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Pamoukdjian F, Paillaud E, Zelek L, Laurent M, Lévy V, Landre T, Sebbane G. Measurement of gait speed in older adults to identify complications associated with frailty: A systematic review. J Geriatr Oncol 2015; 6:484-96. [PMID: 26362356 DOI: 10.1016/j.jgo.2015.08.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022]
Abstract
Several frailty screening tests in older cancer patients were developed but their statistical performance is low. We aimed to assess whether measurement of usual gait speed (GS) alone could be used as a frailty screening test in older cancer patients. This systematic review was conducted on "pub med" between 1984 and 2014 and included reviews and original studies. Eligibility criteria were: GS over a short distance, alone or included in composite walking tests (Timed Get Up and Go test: TGUG, Short Physical Performance Battery: SPPB) in older people (aged 65 and over) living in a community setting and predictive value of GS on medical complications associated with frailty. 46 articles were finally selected. GS alone is consensual and recommended for screening sarcopenia in elderly. A slow GS is predictive of early death, disability, falls and hospitalization/institutionalization in older people living in a community setting. GS alone is comparable to composite walking tests that do not provide additional information on the medical complications associated with frailty. Despite few studies in geriatric oncology, GS seems to predict overall survival and disability. We suggest GS over 4m (at a threshold of 1m/s) as a new frailty screening test in older cancer patients (65 and over) to guide the implementation of a comprehensive geriatric assessment during the initial management phase or during follow-up. Prospective cohort studies are needed to validate this algorithm and compare it with other screening tool.
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302
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Perera S, Patel KV, Rosano C, Rubin SM, Satterfield S, Harris T, Ensrud K, Orwoll E, Lee CG, Chandler JM, Newman AB, Cauley JA, Guralnik JM, Ferrucci L, Studenski SA. Gait Speed Predicts Incident Disability: A Pooled Analysis. J Gerontol A Biol Sci Med Sci 2015; 71:63-71. [PMID: 26297942 DOI: 10.1093/gerona/glv126] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/10/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Functional independence with aging is an important goal for individuals and society. Simple prognostic indicators can inform health promotion and care planning, but evidence is limited by heterogeneity in measures of function. METHODS We performed a pooled analysis of data from seven studies of 27,220 community-dwelling older adults aged 65 or older with baseline gait speed, followed for disability and mortality. Outcomes were incident inability or dependence on another person in bathing or dressing; and difficulty walking ¼ - ½ mile or climbing 10 steps within 3 years. RESULTS Participants with faster baseline gait had lower rates of incident disability. In subgroups (defined by 0.2 m/s-wide intervals from <0.4 to ≥ 1.4 m/s) with increasingly greater gait speed, 3-year rates of bathing or dressing dependence trended from 10% to 1% in men, and from 15% to 1% in women, while mobility difficulty trended from 47% to 4% in men and 40% to 6% in women. The age-adjusted relative risk ratio per 0.1 m/s greater speed for bathing or dressing dependence in men was 0.68 (0.57-0.81) and in women: 0.74 (0.66-0.82); for mobility difficulty, men: 0.75 (0.68-0.82), women: 0.73 (0.67-0.80). Results were similar for combined disability and mortality. Effects were largely consistent across subgroups based on age, gender, race, body mass index, prior hospitalization, and selected chronic conditions. In the presence of multiple other risk factors for disability, gait speed significantly increased the area under the receiver operator characteristic curve. CONCLUSION In older adults, gait speed predicts 3 year incidence of bathing or dressing dependence, mobility difficulty, and a composite outcome of disability and mortality.
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Affiliation(s)
- Subashan Perera
- Division of Geriatric Medicine, University of Pittsburgh, Pennsylvania.
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Susan M Rubin
- Department of Epidemiology and Biostatistics, University of California-San Francisco
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Tamara Harris
- Geriatric Epidemiology Section, National Institute on Aging, Bethesda, Maryland
| | - Kristine Ensrud
- Division of Epidemiology and Community Health, University of Minnesota and Minneapolis VA Health Care System
| | - Eric Orwoll
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health Sciences University, Portland
| | - Christine G Lee
- Research Service, Veterans Affairs Health Care System, Portland, Oregon
| | - Julie M Chandler
- Department of Pharmacoepidemiology, Merck & Co., Kenilworth, New Jersey
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland, College Park
| | - Luigi Ferrucci
- Longitudinal Studies Section, National Institute on Aging, Baltimore, Maryland
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303
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Abstract
We applied principal component analysis (PCA) to thigh, shank, and foot elevation angles to examine the impact of speed on intra-limb coordination during gait. The specific aims were to (1) determine speed-related changes in segment loadings on three principal components (PCs) and (2) examine differences between men and women. The subjects (26 women, 21 men) walked overground at five self-selected paces (very slow, slow, normal, fast, very fast). PCA yielded percent variation (PV) explained by each PC and thigh, shank, and foot loadings on PC1-PC3. These parameters were regressed against the speed normalized to body height (BH/s) to derive individual and aggregate slopes and P values, separately for men and women. PV1 increased with speed, whereas PV2 and PV3 decreased (all P < 0.001). The loadings of thigh and foot segments on PC1 increased with speed (0.14 and 0.04 per BH/s, P < 0.001, respectively), and the loading of shank decreased (-0.10, P < 0.001). Compared to PC1, the changes in segment loadings on PC3 were the opposite (thigh -0.18, shank 0.09, foot -0.04 per BH/s, P < 0.001). The changes in segment loadings on PC2 were inconsistent and generally small. The only significance (P = 0.006), albeit a minor difference between men and women, was in the slope of thigh loading on PC2 (-0.005 ± 0.019 and 0.015 ± 0.026 per BH/s, respectively). We conclude that intersegmental coordination during gait scales with speed, with the greatest impact on the thigh segment, but no differently between men and women.
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Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA.
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
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304
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Castro MP, Figueiredo MC, Abreu S, Sousa H, Machado L, Santos R, Vilas-Boas JP. The influence of gait cadence on the ground reaction forces and plantar pressures during load carriage of young adults. Appl Ergon 2015; 49:41-46. [PMID: 25766421 DOI: 10.1016/j.apergo.2015.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 01/16/2015] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
Biomechanical gait parameters--ground reaction forces (GRFs) and plantar pressures--during load carriage of young adults were compared at a low gait cadence and a high gait cadence. Differences between load carriage and normal walking during both gait cadences were also assessed. A force plate and an in-shoe plantar pressure system were used to assess 60 adults while they were walking either normally (unloaded condition) or wearing a backpack (loaded condition) at low (70 steps per minute) and high gait cadences (120 steps per minute). GRF and plantar pressure peaks were scaled to body weight (or body weight plus backpack weight). With medium to high effect sizes we found greater anterior-posterior and vertical GRFs and greater plantar pressure peaks in the rearfoot, forefoot and hallux when the participants walked carrying a backpack at high gait cadences compared to walking at low gait cadences. Differences between loaded and unloaded conditions in both gait cadences were also observed.
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Affiliation(s)
- Marcelo P Castro
- Center of Research, Education, Innovation and Intervention in Sport, School of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; Activity and Human Movement Study Center/Department of Physiotherapy, School of Allied Health Science, Polytechnic Institute of Porto, Rua Valente Perfeito, 322, 4400-330 Vila Nova de Gaia, Portugal; Porto Biomechanics Laboratory, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal.
| | - Maria Cristina Figueiredo
- Faculty of Biotechnology, Portuguese Catholic University, Rua Diogo Botelho 1327, 4169-005 Porto, Portugal
| | - Sofia Abreu
- Center of Research, Education, Innovation and Intervention in Sport, School of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; Porto Biomechanics Laboratory, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Helena Sousa
- Center of Research, Education, Innovation and Intervention in Sport, School of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; Activity and Human Movement Study Center/Department of Physiotherapy, School of Allied Health Science, Polytechnic Institute of Porto, Rua Valente Perfeito, 322, 4400-330 Vila Nova de Gaia, Portugal
| | - Leandro Machado
- Center of Research, Education, Innovation and Intervention in Sport, School of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; Porto Biomechanics Laboratory, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
| | - Rubim Santos
- Activity and Human Movement Study Center/Department of Physiotherapy, School of Allied Health Science, Polytechnic Institute of Porto, Rua Valente Perfeito, 322, 4400-330 Vila Nova de Gaia, Portugal
| | - João Paulo Vilas-Boas
- Center of Research, Education, Innovation and Intervention in Sport, School of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal; Porto Biomechanics Laboratory, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal
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305
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Sánchez-Rodríguez D, Marco E, Miralles R, Guillén-Solà A, Vázquez-Ibar O, Escalada F, Muniesa JM. Does gait speed contribute to sarcopenia case-finding in a postacute rehabilitation setting? Arch Gerontol Geriatr 2015; 61:176-81. [PMID: 26051706 DOI: 10.1016/j.archger.2015.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 04/20/2015] [Accepted: 05/21/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The European Working Group of Sarcopenia in Older People (EWGSOP) has developed an algorithm based on gait speed measurement to begin sarcopenia case-finding in clinical practice, in which a cut-off point of <0.8m/s identifies risk for sarcopenia in community-dwelling older people. The objective of this study was to assess the application of the EWGSOP algorithm in hospitalised elderly patients with impaired functional capacity. METHODS One hundred in-patients (aged 84.1 SD 8.5, 62% women) were prospectively studied in a postacute care geriatric unit focused on rehabilitation. Sarcopenia was assessed by corporal composition (electrical bioimpedance), handgrip strength, and physical performance (gait speed). Other measurements were Charlson index, length of stay, and functional gain at discharge and 3-month follow-up. All patients were screened by the EWGSOP algorithm and sarcopenia was confirmed according to diagnostic criteria. RESULTS Gait speed was <0.8m/s in all cases and 58 patients had low muscle mass, which, according to the EWGSOP-algorithm, would indicate a diagnosis of sarcopenia. No differences were observed in functional capacity between these patients and those with normal muscle mass. When decreased handgrip strength was considered, 47 of these patients met the EWGSOP criteria for severe sarcopenia. In this group, differences in functional capacity were observed at discharge (Barthel 45.2 vs. 56.3, p=0.042) and 3-month follow-up (48.3 vs. 59.8, p=0.047). CONCLUSION The application of the EWGSOP algorithm in hospitalised, postacute, elderly patients with low gait speed suggested that muscle strength should be considered before confirming or discarding a sarcopenia diagnosis.
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Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum-Hospital del Mar), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d´Investigacions Mèdiques, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain.
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l´Esperança), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d´Investigacions Mèdiques, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain; School of Medicine, Universitat Internacional de Catalunya, Spain
| | - Ramón Miralles
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum-Hospital del Mar), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Anna Guillén-Solà
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l´Esperança), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Olga Vázquez-Ibar
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum-Hospital del Mar), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Ferrán Escalada
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l´Esperança), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d´Investigacions Mèdiques, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar, Hospital de l´Esperança), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d´Investigacions Mèdiques, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain
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306
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Godfrey A, Lara J, Del Din S, Hickey A, Munro CA, Wiuff C, Chowdhury SA, Mathers JC, Rochester L. iCap: Instrumented assessment of physical capability. Maturitas 2015; 82:116-22. [PMID: 25912425 PMCID: PMC4551273 DOI: 10.1016/j.maturitas.2015.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/03/2015] [Accepted: 04/05/2015] [Indexed: 11/05/2022]
Abstract
Instrumented testing of five physical capability tasks with a single accelerometer. Evaluated on a large cohort of older adults. iCap provides robust quantitative data about physical capability. iCap captures gait and postural control data known as sensitive to ageing/pathology. Methodology may have practical utility in a wide range of surveys and studies.
Objectives The aims of this study were to (i) investigate instrumented physical capability (iCap) as a valid method during a large study and (ii) determine whether iCap can provide important additional features of postural control and gait to categorise cohorts not previously possible with manual recordings. Study design Cross-sectional analysis involving instrumented testing on 74 adults who were recruited as part of a pilot intervention study; LiveWell. Participants wore a single accelerometer-based monitor (lower back) during standardised physical capability tests so that outcomes could be compared directly with manual recordings (stopwatch and measurement tape) made concurrently. Main outcome measures Time, distance, postural control and gait characteristics. Results Agreement between manual and iCap ranged from moderate to excellent (0.649–0.983) with mean differences between methods low and deemed acceptable. Additionally, iCap successfully quantified (i) postural control characteristics which showed sensitivity to distinguish between 5 variations of the standing balance test and (ii) 14 gait characteristics known to be sensitive to age/pathology. Conclusions Our findings show that iCap can provide robust quantitative data about physical capability during standardised tests while also providing sensitive (age/pathology) postural control and gait characteristics not previously quantifiable with manual recordings. The methodology which we propose may have practical utility in a wide range of clinical and public health surveys and studies, including intervention studies, where assessment could be undertaken within diverse settings. This will need to be tested in further validation studies in a wider range of settings.
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Affiliation(s)
- A Godfrey
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - J Lara
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - S Del Din
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - A Hickey
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - C A Munro
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - C Wiuff
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - S A Chowdhury
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - J C Mathers
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - L Rochester
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK.
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307
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Yu L, Zhang Q, Hu C, Huang Q, Ye M, Li D. Effects of different frequencies of rhythmic auditory cueing on the stride length, cadence, and gait speed in healthy young females. J Phys Ther Sci 2015; 27:485-7. [PMID: 25729197 PMCID: PMC4339167 DOI: 10.1589/jpts.27.485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to explore the effects of different frequencies of
rhythmic auditory cueing (RAC) on stride length, cadence, and gait speed in healthy young
females. The findings of this study might be used as clinical guidance of physical therapy
for choosing the suitable frequency of RAC. [Subjects] Thirteen healthy young females were
recruited in this study. [Methods] Ten meters walking tests were measured in all subjects
under 4 conditions with each repeated 3 times and a 3-min seated rest period between
repetitions. Subjects first walked as usual and then were asked to listen carefully to the
rhythm of a metronome and walk with 3 kinds of RAC (90%, 100%, and 110% of the mean
cadence). The three frequencies (90%, 100%, and 110%) of RAC were randomly assigned. Gait
speed, stride length, and cadence were calculated, and a statistical analysis was
performed using the SPSS (version 17.0) computer package. [Results] The gait speed and
cadence of 90% RAC walking showed significant decreases compared with normal walking and
100% and 110% RAC walking. The stride length, cadence, and gait speed of 110% RAC walking
showed significant increases compared with normal walking and 90% and 100% RAC walking.
[Conclusion] Our results showed that 110% RAC was the best of the 3 cueing frequencies for
improvement of stride length, cadence, and gait speed in healthy young females.
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Affiliation(s)
- Lili Yu
- Capital Medical University, School of Rehabilitation Medicine, China ; China Rehabilitation Research Center, Department of Physical Therapy, China
| | - Qi Zhang
- Capital Medical University, School of Rehabilitation Medicine, China ; China Rehabilitation Research Center, Department of Physical Therapy, China
| | - Chunying Hu
- Capital Medical University, School of Rehabilitation Medicine, China ; China Rehabilitation Research Center, Department of Physical Therapy, China
| | - Qiuchen Huang
- Capital Medical University, School of Rehabilitation Medicine, China ; China Rehabilitation Research Center, Department of Physical Therapy, China
| | - Miao Ye
- Capital Medical University, School of Rehabilitation Medicine, China ; China Rehabilitation Research Center, Department of Physical Therapy, China
| | - Desheng Li
- Capital Medical University, School of Rehabilitation Medicine, China ; China Rehabilitation Research Center, Department of Physical Therapy, China
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308
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Hurt CP, Burgess JK, Brown DA. Limb contribution to increased self-selected walking speeds during body weight support in individuals poststroke. Gait Posture 2015; 41:857-9. [PMID: 25770079 PMCID: PMC4408234 DOI: 10.1016/j.gaitpost.2015.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/07/2015] [Accepted: 02/15/2015] [Indexed: 02/02/2023]
Abstract
Individuals poststroke walk at faster self-selected speeds under some nominal level of body weight support (BWS) whereas nonimpaired individuals walk slower after adding BWS. The purpose of this study was to determine whether increases in self-selected overground walking speed under BWS conditions of individuals poststroke can be explained by changes in their paretic and nonparetic ground reaction forces (GRF). We hypothesize that increased self-selected walking speed, recorded at some nominal level of BWS, will relate to decreased braking GRFs by the paretic limb. We recruited 10 chronic (>12 months post-ictus, 57.5±9.6 y.o.) individuals poststroke and eleven nonimpaired participants (53.3±4.1 y.o.). Participants walked overground in a robotic device, the KineAssist Walking and Balance Training System that provided varying degrees of BWS (0-20% in 5% increments) while individuals self-selected their walking speed. Self-selected walking speed and braking and propulsive GRF impulses were quantified. Out of 10 poststroke individuals, 8 increased their walking speed 13% (p=0.004) under some level of BWS (5% n=2, 10% n=3, 20% n=3) whereas nonimpaired controls did not change speed (p=0.470). In individuals poststroke, changes to self-selected walking speed were correlated with changes in paretic propulsive impulses (r=0.68, p=0.003) and nonparetic braking impulses (r=-0.80, p=0.006), but were not correlated with decreased paretic braking impulses (r=0.50 p=0.14). This investigation demonstrates that when individuals poststroke are provided with BWS and allowed to self-select their overground walking speed, they are capable of achieving faster speeds by modulating braking impulses on the nonparetic limb and propulsive impulses of the paretic limb.
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Affiliation(s)
- Christopher P. Hurt
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jamie K. Burgess
- Department of Neuroscience, Northwestern University, Chicago, IL, USA
| | - David A. Brown
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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309
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Kwon JW, Son SM, Lee NK. Changes of kinematic parameters of lower extremities with gait speed: a 3D motion analysis study. J Phys Ther Sci 2015; 27:477-9. [PMID: 25729195 PMCID: PMC4339165 DOI: 10.1589/jpts.27.477] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/02/2014] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the changes in hip, knee and ankle kinematic variables of the lower extremities at different gait speeds. [Subjects and Methods] Forty healthy subjects who had no previous history of neurological, musculo-skeletal or other medical conditions that could affect gait were recruited. The subjects were asked to walk 10 m down a walkway at three different gait speeds: normal gait speed, and self-selected fast, and slow speeds. The experimental order was randomly chosen across these gaits. The hip, knee and ankle kinematic data were evaluated using a VICON 3D motion analysis system and force plates. [Results] The flexion peak and external rotation peak of the knee joint significantly increased with the increase of gait speed. The plantarflexion peaks of the ankle joint significantly increased with increase of gait speed. However, none of the kinematic data of the hip joint were significantly dependent on increase of gait speed. [Conclusion] The relationship of the knee and ankle joint can be described as coupling motion which is dependent on gait speed. Our present findings suggest that coupling motion of the knee joint and plantarflexion of the ankle joint significantly increase with increase of gait speed. These results will provide important insight into gait mechanisms for the evaluation of pathological populations.
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Affiliation(s)
- Jung Won Kwon
- Department of Physical Therapy, College of Rehabilitation
Science, Daegu University, Republic of Korea
| | - Sung Min Son
- Department of Physical Therapy, College of Health Science,
Cheongju University, Republic of Korea
| | - Na Kyung Lee
- Department of Physical Therapy, College of Rehabilitation
Science, Daegu University, Republic of Korea
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310
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Ojagbemi A, D'Este C, Verdes E, Chatterji S, Gureje O. Gait speed and cognitive decline over 2 years in the Ibadan study of aging. Gait Posture 2015; 41:736-40. [PMID: 25698351 PMCID: PMC4392394 DOI: 10.1016/j.gaitpost.2015.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 12/23/2014] [Accepted: 01/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The evidence suggesting that gait speed may represent a sensitive marker for cognitive decline in the elderly requires support from diverse racial groups. OBJECTIVE We investigated the relationship between gait speed and cognitive decline over 2 years in a community dwelling sample of elderly Africans. METHODS Data are from the Ibadan study of aging (ISA) conducted among a household multi-stage probability sample of 2149 Yoruba Nigerians aged 65 years or older. Gait speed was measured as the time taken to complete a 3 or 4m distance at normal walking speed. We assessed cognitive functions with a modified version of the 10-word learning list and delay recall test, and examined the relationship between baseline gait speed, as well as gait speed changes, and follow-up cognition using multiple linear regression and longitudinal analyses using random effects. RESULTS Approximately 71% of 1461 participants who were dementia free and who had their gait speed measured at baseline (2007) were successfully followed up in two waves (2008 and 2009). Along with increasing age, poor health and economic status, a slower baseline gait speed was independently associated with poorer follow-up cognition in both linear regression (1.2 words, 95% CI=0.48-2.0) and longitudinal analyses (0.8 words, 95% CI=0.44-1.2). Also, a greater change in gait speed between 2007 and 2009 was associated with the worst follow-up cognition (0.3 words, 95% CI=0.09-0.51). CONCLUSION The finding that a substantial change in gait speed was associated with reduced cognitive performance is of potential importance to efforts aimed at early identification of cognitive disorders in this population.
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Affiliation(s)
- Akin Ojagbemi
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B. 5017 (GPO), Ibadan, Nigeria
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Building 62 Mills Road, Canberra ACT 0200, Australia
| | - Emese Verdes
- Department of Health Statistics and Informatics at the World Health Organization (WHO), 20 Avenue Appia, Geneva 1207 CH-1211, Switzerland
| | - Somnath Chatterji
- Department of Health Statistics and Informatics at the World Health Organization (WHO), 20 Avenue Appia, Geneva 1207 CH-1211, Switzerland
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B. 5017 (GPO), Ibadan, Nigeria.
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311
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Chen MA. Frailty and cardiovascular disease: potential role of gait speed in surgical risk stratification in older adults. J Geriatr Cardiol 2015; 12:44-56. [PMID: 25678904 PMCID: PMC4308458 DOI: 10.11909/j.issn.1671-5411.2015.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 10/23/2014] [Accepted: 10/30/2014] [Indexed: 04/19/2023] Open
Abstract
Frailty is a state of late life decline and vulnerability, typified by physical weakness and decreased physiologic reserve. The epidemiology and pathophysiology of frailty share features with those of cardiovascular disease. Gait speed can be used as a measure of frailty and is a powerful predictor of mortality. Advancing age is a potent risk factor for cardiovascular disease and has been associated with an increased risk of adverse outcomes. Older adults comprise approximately half of cardiac surgery patients, and account for nearly 80% of the major complications and deaths following surgery. The ability of traditional risk models to predict mortality and major morbidity in older patients being considered for cardiac surgery may improve if frailty, as measured by gait speed, is included in their assessment. It is possible that in the future frailty assessment may assist in choosing among therapies (e.g., surgical vs. percutaneous aortic valve replacement for patients with aortic stenosis).
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Affiliation(s)
- Michael A Chen
- Harborview Medical Center, University of Washington School of Medicine, 325 9th Avenue, Box 359748, Seattle, WA 98104, USA
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312
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Sustakoski A, Perera S, VanSwearingen JM, Studenski SA, Brach JS. The impact of testing protocol on recorded gait speed. Gait Posture 2015; 41:329-31. [PMID: 25468684 PMCID: PMC4271538 DOI: 10.1016/j.gaitpost.2014.10.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 10/14/2014] [Accepted: 10/19/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait speed predicts disability, cognitive decline, hospitalization, nursing home admission and mortality. Although gait speed is often measured in clinical practice and research, testing protocols vary widely and their impact on recorded gait speed has yet to be explored. OBJECTIVES Our purpose is to describe and compare gait speeds obtained from different testing protocols in the same individuals. DESIGN Cross-sectional. SETTING University research setting. Participants Subjects were 104 community-dwelling older adults who could ambulate household distances independently (mean age = 77.2 ± 6.1). MEASUREMENTS Gait speed was recorded over 4m using the protocols: (1) standing start, usual pace over ground, (2) walking start, usual pace over ground with an optokinetic device, (3) walking start, usual pace over ground with a stop watch (4) walking start, usual pace on a computerized walkway, and (5) walking start, fast pace on a computerized walkway. A linear mixed model and pairwise comparisons was used to compare gait speeds within individuals across different protocols. RESULTS Mean ± SD gait speed for each condition was: standing start, usual pace over ground 0.97 ± 0.23 m/s; walking start, usual pace over ground 1.14 ± 0.2 5m/s; walking start, usual pace on walkway 1.01 ± 0.26 m/s; and walking start, fast pace on walkway 1.31 ± 0.34 m/s. On average, the determined gait speed was 0.17 m/s faster during the walking compared to the standing start (p < .001), 0.07 m/s slower on the computerized walkway compared to over ground (p < .001), and 0.25 m/s faster during the fast pace compared to the usual pace walk (p < .001). CONCLUSION Starting protocol (standing vs. walking), testing surface (over ground vs. computerized walkway), and walking pace (usual vs. fast) impact recorded gait speed in older adults. Care should be taken when comparing gait speeds from studies with different testing protocols.
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Affiliation(s)
- Ashley Sustakoski
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Stephanie A Studenski
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
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Doi T, Shimada H, Makizako H, Tsutsumimoto K, Hotta R, Nakakubo S, Suzuki T. Association of insulin-like growth factor-1 with mild cognitive impairment and slow gait speed. Neurobiol Aging 2014; 36:942-7. [PMID: 25467636 DOI: 10.1016/j.neurobiolaging.2014.10.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/15/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
The decrease in serum insulin-like growth factor-1 (IGF-I) with aging is related to the neurobiological processes in Alzheimer's disease. IGF-1 mediates effects of physical exercise on the brain, and cognition has a common pathophysiology with physical function, particularly with gait. The aim of this study was to examine whether mild cognitive impairment (MCI) and slow gait are associated with the serum IGF-1 level. A population survey was conducted in 3355 participants (mean age, 71.4 years). Cognitive functions (attention, executive function, processing speed, visuospatial skill, and memory), gait speed, and demographic variables were measured. All cognitive functions and gait speed were associated with the IGF-1 level (p < 0.001). The association of IGF-1 with slow gait was weakened by adjustment for covariates, but MCI and the combination of MCI and slow gait were independently related to the IGF-1 level in multivariate analysis (p < 0.05). Our findings support the association of a low IGF-1 level with reduced cognitive function and gait speed, particularly with a combination of MCI and slow gait.
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Affiliation(s)
- Takehiko Doi
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Hiroyuki Shimada
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hyuma Makizako
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Kota Tsutsumimoto
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Ryo Hotta
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Sho Nakakubo
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takao Suzuki
- Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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314
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Weidung B, Boström G, Toots A, Nordström P, Carlberg B, Gustafson Y, Littbrand H. Blood pressure, gait speed, and mortality in very old individuals: a population-based cohort study. J Am Med Dir Assoc 2015; 16:208-14. [PMID: 25441098 DOI: 10.1016/j.jamda.2014.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/04/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Clinical trials and observational studies have produced contradictory results regarding the association of blood pressure (BP) and mortality in people aged 80 years or older. Gait speed at usual pace has been shown to moderate this association in a population of noninstitutionalized people aged 65 years or older. The aims of this study were to investigate the association of BP with all-cause mortality in a representative sample of people aged 85 years or older and to assess whether gait speed moderates this association. DESIGN, SETTING, AND PARTICIPANTS A total of 806 participants in the population-based prospective Umeå 85+/GERDA study aged 85, 90, and 95 years or older. MEASUREMENTS Gait speed at usual pace was measured over 2.4 m. The main outcome was hazard ratios (HRs) for all-cause mortality according to systolic and diastolic BP categories in the total sample and in faster-walking (≥0.5 m/s, n = 312) and slower-walking (<0.5 m/s, n = 433) subcohorts; the latter also included habitually nonwalking participants. Comprehensive adjustments were made for sociodemographic and clinical characteristics associated with death. RESULTS Mean age and baseline systolic and diastolic BP were 89.6 ± 4.6 years, 146.8 ± 23.9 mm Hg, and 74.8 ± 11.1 mm Hg, respectively. Most (n = 561 [69%]) participants were women, 315 (39%) were care facility residents, and 566 (70%) were prescribed BP-lowering drugs. Within 5 years, 490 (61%) participants died. In the total sample and slower-walking subcohort, systolic BP appeared to be inversely associated with mortality, although not independent of adjustments. Among faster-walking participants, mortality risk after adjustment was more than 2 times higher in those with systolic BP of 140 to 149 mm Hg (HR = 2.25, 95% confidence interval [CI] = 1.03-4.94) and 165 mm Hg or higher (HR = 2.13, 95% CI = 1.01-4.49), compared with systolic BP of 126 to 139 mm Hg. Mortality risk was also independently higher in faster-walking participants with diastolic BP higher than 80 mm Hg, compared with diastolic BP of 75 to 80 mm Hg (HR = 1.76, 95% CI = 1.07-2.90). CONCLUSION The gait speed threshold of 0.5 m/s may be clinically useful for the distinction of very old people with and without increased all-cause mortality risk due to elevated systolic and diastolic BP.
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315
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Richardson CA, Glynn NW, Ferrucci LG, Mackey DC. Walking energetics, fatigability, and fatigue in older adults: the study of energy and aging pilot. J Gerontol A Biol Sci Med Sci 2014; 70:487-94. [PMID: 25190069 DOI: 10.1093/gerona/glu146] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Slow gait speed increases morbidity and mortality in older adults. We examined how preferred gait speed is associated with energetic requirements of walking, fatigability, and fatigue. METHODS Older adults (n = 36, 70-89 years) were categorized as slow or fast walkers based on median 400-m gait speed. We measured VO2peak by graded treadmill exercise test and VO2 during 5-minute treadmill walking tests at standard (0.72 m/s) and preferred gait speeds. Fatigability was assessed with the Situational Fatigue Scale and the Borg rating of perceived exertion at the end of walking tests. Fatigue was assessed by questionnaire. RESULTS Preferred gait speed over 400 m (range: 0.75-1.58 m/s) averaged 1.34 m/s for fast walkers versus 1.05 m/s for slow walkers (p < .001). VO2peak was 26% lower (18.5 vs 25.1ml/kg/min, p = .001) in slow walkers than fast walkers. To walk at 0.72 m/s, slow walkers used a larger percentage of VO2peak (59% vs 42%, p < .001). To walk at preferred gait speed, slow walkers used more energy per unit distance (0.211 vs 0.186ml/kg/m, p = .047). Slow walkers reported higher rating of perceived exertion during walking and greater overall fatigability on the Situational Fatigue Scale, but no differences in fatigue. CONCLUSIONS Slow walking was associated with reduced aerobic capacity, greater energetic cost of walking, and greater fatigability. Interventions to improve aerobic capacity or decrease energetic cost of walking may prevent slowing of gait speed and promote mobility in older adults.
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Affiliation(s)
- Catherine A Richardson
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Luigi G Ferrucci
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute
| | - Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada. California Pacific Medical Center, San Francisco.
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316
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Montero-Odasso M, Oteng-Amoako A, Speechley M, Gopaul K, Beauchet O, Annweiler C, Muir-Hunter SW. The motor signature of mild cognitive impairment: results from the gait and brain study. J Gerontol A Biol Sci Med Sci 2014; 69:1415-21. [PMID: 25182601 PMCID: PMC4197903 DOI: 10.1093/gerona/glu155] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early motor changes associated with aging predict cognitive decline, which suggests that a "motor signature" can be detected in predementia states. In line with previous research, we aim to demonstrate that individuals with mild cognitive impairment (MCI) have a distinct motor signature, and specifically, that dual-task gait can be a tool to distinguish amnestic (a-MCI) from nonamnestic MCI. METHODS Older adults with MCI and controls from the "Gait and Brain Study" were assessed with neurocognitive tests to assess cognitive performance and with an electronic gait mat to record temporal and spatial gait parameters. Mean gait velocity and stride time variability were evaluated under simple and three separate dual-task conditions. The relationship between cognitive groups (a-MCI vs nonamnestic MCI) and gait parameters was evaluated with linear regression models and adjusted for confounders. RESULTS Ninety-nine older participants, 64 MCI (mean age 76.3±7.1 years; 50% female), and 35 controls (mean age 70.4±3.9 years; 82.9% female) were included. Forty-two participants were a-MCI and 22 were nonamnestic MCI. Multivariable linear regression (adjusted for age, sex, physical activity level, comorbidities, and executive function) showed that a-MCI was significantly associated with slower gait and higher dual-task cost under dual-task conditions. CONCLUSION Participants with a-MCI, specifically with episodic memory impairment, had poor gait performance, particularly under dual tasking. Our findings suggest that dual-task assessment can help to differentiate MCI subtyping, revealing a motor signature in MCI.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute, Schulich School of Medicine and Dentistry, Department of Medicine and Division of Geriatric Medicine and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada.
| | - Afua Oteng-Amoako
- Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute
| | - Mark Speechley
- Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute, Schulich School of Medicine and Dentistry, Department of Medicine and Division of Geriatric Medicine and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Karen Gopaul
- Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute
| | - Olivier Beauchet
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France
| | - Cedric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France
| | - Susan W Muir-Hunter
- Gait and Brain Lab, Parkwood Hospital, Lawson Health Research Institute, Schulich School of Medicine and Dentistry, Department of Medicine and Division of Geriatric Medicine and
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317
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Abe T, Thiebaud RS, Loenneke JP, Ogawa M, Mitsukawa N. Association between forearm muscle thickness and age-related loss of skeletal muscle mass, handgrip and knee extension strength and walking performance in old men and women: a pilot study. Ultrasound Med Biol 2014; 40:2069-75. [PMID: 25023107 DOI: 10.1016/j.ultrasmedbio.2014.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/02/2014] [Accepted: 05/09/2014] [Indexed: 05/08/2023]
Abstract
Very little information is available concerning the relationship between handgrip strength and muscle size in the upper and lower extremities, especially the forearm muscle itself. To investigate the relationships among ultrasound-measured forearm muscle thickness from the radius and ulna bone interface with handgrip strength, knee extension strength, walking speed and absolute/relative total skeletal muscle mass (TMM), 32 Japanese men and 21 Japanese women ages 70-83 years had muscle thickness (MT) measured by ultrasound. In the forearm, two MTs (forearm-radius and forearm-ulna MT) were measured. TMM was estimated from an ultrasound-derived prediction equation. Handgrip-strength was significantly correlated with forearm-ulna MT in both men and women. There were no significant correlations between forearm MT and walking speed in either sex. In men, both forearm-radius and forearm-ulna MT were significantly correlated with TMM and TMM index. In women, a significant correlation was only observed between forearm-ulna MT and TMM index. Our results suggest that forearm-ulna MT may be a useful parameter for evaluating handgrip strength and TMM index in older Japanese men and women.
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Affiliation(s)
- Takashi Abe
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN; Active Aging Research Center, Toyo Gakuen University, Nagareyama, Chiba, Japan.
| | - Robert S Thiebaud
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Jeremy P Loenneke
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK
| | - Madoka Ogawa
- Active Aging Research Center, Toyo Gakuen University, Nagareyama, Chiba, Japan
| | - Naotoshi Mitsukawa
- Active Aging Research Center, Toyo Gakuen University, Nagareyama, Chiba, Japan
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318
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Fragala MS, Dam TTL, Barber V, Judge JO, Studenski SA, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Kiel DP, Kritchevsky SB, Shardell MD, Vassileva MT, Kenny AM. Strength and function response to clinical interventions of older women categorized by weakness and low lean mass using classifications from the Foundation for the National Institute of Health sarcopenia project. J Gerontol A Biol Sci Med Sci 2014; 70:202-9. [PMID: 25135999 DOI: 10.1093/gerona/glu110] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Foundation for the National Institutes of Health Sarcopenia Project developed data-driven cut-points for clinically meaningful weakness and low lean body mass. This analysis describes strength and function response to interventions based on these classifications. METHODS In data from four intervention studies, 378 postmenopausal women with baseline and 6-month data were evaluated for change in grip strength, appendicular lean mass corrected for body mass index, leg strength and power, and short physical performance battery (SPPB). Clinical interventions included hormones, exercise, and nutritional supplementation. Differences in outcomes were evaluated between (i) those with and without weakness and (ii) those with weakness and low lean mass or with one but not the other. We stratified analyses by slowness (walking speed ≤ 0.8 m/s) and by treatment assignment. RESULTS The women (72±7 years; body mass index of 26±5kg/m(2)) were weak (33%), had low lean mass (14%), or both (6%). Those with weakness increased grip strength, lost less leg power, and gained SPPB score (p < .05) compared with nonweak participants. Stratified analyses were similar for grip strength and SPPB. With lean mass in the analysis, individuals with weakness had larger gains in grip strength and SPPB scores regardless of low lean mass (p < .01). CONCLUSIONS Older women with clinically meaningful muscle weakness increased grip strength and SPPB, regardless of the presence of low lean mass following treatment with interventions for frailty. Thus, results suggest that muscle weakness, as defined by the Foundation for the National Institutes of Health Sarcopenia Project, appears to be a treatable symptom.
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Affiliation(s)
| | - Thuy-Tien L Dam
- Columbia University College of Physicians and Surgeons, New York
| | | | | | | | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco
| | - Robert R McLean
- Hebrew Senior Life Institute for Aging Research, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | - Tamara B Harris
- National Institute of Aging, National Institutes of Health, Bethesda, Maryland
| | - Luigi Ferrucci
- National Institute of Aging, National Institutes of Health, Bethesda, Maryland
| | | | - Douglas P Kiel
- Hebrew Senior Life Institute for Aging Research, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | | | | | - Maria T Vassileva
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Anne M Kenny
- University of Connecticut Health Center, Farmington.
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319
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Kutner NG, Zhang R, Huang Y, Wasse H. Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data. World J Nephrol 2014; 3:101-106. [PMID: 25332901 PMCID: PMC4202486 DOI: 10.5527/wjn.v3.i3.101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/17/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the association of measured gait speed with hemodialysis (HD) patients’ hospitalization, in conjunction with, and apart from, recent fall history.
METHODS: Gait speed was measured by a standard protocol and falls during the past 12 mo were ascertained for a prevalent multi-center HD cohort (n = 668) aged 20-92. Hospitalization during the past 12 mo was identified in the patient’s clinic records, and the first hospitalization after gait speed assessment (or the competing event of death) was identified in the 2013 United States Renal Data System Standard Analysis Files.
RESULTS: Slow gait speed, defined as < 0.8 m/s, characterized 34.7% of the patients, and 27.1% had experienced a recent fall. Patients with slow gait speed but without a history of recent falls were 1.79 times more likely to have been hospitalized during the past 12 mo (OR = 1.79, 95%CI: 1.11-2.88, P = 0.02), and patients with slow gait speed and a history of recent falls were over two times more likely to have been hospitalized (OR = 2.10, 95%CI: 1.19-3.73, P = 0.01), compared with patients having faster gait speed and no recent fall history. Prospective examination of gait speed/fall history status in relation to first hospitalization (or death) incurred by the end of follow-up December 31, 2011 also showed that slow gait speed was associated with these events in conjunction with a history of falls (HR = 1.54, 95%CI: 1.04-2.30, P = 0.03).
CONCLUSION: The International Task Force on Nutrition and Aging reported that gait speed is a powerful predictor for older adults of adverse outcomes such as hospitalization. In our data, gait speed--apart from, as well as in conjunction with, recent fall history--was associated with HD patients’ hospitalization for multiple causes. Gait speed may be a sensitive health indicator among HD patients across the age spectrum.
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320
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Díaz Villegas GM, Runzer Colmenares F. [Calf circumference and its association with gait speed in elderly participants at Peruvian Naval Medical Center]. Rev Esp Geriatr Gerontol 2014; 50:22-5. [PMID: 25081307 DOI: 10.1016/j.regg.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the association between calf circumference and gait speed in elderly patients 65 years or older at Geriatric day clinic at Peruvian Centro Médico Naval. MATERIAL AND METHODS Cross-sectional, retrospective study. We assessed 139 participants, 65 years or older at Peruvian Centro Médico Naval including calf circumference, gait speed and Short Physical Performance Battery. With bivariate analyses and logistic regression model we search for association between variables. RESULTS The age mean was 79.37 years old (SD: 8.71). 59.71% were male, the 30.97% had a slow walking speed and the mean calf circumference was 33.42cm (SD: 5.61). After a bivariate analysis, we found a calf circumference mean of 30.35cm (SD: 3.74) in the slow speed group and, in normal gait group, a mean of 33.51cm (SD: 3.26) with significantly differences. We used logistic regression to analyze association with slow gait speed, founding statistically significant results adjusting model by disability and age. CONCLUSION Low calf circumference is associated with slow speed walk in population over 65 years old.
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Affiliation(s)
| | - Fernando Runzer Colmenares
- Servicio de Geriatría, Centro Médico Naval, Centro de Investigación del Envejecimiento (CIEN), Facultad de Medicina Humana, Universidad de San Martin de Porres, Lima, Perú
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321
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Menant JC, Schoene D, Sarofim M, Lord SR. Single and dual task tests of gait speed are equivalent in the prediction of falls in older people: a systematic review and meta-analysis. Ageing Res Rev 2014; 16:83-104. [PMID: 24915643 DOI: 10.1016/j.arr.2014.06.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/19/2022]
Abstract
Although simple assessments of gait speed have been shown to predict falls as well as hospitalisation, functional decline and mortality in older people, dual task gait speed paradigms have been increasingly evaluated with respect to fall prediction. Some studies have found that dual task walking paradigms can predict falls in older people. A systematic review and meta-analysis was conducted to determine whether dual task walking paradigms involving a secondary cognitive task have greater ability to predict falls than single walking tasks. The meta-analytic findings indicate single and dual task tests of gait speed are equivalent in the prediction of falls in older people and sub-group analyses revealed similar findings for studies that included only cognitively impaired participants, slow walkers or used secondary mental-tracking or verbal fluency tasks.
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Affiliation(s)
- Jasmine C Menant
- Falls and Balance Research Group, Neuroscience Research Australia, P.O. Box 1165, Randwick, NSW 2031, Australia; School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney 2052, Australia
| | - Daniel Schoene
- Falls and Balance Research Group, Neuroscience Research Australia, P.O. Box 1165, Randwick, NSW 2031, Australia; School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney 2052, Australia
| | - Mina Sarofim
- School of Medicine, University of New South Wales (UNSW), Sydney 2052, Australia
| | - Stephen R Lord
- Falls and Balance Research Group, Neuroscience Research Australia, P.O. Box 1165, Randwick, NSW 2031, Australia; School of Public Health and Community Medicine, University of New South Wales (UNSW), Sydney 2052, Australia.
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322
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Bolandzadeh N, Liu-Ambrose T, Aizenstein H, Harris T, Launer L, Yaffe K, Kritchevsky SB, Newman A, Rosano C. Pathways linking regional hyperintensities in the brain and slower gait. Neuroimage 2014; 99:7-13. [PMID: 24841418 DOI: 10.1016/j.neuroimage.2014.05.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/28/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022] Open
Abstract
IMPORTANCE Cerebral white matter hyperintensities (WMHs) are involved in the evolution of impaired mobility and executive functions. Executive functions and mobility are also associated. Thus, WMHs may impair mobility directly, by disrupting mobility-related circuits, or indirectly, by disrupting circuits responsible for executive functions. Understanding the mechanisms underlying impaired mobility in late life will increase our capacity to develop effective interventions. OBJECTIVE To identify regional WMHs most related to slower gait and to examine whether these regional WMHs directly impact mobility, or indirectly by executive functions. DESIGN Cross-sectional study. Twenty-one WMH variables (i.e., total WMH volume and WMHs in 20 tracts), gait speed, global cognition (Modified Mini-Mental State Examination; 3MS), and executive functions and processing speed (Digit-Symbol Substitution Test; DSST) were assessed. An L1-L2 regularized regression (i.e., Elastic Net model) identified the WMH variables most related to slower gait. Multivariable linear regression models quantified the association between these WMH variables and gait speed. Formal tests of mediation were also conducted. SETTING Community-based sample. PARTICIPANTS Two hundred fifty-three adults (mean age: 83years, 58% women, 41% black). MAIN OUTCOME MEASURE Gait speed. RESULTS In older adults with an average gait speed of 0.91m/sec, total WMH volume, WMHs located in the right anterior thalamic radiation (ATRR) and frontal corpuscallosum (CCF) were most associated with slower gait. There was a >10% slower gait for each standard deviation of WMH in CCF, ATRR or total brain (standardized beta in m/sec [p value]: -0.11 [p=0.046], -0.15 [p=0.007] and -0.14 [p=0.010], respectively). These associations were substantially and significantly attenuated after adjustment for DSST. This effect was stronger for WMH in CCF than for ATRR or total WMH (standardized beta in m/sec [p value]: -0.07 [p=0.190], -0.12 [p=0.024] and -0.10 [p=0.049], respectively). Adjustment for 3MS did not change these associations. The mediation analyses also found that DSST significantly mediated the associations between WMHs and gait speed. Our models were adjusted for age, sex, BMI, quadriceps strength, years of education, standing height, and prevalent hypertension. CONCLUSION The impact, direct or indirect, of WMHs on gait speed depended on their location and was mediated by executive function. Thus, multi-faceted interventions targeting executive control functions as well as motor functions, such as balance and strength training, are candidates to the maintenance of mobility across the lifespan.
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Affiliation(s)
- Niousha Bolandzadeh
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Brain Research Centre, University of British Columbia, Vancouver, BC, Canada; Experimental Medicine Graduate Program, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Brain Research Centre, University of British Columbia, Vancouver, BC, Canada
| | - Howard Aizenstein
- Geriatric Psychiatry Neuroimaging Laboratory, Faculty of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD, USA
| | - Lenore Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, MD, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Anne Newman
- Center for Aging and Population Health, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Center for Aging and Population Health, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
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Krampe J, Wagner JM, Hawthorne K, Sanazaro D, Wong-Anuchit C, Budhathoki C, Lorenz RA, Raaf S. Does dance-based therapy increase gait speed in older adults with chronic lower extremity pain: a feasibility study. Geriatr Nurs 2014; 35:339-44. [PMID: 24795258 DOI: 10.1016/j.gerinurse.2014.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 03/27/2014] [Accepted: 03/31/2014] [Indexed: 11/23/2022]
Abstract
A decreased gait speed in older adults can lead to dependency when the individuals are no longer able to participate in activities or do things for themselves. Thirty-seven senior apartment residents (31 females; Mean age=80.6 years; SD=8.9) with lower extremity pain/stiffness participated in a feasibility and preliminary efficacy study of 12 weeks (24 sessions). Healthy-Steps dance therapy compared to a wait-list control group. Small improvements in gait speed ([ES]=0.33) were noted for participants completing 19-24 dance sessions. Improvements in gait speed measured by a 10 Meter Walk Test (0.0517 m/s) exceeded 0.05 m/s, a value deemed to be meaningful in community dwelling older adults. These feasibility study findings support the need for additional research using dance-based therapy for older adults with lower extremity pain.
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324
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Niederer D, Schmidt K, Vogt L, Egen J, Klingler J, Hübscher M, Thiel C, Bernhörster M, Banzer W. Functional capacity and fear of falling in cancer patients undergoing chemotherapy. Gait Posture 2014; 39:865-9. [PMID: 24360638 DOI: 10.1016/j.gaitpost.2013.11.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 08/23/2013] [Accepted: 11/25/2013] [Indexed: 02/02/2023]
Abstract
Cancer patients, particularly during chemotherapy, often encounter functional status limitations. This study examines fear of falling, balance, gait and lower limb strength in cancer patients during ongoing or recently completed (≤12 months) chemotherapeutic treatment in comparison to age-matched and senior controls (≥65 years). Data were obtained from 69 subjects; 21 cancer patients (51±7 years) with histological confirmed diagnosis and two control groups (2×n=24): one age-matched (53±7 years) and one senior group (70±3 years). Fear of falling (FoF) was evaluated using the Falls Efficacy Scale-International Version. Motor function measurement included postural sway (centre of pressure) in upright stance with eyes covered, gait speed (comfortable fluid walking) and maximum voluntary isometric quadriceps strength (MIVF). One-way ANOVA followed by corrected post hoc paired-sample t-test revealed inferior values in cancer patients than in age-matched healthy regarding all parameters. Gait speed and MIVF of cancer patients were higher than in the senior control group (p<.05), whereas their FoF and postural sway were comparable (p>.05). Physical performance parameters of cancer patients were found to be lower in comparison to healthy age-matched subjects. Cancer patients show physical impairments which may limit independence and may increase fall risk. The present findings call for routine screening of physical function in cancer patients, and further stress the relevance of exercise interventions during and after chemotherapy.
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Affiliation(s)
- Daniel Niederer
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Katharina Schmidt
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Lutz Vogt
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Janis Egen
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Julia Klingler
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Markus Hübscher
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany; Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, Sydney, NSW 2141, Australia.
| | - Christian Thiel
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Marcus Bernhörster
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
| | - Winfried Banzer
- Department of Sports Medicine, Goethe-University Frankfurt/Main, Ginnheimer Landstraße 39, D-60487 Frankfurt am Main, Germany.
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325
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Frykberg GE, Johansson GM, Schelin L, Häger CK. The Arm Posture Score for assessing arm swing during gait: an evaluation of adding rotational components and the effect of different gait speeds. Gait Posture 2014; 40:64-9. [PMID: 24647039 DOI: 10.1016/j.gaitpost.2014.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 02/05/2014] [Accepted: 02/13/2014] [Indexed: 02/02/2023]
Abstract
In 3D gait analysis, quantification of leg movements is well established, whereas a measure of arm swing has been lacking. Recently, the Arm Posture Score (APS) was introduced to characterize arm movements in children with cerebral palsy, including information from four variables (APS4) in the sagittal and frontal planes. A potential limitation of the APS is that it does not include rotational movements and has not yet been evaluated with regard to gait speed. The aims of this study were (i) to investigate the effect on APS of adding two components of arm rotation (APS6) and (ii) to determine the influence of gait speed on the APS measures, when applied to non-disabled adults. Forty-two subjects walked 10 m at a self-selected speed (1.34 m/s), and in addition a subgroup of 28 subjects walked at a slow speed (0.66 m/s) set by a metronome. Data were collected from markers in a whole-body set up and by eight optoelectronic cameras. The results demonstrated significantly higher APS6 than APS4 values for both arms, irrespective of gait speed. Speed condition, whether self-selected or slow, had a significant effect on both APS measures. The two additional arm components are suggested to provide relevant information about arm swing during walking. However, APS6 needs to be implemented in gait analysis of individuals with gait arm pathologies in order to further examine its utility. We recommend that gait speed should to be taken into account when using APS measures to quantify arm swing during gait.
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326
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Kuys SS, Peel NM, Klein K, Slater A, Hubbard RE. Gait speed in ambulant older people in long term care: a systematic review and meta-analysis. J Am Med Dir Assoc 2013; 15:194-200. [PMID: 24388775 DOI: 10.1016/j.jamda.2013.10.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gait speed, recently proposed as the sixth vital sign of geriatric assessment, is a strong predictor of adverse outcomes. Walking faster than 1.0 m/s is associated with better survival in community-dwelling older adults, and a recent meta-analysis of older adults in clinical settings estimated usual gait speed to be 0.58 m/s. Here, we aimed to review gait speed values for long term care residents. METHODS Relevant databases were systematically searched for original research studies published prior to December 2012. Inclusion criteria were participants living in long term care, mean age >70 years, and gait speed measured over a short distance. Meta-analysis determined gait speed data adjusting for covariates including age, sex, and cognition. RESULTS Final data included 2888 participants from 34 studies. The percentage of residents ineligible because of inability to mobilize was stated in only 1 study. Of the 34 studies, 22 reported cognitive status using the Mini-Mental State Examination. Usual pace and maximal pace gait speeds were determined separately using a random effects model. No association between gait speed and covariates was found. Usual pace gait speed was 0.475 m/s (95% confidence interval 0.396-0.554) and maximal pace was 0.672 m/s (95% confidence interval 0.532-0.811). CONCLUSIONS In ambulant older people in long term care, gait speed is slow but remains functional. However, since many residents are likely to have been ineligible to participate in assessments, these results cannot be generalized to the long term care population as a whole.
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Affiliation(s)
- Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Health Service District, Queensland Health, Queensland, Australia; School of Rehabilitation Science, Griffith Health Institute, Griffith University, Australia.
| | - Nancye M Peel
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Queensland, Australia
| | - Kerenaftali Klein
- Queensland Clinical Trials & Biostatistics, School of Population Health, The University of Queensland, Queensland, Australia
| | - Alexandra Slater
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Queensland, Australia
| | - Ruth E Hubbard
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Queensland, Australia
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327
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Barthuly AM, Bohannon RW, Gorack W. Limitations in gait speed persist at discharge from subacute rehabilitation. J Phys Ther Sci 2013; 25:891-3. [PMID: 24259878 PMCID: PMC3820404 DOI: 10.1589/jpts.25.891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/19/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Walking speed is related to important outcomes such as mortality and is
fundamental to independent and safe ambulation in the community. The objectives of this
study were to determine if the discharge gait speed of patients completing subacute
rehabilitation was slow relative to normative and street crossing reference values, and
whether such speed was associated with age, gender, or diagnosis. [Subjects and Methods]
Consecutive patients admitted to a subacute rehabilitation facility were screened based on
inclusion and exclusion criteria. Participants were 109 patients (56 women) 60 to 98
(mean=78.2) years old who were divided into 10 diagnostic categories. Gait speed was
measured over a distance of 5.2 meters as patients walked at their most comfortable speed
beyond a designated finish line. Timing with a digital stopwatch began after an
acceleration distance of 1 meter and ceased as patients crossed the finish line. [Results]
The patients' comfortable gait speed (mean=0.58; SD=0.19; range=0.09–1.10 m/s) was
significantly less than 1.0m/s (normal reference value) (1.11±0.15 m/s) but significantly
greater than that required for crossing the street (0.49 m/s). Nevertheless, 27.5% of
patients did not achieve a walking speed of 0.49 m/s. Speed was inversely related to age
and was lower among women, but it was not affected by diagnostic category. [Conclusion]
Gait speed remains limited when patients are discharged home from subacute rehabilitation
and was slowest among older women patients. Further therapy may be warranted for such
patients after discharge.
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328
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Bohannon RW, Andrews AW, Glenney SS. Minimal clinically important difference for comfortable speed as a measure of gait performance in patients undergoing inpatient rehabilitation after stroke. J Phys Ther Sci 2013; 25:1223-5. [PMID: 24259762 PMCID: PMC3820183 DOI: 10.1589/jpts.25.1223] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/10/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this retrospective study was to determine the minimal
clinically important difference for comfortable gait speed for patients with stroke.
[Subjects] Data were analyzed from 35 patients undergoing inpatient rehabilitation.
[Methods] Two characteristics of gait were measured, assistance required and comfortable
gait speed. Patients were grouped as either experiencing or not experiencing a decrease of
2 or more levels of assistance required over the course of rehabilitation. Receiver
operating characteristic curve analysis was used to identify the change in gait speed that
best differentiated between patients who did and did not experience the requisite decrease
in assistance required for gait. [Results] Twenty-one patients decreased 2 or more levels
of assistance whereas 14 did not. Walking speed increased significantly more in the group
who experienced a decrease in assistance of at least 2 levels. The receiver operating
characteristic curve analysis showed a change in walking speed of 0.13 m/s best
distinguished between patients who did versus did not experience a reduction in assistance
required. [Conclusion] An improvement in gait speed of 0.13 m/s or more is clinically
important in patients with stroke.
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Affiliation(s)
- Richard W Bohannon
- Physical Therapy Program, Department of Kinesiology, Neag School of Education, University of Connecticut, USA
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329
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Caderby T, Yiou E, Peyrot N, Begon M, Dalleau G. Influence of gait speed on the control of mediolateral dynamic stability during gait initiation. J Biomech 2013; 47:417-23. [PMID: 24290175 DOI: 10.1016/j.jbiomech.2013.11.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 11/04/2013] [Accepted: 11/06/2013] [Indexed: 02/07/2023]
Abstract
This study investigated the influence of gait speed on the control of mediolateral dynamic stability during gait initiation. Thirteen healthy young adults initiated gait at three self-selected speeds: Slow, Normal and Fast. The results indicated that the duration of anticipatory postural adjustments (APA) decreased from Slow to Fast, i.e. the time allocated to propel the centre of mass (COM) towards the stance-leg side was shortened. Likely as an attempt at compensation, the peak of the anticipatory centre of pressure (COP) shift increased. However, COP compensation was not fully efficient since the results indicated that the mediolateral COM shift towards the stance-leg side at swing foot-off decreased with gait speed. Consequently, the COM shift towards the swing-leg side at swing heel-contact increased from Slow to Fast, indicating that the mediolateral COM fall during step execution increased as gait speed rose. However, this increased COM fall was compensated by greater step width so that the margin of stability (the distance between the base-of-support boundary and the mediolateral component of the "extrapolated centre of mass") at heel-contact remained unchanged across the speed conditions. Furthermore, a positive correlation between the mediolateral extrapolated COM position at heel-contact and step width was found, indicating that the greater the mediolateral COM fall, the greater the step width. Globally, these results suggest that mediolateral APA and step width are modulated with gait speed so as to maintain equivalent mediolateral dynamical stability at the time of swing heel-contact.
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Affiliation(s)
- Teddy Caderby
- Laboratoire DIMPS-CURAPS, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion.
| | - Eric Yiou
- Laboratoire CIAMS, Team RIME, UFR STAPS, Université Paris-Sud, 91440 Orsay Cedex, France
| | - Nicolas Peyrot
- Laboratoire DIMPS-CURAPS, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion
| | - Mickaël Begon
- Laboratoire de Simulation et Modélisation du Mouvement, Département de Kinésiologie, Université de Montréal, Laval, QC, Canada
| | - Georges Dalleau
- Laboratoire DIMPS-CURAPS, UFR des Sciences de l'Homme et de l'Environnement, Université de la Réunion, 117 rue du Général Ailleret, 97430 Le Tampon, Ile de la Réunion
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330
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Shin SJ, Kim TY, Yoo WG. Effects of various gait speeds on the latissimus dorsi and gluteus maximus muscles associated with the posterior oblique sling system. J Phys Ther Sci 2013; 25:1391-2. [PMID: 24396195 PMCID: PMC3881462 DOI: 10.1589/jpts.25.1391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/04/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effect of different gait speeds on the muscle
activities of the latissimus dorsi and gluteus maximus muscles in relation to the
posterior oblique sling system. [Subjects] We recruited 14 young adult males. [Methods] We
measured the left latissimus dorsi muscle activity and right gluteus maximus muscle
activity of all subjects while they walked on a treadmill at speeds of 1.5 km/h, 3.5 km/h
and 5.5 km/h. [Results] There was a significant increase in latissimus dorsi muscle
activity with a treadmill speed of 5.5 km/h compared with 1.5 km/h and 3.5 km/h. The
gluteus maximus muscle activity significantly increased in the order of 1.5 km/h <
3.5 km/h < 5.5 km/h. [Conclusion] The present results indicate that arm swing connected
to increasing gait speed influences the muscle activity of the lower limbs through the
posterior oblique sling system.
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Affiliation(s)
- Seung-Je Shin
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Tae-Young Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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331
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Lee M, Kim S, Park S. Resonance-based oscillations could describe human gait mechanics under various loading conditions. J Biomech 2013; 47:319-22. [PMID: 24210476 DOI: 10.1016/j.jbiomech.2013.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 08/05/2013] [Accepted: 09/17/2013] [Indexed: 11/25/2022]
Abstract
The oscillatory behavior of the center of mass (CoM) and the corresponding ground reaction force (GRF) of human gait for various gait speeds can be accurately described in terms of resonance using a spring-mass bipedal model. Resonance is a mechanical phenomenon that reflects the maximum responsiveness and energetic efficiency of a system. To use resonance to describe human gait, we need to investigate whether resonant mechanics is a common property under multiple walking conditions. Body mass and leg stiffness are determinants of resonance; thus, in this study, we investigated the following questions: (1) whether the estimated leg stiffness increased with inertia, (2) whether a resonance-based CoM oscillation could be sustained during a change in the stiffness, and (3) whether these relationships were consistently observed for different walking speeds. Seven healthy young subjects participated in over-ground walking trials at three different gait speeds with and without a 25-kg backpack. We measured the GRFs and the joint kinematics using three force platforms and a motion capture system. The leg stiffness was incorporated using a stiffness parameter in a compliant bipedal model that best fitted the empirical GRF data. The results showed that the leg stiffness increased with the load such that the resonance-based oscillatory behavior of the CoM was maintained for a given gait speed. The results imply that the resonance-based oscillation of the CoM is a consistent gait property and that resonant mechanics may be useful for modeling human gait.
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Affiliation(s)
- Myunghyun Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Seyoung Kim
- Korea Institute of Machinery and Materials, Daejeon, Republic of Korea
| | - Sukyung Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea.
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332
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Jung CK, Park S. Compliant bipedal model with the center of pressure excursion associated with oscillatory behavior of the center of mass reproduces the human gait dynamics. J Biomech 2014; 47:223-9. [PMID: 24161797 DOI: 10.1016/j.jbiomech.2013.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 11/20/2022]
Abstract
Although the compliant bipedal model could reproduce qualitative ground reaction force (GRF) of human walking, the model with a fixed pivot showed overestimations in stance leg rotation and the ratio of horizontal to vertical GRF. The human walking data showed a continuous forward progression of the center of pressure (CoP) during the stance phase and the suspension of the CoP near the forefoot before the onset of step transition. To better describe human gait dynamics with a minimal expense of model complexity, we proposed a compliant bipedal model with the accelerated pivot which associated the CoP excursion with the oscillatory behavior of the center of mass (CoM) with the existing simulation parameter and leg stiffness. Owing to the pivot acceleration defined to emulate human CoP profile, the arrival of the CoP at the limit of the stance foot over the single stance duration initiated the step-to-step transition. The proposed model showed an improved match of walking data. As the forward motion of CoM during single stance was partly accounted by forward pivot translation, the previously overestimated rotation of the stance leg was reduced and the corresponding horizontal GRF became closer to human data. The walking solutions of the model ranged over higher speed ranges (~1.7 m/s) than those of the fixed pivoted compliant bipedal model (~1.5m/s) and exhibited other gait parameters, such as touchdown angle, step length and step frequency, comparable to the experimental observations. The good matches between the model and experimental GRF data imply that the continuous pivot acceleration associated with CoM oscillatory behavior could serve as a useful framework of bipedal model.
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333
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Muir BC, Rietdyk S, Haddad JM. Gait initiation: the first four steps in adults aged 20-25 years, 65-79 years, and 80-91 years. Gait Posture 2013; 39:490-4. [PMID: 24074729 DOI: 10.1016/j.gaitpost.2013.08.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 02/02/2023]
Abstract
Transitioning from standing to walking requires equilibrium to be maintained while a forward propulsive force is generated. The ability to manage these competing demands is compromised by the progressive sensory, neural and motor declines associated with aging. The purpose of this study was to establish the age-related changes in the first four steps of gait in three age groups: 20-25 years old (yo) (N=19), 65-79 yo (N=11), and 80-91 yo (N=18). Participants stood comfortably and then walked at a self-selected pace for 3.2m. Gait speed and step length (SL) both significantly decreased with each age category at each of the first four steps. However, the gait speed changes suggest that older groups control speed in a principled manner across the four steps, which was similar to the speed control of 20-25 yo. With successive steps, 20-25 yo demonstrated a progressive decrease in SL variability, but SL variability of the two older groups did not change. Step width (SW) did not change as a function of age, but SW variability was higher for the two older groups. Higher SL and SW variability may reflect more errors in foot placement and/or decreased center of mass control in the older groups. Further, it appears that AP COM control improves with successive steps in young adults while ML COM control decreases with successive steps in all age groups. When comparing the two older groups, healthy 80-91 yo walked slower with a shorter SL, but did not demonstrate changes associated with falls (SL and/or SW variability).
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Affiliation(s)
- B C Muir
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; Center for Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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Rosenbaum D, Westhues M, Bosch K. Effect of gait speed changes on foot loading characteristics in children. Gait Posture 2013; 38:1058-60. [PMID: 23643879 DOI: 10.1016/j.gaitpost.2013.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/20/2013] [Accepted: 03/23/2013] [Indexed: 02/02/2023]
Abstract
Gait speed has been shown to influence foot loading patterns in adults but the mechanism has not been investigated in children. The present study investigated the effects of changes in gait speed on foot loading characteristics in 20 typically developing children who participated in plantar pressure measurements at normal, slow and fast walking speeds. In spite of shorter contact times in the fast walking speed condition, significantly increased foot loading was seen in the hindfoot, medial and central forefoot and toes while it slightly decreased in the lateral midfoot and forefoot. The results generally confirm the findings in adults that gait speed does not uniformly affect foot loading characteristics and that these effects should be kept in mind when comparing different subject groups or children at repeated measurement occasions.
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Affiliation(s)
- Dieter Rosenbaum
- Movement Analysis Lab, Institute for Experimental Musculoskeletal Medicine, University Hospital Münster, Germany.
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335
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Plotnik M, Bartsch RP, Zeev A, Giladi N, Hausdorff JM. Effects of walking speed on asymmetry and bilateral coordination of gait. Gait Posture 2013; 38:864-9. [PMID: 23680424 DOI: 10.1016/j.gaitpost.2013.04.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 04/12/2013] [Accepted: 04/17/2013] [Indexed: 02/02/2023]
Abstract
The mechanisms regulating the bilateral coordination of gait in humans are largely unknown. Our objective was to study how bilateral coordination changes as a result of gait speed modifications during over ground walking. 15 young adults wore force sensitive insoles that measured vertical forces used to determine the timing of the gait cycle events under three walking conditions (i.e., usual-walking, fast and slow). Ground reaction force impact (GRFI) associated with heel-strikes was also quantified, representing the potential contribution of sensory feedback to the regulation of gait. Gait asymmetry (GA) was quantified based on the differences between right and left swing times and the bilateral coordination of gait was assessed using the phase coordination index (PCI), a metric that quantifies the consistency and accuracy of the anti-phase stepping pattern. GA was preserved in the three different gait speeds. PCI was higher (reduced coordination) in the slow gait condition, compared to usual-walking (3.51% vs. 2.47%, respectively, p=0.002), but was not significantly affected in the fast condition. GRFI values were lower in the slow walking as compared to usual-walking and higher in the fast walking condition (p<0.001). Stepwise regression revealed that slow gait related changes in PCI were not associated with the slow gait related changes in GRFI. The present findings suggest that left-right anti-phase stepping is similar in normal and fast walking, but altered during slow walking. This behavior might reflect a relative increase in attention resources required to regulate a slow gait speed, consistent with the possibility that cortical function and supraspinal input influences the bilateral coordination of gait.
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336
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McGough EL, Cochrane BB, Pike KC, Logsdon RG, McCurry SM, Teri L. Dimensions of physical frailty and cognitive function in older adults with amnestic mild cognitive impairment. Ann Phys Rehabil Med 2013; 56:329-41. [PMID: 23602402 DOI: 10.1016/j.rehab.2013.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 02/20/2013] [Accepted: 02/26/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study was to examine relationships between dimensions of physical frailty and severity of cognitive impairment in older adults with amnestic mild cognitive impairment (aMCI). PATIENTS AND METHODS The prevalence of physical frailty dimensions including slow gait speed, low physical activity, and low grip strength was examined among 201 sedentary older adults with aMCI. Associations between dimensions of physical frailty and severity of cognitive impairment, as measured with the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and individual dimensions of cognitive function were examined using multiple linear regression models. RESULTS Greater than 50% of participants met physical frailty criteria on dimensions of slow gait speed, low physical activity and low grip strength. Slower gait speed was associated with elevated severity of cognitive impairment. Both gait speed and physical activity were associated with individual dimensions cognitive function. CONCLUSIONS Dimensions of physical frailty, particularly gait speed, were associated with severity of cognitive impairment, after adjusting for age, sex and age-related factors. Further studies are needed to investigate mechanisms and early intervention strategies that assist older adults with aMCI to maintain function and independence.
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Affiliation(s)
- E L McGough
- Department of Rehabilitation Medicine, University of Washington, 1959, NE Pacific Street, Box 356490, Seattle, WA 98195, USA.
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Mielke MM, Roberts RO, Savica R, Cha R, Drubach DI, Christianson T, Pankratz VS, Geda YE, Machulda MM, Ivnik RJ, Knopman DS, Boeve BF, Rocca WA, Petersen RC. Assessing the temporal relationship between cognition and gait: slow gait predicts cognitive decline in the Mayo Clinic Study of Aging. J Gerontol A Biol Sci Med Sci 2012; 68:929-37. [PMID: 23250002 DOI: 10.1093/gerona/gls256] [Citation(s) in RCA: 298] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The association between gait speed and cognition has been reported; however, there is limited knowledge about the temporal associations between gait slowing and cognitive decline among cognitively normal individuals. METHODS The Mayo Clinic Study of Aging is a population-based study of Olmsted County, Minnesota, United States, residents aged 70-89 years. This analysis included 1,478 cognitively normal participants who were evaluated every 15 months with a nurse visit, neurologic evaluation, and neuropsychological testing. The neuropsychological battery used nine tests to compute domain-specific (memory, language, executive function, and visuospatial skills) and global cognitive z-scores. Timed gait speed (m/s) was assessed over 25 feet (7.6 meters) at a usual pace. Using mixed models, we examined baseline gait speed (continuous and in quartiles) as a predictor of cognitive decline and baseline cognition as a predictor of gait speed changes controlling for demographics and medical conditions. RESULTS Cross-sectionally, faster gait speed was associated with better performance in memory, executive function, and global cognition. Both cognitive scores and gait speed declined over time. A faster gait speed at baseline was associated with less cognitive decline across all domain-specific and global scores. These results were slightly attenuated after excluding persons with incident mild cognitive impairment or dementia. By contrast, baseline cognition was not associated with changes in gait speed. CONCLUSIONS Our study suggests that slow gait precedes cognitive decline. Gait speed may be useful as a reliable, easily attainable, and noninvasive risk factor for cognitive decline.
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Affiliation(s)
- Michelle M Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
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