhood per-capita net income. Neighborhood built environment was measured by the security resources, motion resources, living resources, service resources for older adults, and medical resources of neighborhood. Neighborhood social environment was measured by the organizations, unemployment subsidies, minimum living allowance, subsidies to persons older than 65, and pensions to persons older than 80 of the neighborhood. The two-level logistical regression model and multilevel structural equation model (MSEM) were used.

Results

The rate of ADL/IADL loss among Chinese older adults aged 60 and above in 2011 were 32.17 and 36.87%, respectively. Neighborhood SES was significantly associated with ADL/IADL in older adults. Compared with the respondents living in communities with lower SES, those living in communities with higher SES possessed better ADL (β = -0.33, p < 0.05) and IADL (β = -0.36, p < 0.05) status. The path of neighborhood socioeconomic status on ADL was completely mediated by the neighborhood built environment (β = -0.110, p < 0.05) and neighborhood social environment (β = -0.091, p < 0.05). Additionally, the effect of neighborhood socioeconomic status on IADL was fully mediated by the neighborhood built environment (β = -0.082, p < 0.05) and neighborhood social environment (β = -0.077, p < 0.05).

Conclusion

Neighborhood SES was significantly correlated with ADL/IADL through the neighborhood environment. Improving the ADL/IADL status of older adults residing in low socioeconomic neighborhoods requires enhancing the built and social environment by provisioning additional neighborhood resources.

Attentional Resources and Independence in Basic and Instrumental Activities of Daily Living in Individuals with Intellectual Disabilities

The relationship between attentional resources and functionality in individuals with intellectual disabilities (IDs) is clinically relevant. This study aimed to examine the possible relationship between the degree of ID and attentional resources, and to evaluate whether attentional resources predict the performance of basic and instrumental activities of daily living (ADL) in individuals with mild and moderate ID. This study, which employed a descriptive, cross-sectional, observational design, was conducted between July 2019 and May 2020. The sample consisted of 166 individuals divided into three groups: moderate ID, mild ID, and those without ID. These groups were compared for attentional functions (p < 0.001), obtaining an effect size ranging from medium to large. The results indicated that 40% of the variance in basic ADL performance was explained by the age of the participants, degree of disability, and sustained attention in individuals with ID. Additionally, 64% of the variance in instrumental ADL performance was explained by sustained, divided, and executive attention. Therefore, attentional resources appear to be associated with the performance of basic and instrumental ADL in individuals with mild and moderate ID.

Unmet Needs for Support in Activities of Daily Living among Older Persons: The Effects of Family and Household Structures in a Low- and Middle-Income Context

The unmet need for assistance in activities of daily living (ADLs) accentuates older persons' risk of falls, ill health, hospitalisation, and mortality. In Nigeria, the family arrangements through which older persons derive support are changing due to modernisation, migration, and economic challenges. How the family dynamics explain the unmet needs is poorly understood. This study investigates the influence of family and household structures on older persons' unmet needs in ADLs in southwestern Nigeria. The study analysed the data of 827 older adults aged ≥65 years selected from Oyo State, southwestern Nigeria, using a multi-stage sampling design. Associations were examined using the Poisson-logit hurdle regression model. From the results, 65% of older persons with difficulties had unmet needs in instrumental ADLs and 59% in basic ADLs. Increased unmet needs were associated with older persons living with non-family members (β = 0.19; p < 0.01; 95% C.I. = 0.05-0.32) and widows (β = 0.27; p < 0.01; 95% C.I. = 0.13-0.42). Conversely, unmet needs decreased with higher family size (β = -0.06; p < 0.001; 95% C.I. = -0.08--0.03), living in rich households (β = -0.29; p < 0.001; 95% C.I. = -0.42--0.17), not being the household head (β = -0.27; p < 0.001; 95% C.I. = -0.40--0.15), close family bonds, and proximity to children/caregivers. The study recommends alternative or complementary home-based support mechanisms for seniors with vulnerable family settings in southwestern Nigeria.

Decreased functional mobility in individuals with mild to moderate expanded disability status from relapsing multiple sclerosis: Analysis of the Glittre-ADL test

INTRODUCTION

Multiple sclerosis (MS) is a chronic inflammatory and autoimmune disease that significantly limits an individual's activities of daily living (ADLs) and negatively affects their social participation as it progresses. The impact of activities and participation must be continuously assessed, and the Glittre-ADL is a validated test for MS to assess functional capacity in tasks similar to ADLs.

OBJECTIVE

To evaluate whether the Glittre-ADL test is a valid method for assessing functional mobility in individuals with MS and moderate disability or those who use assistive devices.

METHODS

This cross-sectional study enrolled 30 individuals in two groups: 1) MS group (n = 15); and 2) healthy control group (n = 15). The MS group underwent three functional mobility tests: 1) Glittre-ADL; 2) Timed 25-Foot Walk (T25FWT); and 3) Timed Up and Go (TUG) while the healthy group underwent only the Glittre-ADL test.

RESULTS

An association was found between the Glittre-ADL time and T25FWT (r = 0.78, p < .001) and TUG (r = 0.56, p = .030) times. In the MS group, statistically significant differences were found in time (F = 2.88, p = .038) and speed (F = 5.17, p = .024) between laps. A statistically significant difference was observed between the total time in the MS and control groups (Area Under Curve - AUC: 0.982, p < .0001). A total time > 46.0s represents the reduction of functional performance during ADLs in individuals with MS (sensitivity: 93.3%; specificity: 92.2%).

CONCLUSION

The Glittre-ADL test is a valid tool for assessing functional mobility in individuals with MS and mild to moderate disability (EDSS score ≤ 6.5).

Effects of a lower limb walking exoskeleton on quality of life and activities of daily living in patients with complete spinal cord injury: A randomized controlled trial

BACKGROUND

In recent years, lower limb walking exoskeletons have been widely used in the study of spinal cord injury (SCI).

OBJECTIVE

To explore the effect of a lower limb walking exoskeleton on quality of life and functional independence in patients with motor complete SCI.

METHODS

This was a multi-center, single blind, randomized controlled trial. A total of 16 SCI patients were randomly assigned to either the exoskeleton-assisted walking (EAW) group (n= 8) or the conventional group (n= 8). Both groups received conventional rehabilitation training, including aerobic exercise and strength training. The EAW group additionally conducted the exoskeleton-assisted walking training using an AIDER powered robotic exoskeleton for 40-50 minutes, 5 times/week for 8 weeks. World Health Organization quality of life-BREF (WHOQOL-BREF) and the Spinal Cord Independence Measure III (SCIM-III) were used for assessment before and after training.

RESULTS

There was an increasing tendency of scores in the psychological health, physical health, and social relationships domain of WHOQOL-BREF in the EAW group after the intervention compared with the pre-intervention period, but there was no significant difference (P> 0.05). SCIM-III scores increased in both groups compared to pre-training, with only the conventional group showing a significant difference after 8 weeks of training (P< 0.05).

CONCLUSION

A lower limb walking exoskeleton may have potential benefits for quality of life and activities of daily living in patients with motor complete SCI.

Measuring global activity performance in children with cerebral palsy in West Africa: validation of an adapted version of the ACTIVLIM-CP questionnaire

PURPOSE

To calibrate a West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) for children with cerebral palsy (CP).

MATERIALS AND METHODS

We recruited 287 children with CP of various age range: 2-6 years (n = 117, preschoolers), 6-12 years (n = 96, children) and 12-19 years (n = 74, adolescents). Caregivers of children of each age range completed the experimental version of the ACTIVLIM-CP-WA including 76 (preschoolers), 78 (children) and 76 (adolescents) global daily life activities. Responses were analyzed using the Rasch RUMM2030 software.

RESULTS

The final West-African version of ACTIVLIM-CP including 31 items (both common and age-specific items) defined a unidimensional, linear scale with well-discriminated response categories. It presented a high internal consistency (R = 0.94). Moreover, all items were locally independent and the item difficulty hierarchy was invariant regarding caregivers' education, children's age and gender, MACS and GMFCS levels. The ACTIVLIM-CP-WA measures were significantly correlated (p < 0.05) with Gross Motor Function Classification System (ρ = -0.77), Manual Ability Classification System (ρ = -0.75), Box and Block test (dominant hand r = 0.51; non-dominant hand r = 0.49), One-minute walking test (r = 0.28), and Timed up and Go test (r = -0.40).

CONCLUSIONS

The ACTIVLIM-CP-WA questionnaire provides a valid and reliable tool that has the potential to follow children's evolution and quantify changes consecutive to neurorehabilitation in Sub-Saharan Africa.IMPLICATIONS FOR REHABILITATIONThe West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) measures global activities requiring a combination of lower and upper extremities in children with cerebral palsy.As a Rasch-built scale, measures are unidimensional and linear to document changes in children with cerebral palsy from 2 to 19 years in Sub-Saharan Africa.Rehabilitation professionals are encouraged to use the ACTIVLIM-CP-WA questionnaire as a psychometrically robust assessment tool measuring the global performance in daily life activities in children with cerebral palsy in Sub-Saharan Africa.

Outside the Laboratory Assessment of Upper Limb Laterality in Patients With Stroke: A Cross-Sectional Study

BACKGROUND

The rehabilitation of upper limb sensorimotor performance after stroke requires the assessment of daily use, the identification of key levels of impairment, and monitoring the course of recovery. It needs to be answered, how laboratory-based assessments and everyday behavior are connected, which dimension of metrics, that is, volume, intensity, or quality, is most sensitive to reduced function, and what sensor, that is, gyroscope or accelerometer, is best suited to gather such data.

METHODS

Performance in laboratory-based sensorimotor tests, as well as smartwatch-derived kinematic data of everyday life relative upper limb activity, during 1 day of inpatient neurorehabilitation (Germany, 2022) of 50 patients with stroke, was cross-sectionally assessed and resulting laterality indices (performance ratios) between the limbs were analyzed using ANCOVAs and principal component analysis.

RESULTS

Laboratory-based tests revealed the strongest laterality indices, followed by smartwatch-based (intensity>quality>volume) metrics. Angular velocity-based metrics revealed higher laterality indices than acceleration-based ones. Laterality indices were overall well associated; however, a principal component analysis suggested upper limb impairments to be unidimensional.

CONCLUSIONS

Our findings suggest that the use of sensors can deliver valid information of stroke-related laterality. It appeared that commonly used metrics that estimate the volume of use (ie, energy expenditure) are not the most sensitive. Especially reached intensities could be well used for monitoring, because they are more dependent on the performance of the sensorimotor system and less on confounders like age. The unidimensionality of the upper limb laterality suggests that an impaired limb with reduced movement quality and the inability to reach higher intensities will be used less in everyday life, especially when it is the nondominant side.

The impact of cardiac rehabilitation for older adults with heart failure who underwent invasive cardiac treatment eligible for long-term care needs certification: A retrospective cohort study

Background

This study aimed to assess the usefulness of cardiac rehabilitation (CR) for older adults with heart failure (HF) who need nursing care and investigate the effect of CR on cognitive function (CF) and basic activities of daily living (BADL).

Methods

This was a retrospective cohort study. The study included older adults with HF eligible for long-term care insurance in fiscal year 2014 (FY2014) as the baseline and followed them up until March 2018. Patients were divided into two groups, CR (+) and CR (-), and the changes in their CF and BADL scores over time for 3 years were investigated.

Results

Of the 765 patients included in the study, 36.5% performed CR. BADL scores in the CR (+) and CR (-) groups (mean (SE)) were 5.81 (0.26) vs. 5.87 (0.20) in FY2014, 5.6 (0.28) vs. 5.92 (0.21) in FY2015, 5.72 (0.31) vs. 6.15 (0.22) in FY2016, and 5.64 (0.33) vs. 6.40 (0.25) in FY2017, respectively. BADL scores worsened over time in the CR (-) group but had a trend to inhibit decline in the CR (+) group, and a significant difference was observed between both groups (p = 0.04). Multivariate analysis showed a significant difference in CR as a factor suppressing ADL decline after 1 year (adjusted odds ratios: 0.54, 95% confidence intervals: 0.36-0.82; p = 0.004). However, no significant difference in the CF scores was observed.

Conclusion

CR for older adults with HF eligible for long-term care needs certification does not affect CF and may suppress ADL decline.

Preliminary validation of the Virtual Kitchen Challenge as an objective and sensitive measure of everyday function associated with cerebrovascular disease

Preliminary validity of a computer-based test of everyday function (Virtual Kitchen Challenge [VKC]) was examined against brain-imaging markers of cerebrovascular disease and in contrast to conventional neuropsychological and self-report measures. Twenty community-dwelling older adults (n = 6 mild cognitive impairment) performed simulated breakfast and lunch tasks using a computer touchscreen (VKC). Automated measures (completion time, proportion time off screen, etc.) were computed during training and test conditions. White matter hyperintensity (WMH) volumes from brain magnetic resonance imaging and conventional measures of cognition and function also were obtained. VKC completion time and proportion time off screen improved significantly from training to test and were significantly associated with WMH volume (r > 0.573). VKC measures and WMH were not significantly correlated with conventional cognitive or self-report measures. The VKC holds promise as a valid measure of subtle functional difficulties in older adults that is sensitive to change and cerebrovascular pathology, highlighting its potential for clinical trials.

Highlights

Virtual Kitchen Challenge (VKC) scores showed significant improvement from training to test conditions.VKC scores (completion time and proportion of time off screen) were associated with a neuroimaging biomarker of brain health (white matter hyperintensities).

Relationship between independence in activities of daily living at discharge and physical activity at admission of older postoperative hip fracture rehabilitation inpatients: A retrospective case-control study

BACKGROUND AND PURPOSE

Hip fractures are associated with a reduction in activities of daily living (ADL) and require long-term care. The physical activity of patients with hip fractures is temporarily impaired immediately after surgery, causing difficulty in the measurement of physical activities at the time of rehabilitation admission. This study examined the relationship between ADL at discharge and light- and moderate-intensity physical activity at the time of rehabilitation admission by determining a cut-off value predicting ADL independence.

METHODS

This retrospective case control study analyzed 43 postoperative hip fracture patients aged ≥65 years admitting into inpatient rehabilitation. ADL at discharge was assessed using the Functional Independent Measure motor items (FIM-m). The duration of physical activity at the time of rehabilitation admission was measured using an activity tracker equipped with an accelerometer. Prehospital frailty was evaluated using Clinical Frailty Scale. The relationship between these variables was examined using Spearman's product-moment correlation coefficient. Differences in physical activity between patients requiring and not requiring assistance with ADLs were examined using the analysis of covariance. A receiver operating characteristic curve of the need for ADL assistance at discharge was constructed from the duration of physical activity.

RESULTS

The duration of physical activity at the time of rehabilitation admission was related to FIM-m at discharge. The cut-off value of the duration of physical activity for predicting the need for ADL assistance at discharge was 135 s, with a sensitivity of 83.3% and specificity of 68.4% (area under the curve: 0.76).

DISCUSSION

The duration of physical activity at the time of rehabilitation admission may be a factor that can quantitatively predict the risk of requiring assistance with ADLs at discharge in older hip fracture patients. The duration of light-and-moderate intensity physical activity may be a component of multidisciplinary inpatient rehabilitation to improve patients' ADL.