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Franks C, Reis AC, Peel N, Steel KA. A qualitative approach to explore the cognitive processes used by members of an adult learn-to-cycle program. Front Sports Act Living 2024; 6:1220795. [PMID: 39149570 PMCID: PMC11324486 DOI: 10.3389/fspor.2024.1220795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 07/04/2024] [Indexed: 08/17/2024] Open
Abstract
Introduction Attaining movement proficiency under various constraints is well-researched; of particular interest here is how conscious processing and self-consciousness influence learning and performance. Current research relevant to these variables e.g., reinvestment, tends to utilize quantitative methods and thus overlooks a potentially rich source of understanding. Therefore, the purpose of this study was to apply a qualitative approach to explore the cognitive processes and self-consciousness within a less practiced population of adults participating in a non-competitive leisure activity. Methods To achieve this, eleven semi-structured interviews were conducted with adult women learning or relearning to ride a bicycle. Results Using thematic analysis, two distinct themes were evident and corroborated those illustrated in scales such as the movement-specific reinvestment scale. These themes included Conscious Processing, Recalling Experiences and Movement Analysis, in addition to Style of Movement, and Self-Consciousness. Anxiety also emerged as an additional and relevant theme to learning a new complex movement skill. Discussion The findings indicated that participating women attuned to their movements to the extent that there was a conscious attempt to control their movements, but less so regarding movements being altered by self-awareness. Whilst further research is required, qualitative methods provide a promising basis for exploring the cognitive process involved with the conscious process involved in learning.
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Affiliation(s)
- Caitlyn Franks
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Arianne C Reis
- School of Health Science, Western Sydney University, Penrith, NSW, Australia
- THRI, Western Sydney University, Penrith, NSW, Australia
| | - Nicole Peel
- School of Health Science, Western Sydney University, Penrith, NSW, Australia
- THRI, Western Sydney University, Penrith, NSW, Australia
| | - Kylie Ann Steel
- School of Health Science, Western Sydney University, Penrith, NSW, Australia
- MARCS Institute, Western Sydney University, Penrith, NSW, Australia
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Raffegeau TE, Brinkerhoff SA, Clark M, McBride AD, Mark Williams A, Fino PC, Fawver B. Walking (and talking) the plank: dual-task performance costs in a virtual balance-threatening environment. Exp Brain Res 2024; 242:1237-1250. [PMID: 38536454 PMCID: PMC11078829 DOI: 10.1007/s00221-024-06807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings.
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Affiliation(s)
- Tiphanie E Raffegeau
- George Mason University, School of Kinesiology, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA.
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.
| | - Sarah A Brinkerhoff
- George Mason University, School of Kinesiology, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA
| | - Mindie Clark
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Department of Health and Human Performance, Rocky Mountain College, Billings, MT, USA
| | - Ashlee D McBride
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - A Mark Williams
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Institute for Human and Machine Cognition, Human Health, Resilience and Performance, Pensacola, FL, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Bradley Fawver
- Walter Reed Army Institute of Research-West, Joint Base Lewis-McChord, Tacoma, WA, USA
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Norouzian P, Horslen BC, Martens KAE. The effects of trait and state anxiety on gait in healthy young adults. Exp Brain Res 2024:10.1007/s00221-024-06800-3. [PMID: 38456925 DOI: 10.1007/s00221-024-06800-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
Stable, personality-based (trait), and fluctuating, situational (state) anxiety have both been shown to consume attentional resources and reduce functional cognitive capacity, which may play a role in gait control. However, the role of attention in the relationship between trait and state anxiety has not yet been investigated formally. This study used a virtual reality-threat environment to evaluate whether changes in attention mediate the effects of state and trait anxiety on gait. Thirty adults aged 19-28 completed five walking trials in four conditions: (i) low threat-walking across a virtual plank (0.5 m wide) on flat ground; (ii) low threat + dual task (auditory digit monitoring); (iii) high threat-walking across a virtual plank elevated above a deep pit; and (iv) high threat + dual task. Trait anxiety levels were determined by the State-Trait Anxiety Inventory, while state anxiety was captured using self-assessment manikins. Higher trait anxiety predicted slower gait velocity and longer time in double support in the high-threat condition compared to low-threat condition (i vs iii), but not when dual tasking, compared to single-task walking, in the absence of threat (ii vs i). Additionally, higher trait anxiety predicted increased step length variability in the high compared to low-threat dual-task condition. Overall, trait anxiety predicts a slower, more cautious gait pattern during threatening conditions while dual tasking during the threat.
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Affiliation(s)
- Pershia Norouzian
- Neurocognition and Mobility Lab, Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - Brian C Horslen
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, N2L3G1, Canada
| | - Kaylena A Ehgoetz Martens
- Neurocognition and Mobility Lab, Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada.
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, N2L3G1, Canada.
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Otani Y, Aoki O. Fear-related visual stimuli do not promote internal focus of attention in older adults. Gait Posture 2024; 108:70-76. [PMID: 37995552 DOI: 10.1016/j.gaitpost.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/05/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The influence of internal focus (IF) on postural balance needs to be determined when assessing fall risk in older adults. Moreover, the mechanism through which IF is triggered should be elucidated. RESEARCH QUESTION Does fear unrelated to threats to postural balance modulate IF during postural control? METHODS The participants were 16 community-dwelling older adults. We generated visual stimuli for neutral and fear conditions using the International Affective Picture System. Participants were assessed for postural control while standing on a stabilometer and looking at projected images. The IF allocated to postural control during task was assessed immediately after the task using the Conscious Movement Processing subscale of the Movement-Specific Reinvestment Scale (MSRS-CMP). Sympathetic activity was assessed using the mean low-frequency/high-frequency ratio (LF/HF), and posture was evaluated using the root mean square area (RMS-A), anteroposterior mean power frequency (MPF-AP), mediolateral MPF, and co-contraction index. Differences (Δ) in the MSRS-CMP, RMS-A and MPF between the neutral/fear conditions and control condition were calculated. Each index was also compared among the control, neutral, and fear conditions. The correlations between ΔMSRS-CMP and postural measures were evaluated. Equivalence tests were conducted to determine whether change of IF was different among conditions. RESULTS The MSRS-CMP score did not differ significantly among conditions; equivalence was observed. The LF/HF and MPF-AP in the fear condition were higher than in the other conditions. The RMS-A in the fear condition was lower than in the neutral condition. ΔMSRS-CMP and ΔMPF-AP were significantly negatively correlated. SIGNIFICANCE The results of this study suggest that feelings of fear affect postural control but not the IF of attention. Taken together with previous research, the findings of this study suggest that consideration of the fear-inducing context may be useful in assessments of, and interventions for, older adults with a fall risk.
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Affiliation(s)
- Yoshitaka Otani
- Faculty of Rehabilitation, Kobe International University, 9-1-6 Kouyocho-naka, Higashinada, Kobe, Hyogo 658-0032, Japan.
| | - Osamu Aoki
- Faculty of Rehabilitation, Shijonawate Gakuen University, 5-11-10 Houjo, Daito, Osaka 574-0011, Japan
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Ellmers TJ, Wilson MR, Kal EC, Young WR. The perceived control model of falling: developing a unified framework to understand and assess maladaptive fear of falling. Age Ageing 2023; 52:afad093. [PMID: 37466642 PMCID: PMC10355179 DOI: 10.1093/ageing/afad093] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND fear of falling is common in older adults and can have a profound influence on a variety of behaviours that increase fall risk. However, fear of falling can also have potentially positive outcomes for certain individuals. Without progressing our understanding of mechanisms underlying these contrasting outcomes, it is difficult to clinically manage fear of falling. METHODS this paper first summarises recent findings on the topic of fear of falling, balance and fall risk-including work highlighting the protective effects of fear. Specific focus is placed on describing how fear of falling influences perceptual, cognitive and motor process in ways that might either increase or reduce fall risk. Finally, it reports the development and validation of a new clinical tool that can be used to assess the maladaptive components of fear of falling. RESULTS we present a new conceptual framework-the Perceived Control Model of Falling-that describes specific mechanisms through which fear of falling can influence fall risk. The key conceptual advance is the identification of perceived control over situations that threaten one's balance as the crucial factor mediating the relationship between fear and increased fall risk. The new 4-item scale that we develop-the Updated Perceived Control over Falling Scale (UP-COF)-is a valid and reliable tool to clinically assess perceived control. CONCLUSION this new conceptualisation and tool (UP-COF) allows clinicians to identify individuals for whom fear of falling is likely to increase fall risk, and target specific underlying maladaptive processes such as low perceived control.
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Affiliation(s)
| | - Mark R Wilson
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
| | - Elmar C Kal
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
| | - William R Young
- Centre for Cognitive Neuroscience, Brunel University London, London, UK
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, UK
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Lapanan K, Kantha P, Nantachai G, Hemrungrojn S, Maes M. The prefrontal cortex hemodynamic responses to dual-task paradigms in older adults: A systematic review and meta-analysis. Heliyon 2023; 9:e17812. [PMID: 37519646 PMCID: PMC10372207 DOI: 10.1016/j.heliyon.2023.e17812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/16/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Background Functional near-infrared spectroscopy (fNIRS) is a method to measure cerebral hemodynamics. Determining the changes in prefrontal cortex (PFC) hemodynamics during dual-task paradigms is essential in explaining alterations in physical activities, especially in older adults. Aims To systematically review and meta-analyze the effects of dual-task paradigms on PFC hemodynamics in older adults. Methods The search was conducted in PubMed, Scopus, and Web of Science from inception until March 2023 to identify studies on the effects of dual-task paradigms on PFC hemodynamics. The meta-analysis included variables of cerebral hemodynamics, such as oxygenated hemoglobin (HbO2) and deoxygenated hemoglobin (HbR). The heterogeneity of the included studies was determined using the I2 statistic. Additionally, subgroup analysis was conducted to compare the effects of different types of cognitive tasks. Results A total of 37 studies were included in the systematic review, 25 studies comprising 2224 older adults were included in the meta-analysis. Our findings showed that inhibitory control and working memory tasks significantly increased HbO2 in the PFC by 0.53 (p < 0.01, 95% CI = 0.37 to 0.70) and 0.13 (p < 0.01, 95% CI = 0.08 to 0.18) μmol/L, respectively. Overall, HbO2 was significantly increased during dual-task paradigms by 0.36 μmol/L (P < 0.01, 95% CI = 0.27 to 0.45). Moreover, dual-task paradigms also decreased HbR in the PFC by 0.04 (P < 0.01, 95% CI = -0.07 to -0.01). Specifically, HbR decreased by 0.08 during inhibitory control tasks (p < 0.01, 95% CI = -0.13 to -0.02), but did not change during working memory tasks. Conclusion Cognitive tasks related to inhibitory control required greater cognitive demands, indicating higher pfc activation during dual-task paradigms in older adults. for clinical implications, the increase in pfc oxygenated hemoglobin and decrease in pfc deoxygenated hemoglobin may help explain why older adults are more likely to fall during daily activities.
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Affiliation(s)
- Kulvara Lapanan
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Phunsuk Kantha
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Gallayaporn Nantachai
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Somdet Phra Sangharaj Nyanasamvara Geriatric Hospital, Department of Medical Services, Ministry of Public Health, Chon Buri Province, Thailand
| | - Solaphat Hemrungrojn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Fitness and Biopsychiatry Technology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
- Mental Health Center, University of Electronic Science and Technology of China, Chengdu 611731, China
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7
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Raffegeau TE, Clark M, Fawver B, Engel BT, Young WR, Williams AM, Lohse KR, Fino PC. The effect of mobility-related anxiety on walking across the lifespan: a virtual reality simulation study. Exp Brain Res 2023:10.1007/s00221-023-06638-1. [PMID: 37204506 DOI: 10.1007/s00221-023-06638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
Older adults who report a fear of falling are more likely to subsequently fall, yet, some gait anxiety-related alterations may protect balance. We examined the effect of age on walking in anxiety-inducing virtual reality (VR) settings. We predicted a high elevation-related postural threat would impair gait in older age, and differences in cognitive and physical function would relate to the observed effects. Altogether, 24 adults (age (y) = 49.2 (18.7), 13 women) walked on a 2.2-m walkway at self-selected and fast speeds at low (ground) and high (15 m) VR elevation. Self-reported cognitive and somatic anxiety and mental effort were greater at high elevations (all p < 0.001), but age- and speed-related effects were not observed. At high VR elevations, participants walked slower, took shorter steps, and reduced turning speed (all p < 0.001). Significant interactions with age in gait speed and step length showed that relatively older adults walked slower (β = - 0.05, p = 0.024) and took shorter steps (β = - 0.05, p = 0.001) at self-selected speeds at high compared to low elevation settings. The effect of Age on gait speed and step length disappeared between self-selected and fast speeds and at high elevation. At self-selected speeds, older adults took shorter and slower steps at high elevation without changing step width, suggesting that in threatening settings relatively older people change gait parameters to promote stability. At fast speeds, older adults walked like relatively younger adults (or young adults walked like older adults) supporting the notion that people opt to walk faster in a way that still protects balance and stability in threatening settings.
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Affiliation(s)
- Tiphanie E Raffegeau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.
- School of Kinesiology, George Mason University, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA.
| | - Mindie Clark
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Bradley Fawver
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- US Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, Washington, USA
| | - Benjamin T Engel
- University of Utah, Spencer S. Eccles Health Sciences Library, Salt Lake City, UT, USA
| | - William R Young
- School of Sport and Health Science, The University of Exeter, Exeter, UK
| | - A Mark Williams
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- School of Sport and Health Science, The University of Exeter, Exeter, UK
| | - Keith R Lohse
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Physical Therapy and Neurology, School of Medicine, Washington University, Saint Louis, MO, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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Hunt R, Mills C, Frost G, Blackmore T, Miller-Dicks M. The visual control of locomotion when stepping onto moving surfaces: A comparison of younger and older adults. Exp Gerontol 2023; 174:112117. [PMID: 36758648 DOI: 10.1016/j.exger.2023.112117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/27/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
Stepping between static and moving surfaces presents a locomotor challenge associated with increased injury frequency and severity in older adults. The current study evaluates younger and older adults' behaviours when overcoming challenges sampling moving walkway and escalator environments. Twelve younger adults (18-40 years, Male = 8) and 15 older adults (60-81 years, Male = 5) were examined using an integration of optoelectronic motion capture and mobile eye-tracking. Participants were investigated approaching and stepping onto a flat conveyor belt (static or moving; with or without surface (demarcation) lines). Specifically, the four conditions were: (i) static surface without demarcation lines; (ii) static surface with demarcation lines; (iii) moving surface without demarcation lines; and (iv) moving surface with demarcation lines. A two (age group) x two (surface-condition) x two (demarcation-condition) linear mixed-model revealed no main or interaction effects (p > .05) for perturbation magnitude, indicating participants maintained successful locomotion. However, different adaptive behaviours were identified between conditions with moving and accuracy demands (e.g., moving surfaces increased step length, demarcations reduced step length). Between subject effects identified differences between age groups. Older adults utilised different behaviours, such as earlier gaze transfer from the final approach walkway step location. Overall, the current study suggests that adaptive behaviours emerge relative to the environment's specific demands and the individual's action capabilities.
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Affiliation(s)
- Rhys Hunt
- School of Sport, Health and Exercise Science, University of Portsmouth, United Kingdom.
| | - Chris Mills
- School of Sport, Health and Exercise Science, University of Portsmouth, United Kingdom
| | - Gillian Frost
- Health and Safety Executive, Science Division, United Kingdom
| | - Tim Blackmore
- School of Sport, Health and Exercise Science, University of Portsmouth, United Kingdom
| | - Matt Miller-Dicks
- School of Sport, Health and Exercise Science, University of Portsmouth, United Kingdom.
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Zult T, Timmis MA, Pardhan S. The effects of age and central field loss on maintaining balance control when stepping up to a new level under time-pressure. PeerJ 2023; 11:e14743. [PMID: 36846451 PMCID: PMC9948744 DOI: 10.7717/peerj.14743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/23/2022] [Indexed: 02/22/2023] Open
Abstract
Objective To investigate the effects of age and central field loss on the landing mechanics and balance control when stepping up to a new level under time-pressure. Methods Eight older individuals with age-related macular degeneration (AMD), eight visually normal older and eight visually normal younger individuals negotiated a floor-based obstacle followed by a 'step-up to a new level' task. The task was performed under (1) no-pressure; (2) time-pressure: an intermittent tone was played that increased in frequency and participants had to complete the task before the tone ceased. Landing mechanics and balance control for the step-up task was assessed with a floor-mounted force plate on the step. Results Increased ground reaction forces and loading rates were observed under time-pressure for young and older visual normals but not for AMD participants. Across conditions, loading rates and ground reaction forces were higher in young normals compared to older normals and AMD participants. Young visual normals also demonstrated 35-39% shorter double support times prior to and during the step-up compared to older normals and AMD participants. All groups shortened their double support times (31-40%) and single support times (7-9%) in the time-pressure compared to no-pressure condition. Regarding balance control, the centre-of-pressure displacement and velocity in the anterior-poster direction were increased under time-pressure for young and older visual normals but not for AMD participants. The centre-of-pressure displacement and velocity in the medial-lateral direction were decreased for the AMD participants under time-pressure but not for young and older visual normals. Conclusions Despite walking faster, AMD participants did not adapt their landing mechanics under time-pressure (i.e., they remained more cautious), whilst older and young adults with normal vision demonstrated more forceful landing mechanics with the young being most forceful. A more controlled landing might be a safety strategy to maintain balance control during the step-up, especially in time-pressure conditions when balance control in the anterior-posterior direction is more challenged.
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Affiliation(s)
- Tjerk Zult
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
| | - Matthew A. Timmis
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom,Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Cambridge, Cambridgeshire, United Kingdom
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Pourhassan J, Sarginson J, Hitzl W, Richter K. Cognitive function in soccer athletes determined by sleep disruption and self-reported health, yet not by decision-reinvestment. Front Neurol 2023; 13:872761. [PMID: 36814538 PMCID: PMC9939841 DOI: 10.3389/fneur.2022.872761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
Background Sleep disruption (SD) increases sympathetic activity and cortisol secretion, and delays cognitive functions such as reaction-time (RT). Sympathetic activity of disturbed sleepers, is similar to those of so-called decision-reinvesters. Decision-reinvestment refers to traits in individuals with greater tendency to ruminate and reinvest in their decisions, with significant decrease in both motor-control and cognitive performance. Decision-making quality is a crucial attribute to athletic performance which relies on RT. Consequently, SD affects pitch-performance negatively, particularly in decision-reinvesters. This observational pilot-study examined the relationship between SD and cognitive function, perceived health, as well as reinvestment strategies. The hypothesis was that athletes with lower SD perceive their health better, report lower stress levels, perform better in cognitive tasks, and show lower tendency for decision-reinvestment. Methods Twenty-one football player recorded their sleep with fit-trackers for 7 nights. Participants self-reported their mental and physical health, decision-reinvestment strategy, sleep behaviour, and perceived stress levels. Athletes then performed a set of cognitive tests to examine memory function (Backwards Corsi), selective attention (STROOP), and cognitive flexibility (Wisconsin Card Sorting Test, WCST). Normality was tested with a Shapiro-Wilk test, and analysed with a Pearson's or Spearman's correlation test. Results Significant correlation appeared between extended sleep-interruptions and Backwards Corsi RT, r = 0.66, p = 0.010, as further in total sleep time and wellbeing r = 0.50, p = 0.029. A negative correlation exist in regard of pain scores and Backwards Corsi scores r = -0.57, p = 0.110. Physical health correlated with error-rates in the WCST, r = 0.69, p ≤ 0.001. Also, reinvestment negatively correlated with physical health, r = -0.80, p ≤ 0.001. Conclusion Wellbeing relies on total sleep-time. Athletes with extended sleep-interruptions are slower in recalling memory, and those with greater reported pain have lower memory scores. Participants who rate physical health greater, have more error-rates in the WCST; indicating that cognitive flexibility is enhanced in individuals with inferior perceived health. However, individuals with lower physical health scores also have greater tendency to ruminate and reinvest in decisions, suggesting interrelation between reinvestment and physical health.
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Affiliation(s)
- Jasmin Pourhassan
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom,University Clinic for Psychiatry and Psychotherapy, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany,*Correspondence: Jasmin Pourhassan ✉
| | - Jane Sarginson
- Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Wolfgang Hitzl
- Department Research and Innovation Management (RIM), Biostatistics and Publication of Clinical Trial Studies, Paracelsus Medical University, Salzburg, Austria,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany,Faculty for Social Work, Technical University for Applied Sciences, Nuremberg, Germany,Faculty for Medical Sciences, Goce Delcev University, Stip, North Macedonia,Kneginja Richter ✉
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Andrade V, Mazoni A, Vasconcelos C, Mattos D, Mitra S, Ocarino J, Vaz D. Effects of Age and Attentional Focus on the Performance and Coordination of the Sit-to-Stand Task. J Mot Behav 2022; 55:78-91. [PMID: 36120733 DOI: 10.1080/00222895.2022.2122921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study investigated whether age and attentional focus affect synergy organization of sit-to-stand (STS). Young and older adults performed STS while holding a cup under internal (IF) and external focus (EF) instructions. Uncontrolled manifold analysis was used to decompose trial-to-trial variability in joint kinematics into variability that preserves (VUCM) and interferes (VORT) with the horizontal and vertical positions of the center of mass (CoM) and cup. VUCM was significantly higher than VORT for all variables in both age groups and focus conditions. Older adults demonstrated higher VUCM for all variables and higher VORT for all variables except the vertical position of the cup. IF instructions benefited older adults, leading to decreased VORT of the vertical position of CoM and horizontal and vertical positions of the cup.
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Affiliation(s)
- Valéria Andrade
- Center for Cognition, Action, & Perception, Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alysson Mazoni
- InSySPo, System Innovation Institute of Geosciences, UniversidadeEstadualde Campinas, Campinas, São Paulo, Brazil
| | - Camila Vasconcelos
- Department of Physical Therapy, School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela Mattos
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Suvobrata Mitra
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Juliana Ocarino
- Department of Physical Therapy, School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela Vaz
- Department of Physical Therapy, School of Physical Education, Physical Therapy, and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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12
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The Effect of Attentional Focus on Real-Time Conscious Motor Processing During Tandem Walking in Young Adults. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2022. [DOI: 10.1123/jmld.2022-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The theory of reinvestment in experimental psychology suggested that automated performance could be degraded if attention was internally diverted to the process of skill execution. This study examined the role of attentional focus instructions on real-time conscious motor processing (i.e., reinvestment) during tandem walking. Thirty-six young adults (mean age = 20.94, SD = 1.43 years) participated; their electroencephalography T3–Fz coherence (i.e., real-time reinvestment) was measured during three walking conditions with different attentional focus instructions: external focus, internal focus, and control conditions. The results suggested that attentional focus instructions did not significantly affect real-time conscious motor processing during tandem walking in young adults, possibly due to the low level of motor task complexity of walking by young adults. The Movement-Specific Reinvestment Scale appears to be not sensitive enough to reflect the real-time reinvestment during gait-related movements in young adults.
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13
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Ziegelman L, Alkurdi A, Hu Y, Bishnoi A, Kaur R, Sowers R, Hsiao-Wecksler ET, Hernandez ME. Feasibility of VR Technology in Eliciting State Anxiety Changes While Walking in Older Women. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:583-586. [PMID: 34891361 DOI: 10.1109/embc46164.2021.9630542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Virtual reality (VR) technology offers an exciting way to emulate real-life walking conditions that may better elicit changes in emotional state. We aimed to determine whether VR technology is a feasible way to elicit changes in state anxiety during walking. Electrocardiogram data were collected for 18 older adult women while they navigated a baseline walking task, a dual walking task, and four walking VR environments. Using heart rate variability (HRV) analysis, we found that all four of the VR environments successfully elicited a significantly higher level of state anxiety as compared to the walking baseline, with 84% of participants eliciting a significantly lower HRV in each of the four VR conditions as compared to baseline walking. VR was also found to be a more reliable tool for increasing state anxiety as compared to a dual task, where only 47% of participants demonstrated a significantly lower HRV as compared to baseline walking. VR, therefore, could be promising as a tool to elicit changes in state anxiety and less limited in its ability to elicit changes as compared to a traditional dual task condition.
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14
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Li DKT, Mak TCT, Wong TWL. Does an Externally Focused Dual-task Mitigate Real-time Conscious Postural Control in Older Adults? Exp Aging Res 2021; 48:295-310. [PMID: 34590545 DOI: 10.1080/0361073x.2021.1982343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: This study first examined whether real-time conscious postural control (reinvestment) and postural sway increase with different postural difficulties on a compliant surface among older adults. The second objective was to investigate the effect of an externally focused dual-task on real-time reinvestment and postural sway under a relatively challenging standing position. Method: Thirty-two community-dwelling older adults (mean age = 72.09, SD = 4.18 years) were recruited. Participants performed balance tasks in four standing positions in a randomized order on a balance foam pad. The four positions included wide-based standing on foam (WBF), narrow-based standing on foam (NBF), tandem-based standing on foam (TBF) and tandem-based standing on foam with an externally focused dual-task (TBFE). Throughout all the balance tasks, participants' real-time reinvestment and body sway were indicated by the Alpha2 T3-Fz Electroencephalogram (EEG) coherence and the total sway length (TSL), respectively. Results and Discussion: Our results revealed no significant difference in real-time reinvestment among different standing positions while postural sway increased from WBF to NBF and reduced from NBF to TBF. We also demonstrated that when performing a relatively challenging standing task on a compliant surface, an externally focused dual-task (TBFE), compared to a baseline single task (TBF), can neither mitigate real-time reinvestment nor improve balance performance in community-dwelling older adults with good balance capability. Potential explanations and implications are discussed.
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Affiliation(s)
- Devon K T Li
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Toby C T Mak
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Thomson W L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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15
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Mak TCT, Wong TWL. Do attentional focus instructions affect real-time reinvestment during level-ground walking in older adults? Cogn Process 2021; 23:121-128. [PMID: 34322782 DOI: 10.1007/s10339-021-01044-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
This study represents the first attempt in exploring whether attentional focus instructions could affect real-time reinvestment (conscious movement processing) in older adults during level-ground walking. Forty-five community-dwelling older adults were instructed to walk at a self-selected pace along a 6-m level-ground walkway under three randomized attentional focus conditions (i.e., Internal, External, and Control) for a total of fifteen trials (five trials for each condition). Electroencephalography (EEG) T3-Fz coherence was utilized as an objective measurement of real-time reinvestment during walking. The Chinese version of the Movement-Specific Reinvestment Scale (MSRS-C) was used to measure the trait reinvestment propensity. Results revealed that the EEG T3-Fz coherence did not differ among the three conditions. The EEG T3-Fz coherence at the Control condition was not correlated with the scores of the MSRS-C. Our findings suggest that the measurement of trait reinvestment propensity (MSRS-C) may not be sensitive enough to reflect real-time reinvestment. Moreover, attentional focus instructions do not affect real-time reinvestment during level-ground walking, possibly due to the low level of motor task difficulty in level-ground walking for healthy older adults. Future studies should investigate this influential issue with a more challenging walking task.
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Affiliation(s)
- Toby C T Mak
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China. .,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong SAR, China.
| | - Thomson W L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hunghom, Hong Kong SAR, China
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16
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Cocks AJ, Young WR, Ellmers TJ, Jackson RC, Williams AM. Concern about falling is associated with segmental control when turning in older adults. Gait Posture 2021; 88:105-108. [PMID: 34023653 DOI: 10.1016/j.gaitpost.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Healthy young adults typically exhibit a progressive 'top-down' reorientation of body segments (i.e., head, trunk, then pelvis) during turning. This behaviour is less evident in older adults at risk of falling, who often reduce angular displacement between body segments during turns. The potential functional and psychological contributors to this so-called 'en-bloc' turning strategy are not yet understood. RESEARCH QUESTION Are there associations between concern about falling and variables representing en-bloc turning (i.e., increased coupling between body segments)? METHODS Twenty-one older adults were assessed while turning during an adaptive walking task. We collected data from markers forming the head, trunk, and pelvis segments, while gait velocity throughout the turn was calculated from a sternum marker. We correlated several variables with concern about falling alone, as well as while controlling for functional balance ability. RESULTS Correlation analyses revealed that concern about falling was related to en-bloc turning strategies and slower gait velocity throughout the turn, when analysed independently of functional balance. When controlling for balance ability, en-bloc turning strategies between the head and trunk, as well as the head and pelvis, remained significantly associated with concern about falling. SIGNIFICANCE Findings offer an insight into the potential role that psychological characteristics may have in determining older adults' turning behaviour and associated risk of falling.
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Affiliation(s)
- Adam J Cocks
- Division of Sport, Health and Exercise Sciences, Brunel University London, Uxbridge, UK; Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, UK; College of Health and Life Sciences, Brunel University London, Uxbridge, UK.
| | - William R Young
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK; School of Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Toby J Ellmers
- Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, UK; College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Robin C Jackson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Mark Williams
- Department of Health, Kinesiology, and Recreation, College of Health, University of Utah, Salt Lake City, USA
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Movement-Specific Reinvestment in Older People Explains Past Falls and Predicts Future Error-Prone Movements. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105129. [PMID: 34066063 PMCID: PMC8151735 DOI: 10.3390/ijerph18105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
The tendency to think about or consciously control automated movements (i.e., movement-specific reinvestment) is a crucial factor associated with falling in the elderly. We tested whether elderly people's movement-specific reinvestment depended on their past falling history and whether it can predict future error-prone movements. In a longitudinal pre-post design, we assessed n = 21 elderly people's (Mage = 84.38 years, SD = 5.68) falling history, movement-specific reinvestment (i.e., Movement-Specific Reinvestment Scale), and physical functioning (i.e., Short-Physical-Performance Battery). Following a baseline assessment, participants reported their movement behavior in a daily diary for 2 months, after which we assessed their movement-specific reinvestment and physical functioning again (longitudinal, pre-post design). Results revealed, first, that participants' movement self-consciousness score was fairly stable, while their conscious-motor-processing score was less stable. Second, conscious motor processing was higher in participants who had fallen as opposed to those who had not fallen in the past. Third, conscious motor processing predicted error-prone future movement behavior reported in the daily diary. For identifying individuals who are more prone to fall, caregivers, rehabilitation staff, or doctors could apply the Movement-Specific Reinvestment Scale to screen elderly people's psychomotor behavior. Based on conscious motor processing, monitoring cognitions could be tailored in theory-based, individual interventions involving both cognitive and motor training.
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18
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Ellmers TJ, Cocks AJ, Kal EC, Young WR. Conscious Movement Processing, Fall-Related Anxiety, and the Visuomotor Control of Locomotion in Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 75:1911-1920. [PMID: 32761087 PMCID: PMC7566972 DOI: 10.1093/geronb/gbaa081] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives Older adults anxious about falling will often consciously process walking movements in an attempt to avoid falling. They also fixate their gaze on the present step rather than looking ahead to plan future actions. The present work examined whether conscious movement strategies result in such restricted visual planning. Methods A total of 18 community-dwelling older adults (agemean = 71.22; SD = 5.75) walked along a path and stepped into two raised targets. Repeated-measures analyses of variance were used to compare gaze behavior and movement kinematics when participants walked: (a) at baseline (ground level); (b) under conditions designed to induce fall-related anxiety (walkway elevated 0.6 m); and (c) in the absence of anxiety (ground level), but with explicit instructions to consciously process movements. Results Participants reported increased conscious movement processing when walking both on the elevated walkway (fall-related anxiety condition) and at ground level when instructed to consciously process gait. During both conditions, participants altered their gaze behavior, visually prioritizing the immediate walkway 1–2 steps ahead (areas needed for the on-line visual control of individual steps) at the expense of previewing distal areas of the walking path required to plan future steps. These alterations were accompanied by significantly slower gait and increased stance durations prior to target steps. Conclusions Consciously processing movement (in the relative absence of anxiety) resulted in gaze behavior comparable to that observed during conditions of fall-related anxiety. As anxious participants also self-reported directing greater attention toward movement, this suggests that fall-related anxiety may disrupt the visual control of gait through increased conscious movement processing.
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Affiliation(s)
- Toby J Ellmers
- College of Health and Life Sciences, Brunel University London, UK.,Centre for Cognitive Neuroscience, Brunel University London, UK
| | - Adam J Cocks
- College of Health and Life Sciences, Brunel University London, UK.,Centre for Cognitive Neuroscience, Brunel University London, UK
| | - Elmar C Kal
- College of Health and Life Sciences, Brunel University London, UK.,Centre for Cognitive Neuroscience, Brunel University London, UK
| | - William R Young
- College of Health and Life Sciences, Brunel University London, UK.,School of Sport and Health Sciences, University of Exeter, UK
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19
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Mak TCT, Young WR, Wong TWL. Conscious Control of Gait Increases with Task Difficulty and Can Be Mitigated by External Focus Instruction. Exp Aging Res 2021; 47:288-301. [PMID: 33687313 DOI: 10.1080/0361073x.2021.1891811] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objectives: We aimed to address whether increased task difficulty is sufficient to induce heightened conscious control and influence gait performance in older adults through the manipulations of either task difficulty or attentional focus. Method: Fifty older adults, split into high- (HR) and low-reinvestor (LR) groups, performed a walking task on a 7.4 m straight walkway in two conditions: firm level-ground surface (GW) and foam surface (FW). They subsequently performed the same walking task under two attentional focus conditions: Internal focus (IF) and External focus (EF). Electroencephalography (EEG) T3-Fz and T4-Fz coherences were used to indicate real-time conscious motor control and visual-spatial control, respectively. Results: We observed significantly higher T3-Fz and T4-Fz coherences under FW compared to GW. HR reduced their gait speed at a greater extent than LR under FW. Significantly lower T3-Fz coherence and faster gait were demonstrated under EF compared to IF. LR walked slower under IF compared to Baseline while gait speed of HR did not differ. Discussion: Visual-spatial and conscious movement processing increase as a function of task difficulty during gait. Our findings also advocate the use of external focus instructions in clinical settings, with the potential to reduce conscious control and promote movement automaticity, even in relatively complex gait tasks.
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Affiliation(s)
- Toby C T Mak
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - William R Young
- School of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Thomson W L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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20
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Leung TYH, Mak TCT, Wong TWL. Real-time conscious postural control is not affected when balancing on compliant surface by young adults. J Mot Behav 2021; 54:37-43. [PMID: 33530878 DOI: 10.1080/00222895.2021.1879724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous research has illustrated that real-time conscious postural control (i.e., reinvestment - shifting from movement automaticity to a more consciously controlled and monitoring of movement) increased with standing task difficulties among healthy older adults. However, such association has not been investigated in the younger population. This study attempted to examine real-time conscious postural control among healthy young adults when performing different standing tasks on a compliant (foam) surface. T3-Fz EEG (electroencephalography) coherence, indicative of real-time conscious postural control, was recorded during the standing tasks (i.e., wide base on foam (WBF), narrow base on foam (NBF) and tandem stance on foam (TAF)). Body sway was also recorded by a motion capture system. Participants' perceived difficulty on the different standing tasks was evaluated by the Visual Analogue Scale (VAS). Results revealed that while body sway and perceived difficulty increased significantly with task difficulties, T3-Fz EEG coherence did not differ among standing tasks. In addition, no differences of any measures were found between young adults with high and low trait reinvestment propensity. Our findings indicate that young adults do not pose higher real-time conscious postural control when task difficulty increases. We also add support to the existing literature; the between-group effect of trait reinvestment appears to be minimal in real-time.
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Affiliation(s)
- Tiffany Y H Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Toby C T Mak
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Thomson W L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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21
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Re-evaluating the measurement and influence of conscious movement processing on gait performance in older adults: Development of the Gait-Specific Attentional Profile. Gait Posture 2020; 81:73-77. [PMID: 32683216 DOI: 10.1016/j.gaitpost.2020.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/28/2020] [Accepted: 07/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Recent decades have seen increased interest in how anxiety-and associated changes in conscious movement processing (CMP)-can influence the control of balance and gait, particularly in older adults. However, the most prevalent scale used to measure CMP during gait (the Movement-Specific Reinvestment Scale (MSRS)) is generic (i.e., non-gait-specific) and potentially lacks sensitivity in this context. METHODS In a preliminary study, we first sought to evaluate if MSRS scores associated with the number of CMP-related thoughts self-reported by older adults while walking. The next aim was to develop and validate a new questionnaire (the Gait-Specific Attentional Profile, G-SAP) capable of measuring gait-specific CMP, in addition to other attentional processes purported to influence gait. This scale was validated using responses from 117 (exploratory) and 107 (confirmatory factor analysis) older adults, resulting in an 11-item scale with four sub-scales: CMP, anxiety, fall-related ruminations, and processing inefficiencies. Finally, in a separate cohort of 53 older adults, we evaluated associations between scores from both the G-SAP CMP subscale and the MSRS, and gait outcomes measured using a GAITRite walkway in addition to participants' fall-history. RESULTS MSRS scores were not associated with self-reported thoughts categorised as representing CMP. In regression analyses that controlled for functional balance, unlike the MSRS, the G-SAP subscale of CMP significantly predicted several gait characteristics including velocity (p = .033), step length (p = .032), and double-limb support (p = .015). SIGNIFICANCE The G-SAP provides gait-specific measures of four psychological factors implicated in mediating the control of balance and gait. In particular, unlike the MSRS, the G-SAP subscale of CMP appears sensitive to relevant attentional processes known to influence gait performance. We suggest that the G-SAP offers an opportunity for the research community to further develop understanding of psychological factors impacting gait performance across a range of applied clinical contexts.
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22
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Lo ESC, Wong AWK, Tse ACY, Ma EPM, Whitehill TL, Masters RSW. Development of a Psychometric Measure of the Propensity to Consciously Control and Monitor Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:963-982. [PMID: 32310711 DOI: 10.1044/2020_jslhr-19-00365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose A speech-specific reinvestment scale (SSRS) is a psychometric measure of the propensity to consciously control and monitor speech production. This study develops and validates an SSRS as well as examines its relationship with speech performance with the moderating effects of trait social anxieties (i.e., social interaction anxiety, public speaking anxiety, and social phobia). Method Scale development involves the following stages: (a) initial item generation based on relevant literature, (b) item evaluation through cognitive interviews with 24 healthy respondents, (c) scale reliability and validity tests using cross-sectional survey data from 498 healthy respondents, and (d) test-retest reliability assessment using longitudinal survey data from 185 healthy respondents. Respondents' speech performance is quantified using speech examination scores. Hierarchical moderated regression analyses are conducted to examine the moderating effects of trait social anxieties. Results The validated SSRS comprises 35 items, which can be categorized into four subdimensions, namely, speech movement self-consciousness, public consciousness of speech content, speech manner, and speech movement. Results show that respondents with low trait social anxieties indicate a generally positive relationship between public consciousness of speech movement and speech performance, whereas respondents with high trait social anxieties exhibit a nonsignificant relationship. Conclusions SSRS offers a reliable and valid method for assessing the predisposition for conscious speech control and monitoring, which plays a role in speech performance and is moderated by an individual's level of trait social anxiety. SSRS is a potential assessment tool for speech-language pathologists to evaluate the impacts of conscious speech control and monitoring on individuals with speech impairment.
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Affiliation(s)
- Eric Siu-Chung Lo
- Nam Shan Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, China
| | - Andus Wing-Kuen Wong
- Nam Shan Psychology Laboratory, Department of Social and Behavioural Sciences, City University of Hong Kong, China
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, China
| | | | - Tara L Whitehill
- Division of Speech and Hearing Sciences, University of Hong Kong, China
| | - Rich S W Masters
- Te Huataki Waiora Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
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23
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The feasibility of using virtual reality to induce mobility-related anxiety during turning. Gait Posture 2020; 77:6-13. [PMID: 31951915 DOI: 10.1016/j.gaitpost.2020.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 02/02/2023]
Abstract
UNLABELLED The fear of falling, or mobility-related anxiety, profoundly affects gait, but is challenging to study without risk to participants. PURPOSE To determine the efficacy of using virtual reality (VR) to manipulate illusions of height and consequently, elevated mobility-related anxiety when turning. Moreover, we examined if mobility-related anxiety effects decline across time in VR environments as participants habituate. METHODS Altogether, 10 healthy participants (five women, mean (standard deviation) age = 28.5 (8.5) years) turned at self-selected and fast speeds on a 2.2 m walkway under two simulated environments: (1) ground elevation; and (2) high elevation (15 m above ground). Peak turning velocity was recorded using inertial sensors and participants rated their cognitive (i.e., worry) and somatic (i.e., tension) anxiety, confidence, and mental effort. RESULTS A significant Height × Speed × Trial interaction (p = 0.013) was detected for peak turning velocity. On average, the virtual height illusion decreased peak turning velocity, especially at fast speeds. At low elevation, participants decreased speed across trials, but not significantly (p = 0.381), but at high elevation, they significantly increased speed across trials (p = 0.001). At self-selected speeds, no effects were revealed (all p > 0.188) and only effects for Height were observed for fast speeds (p < 0.001). After turning at high elevation, participants reported greater cognitive (p = 0.008) and somatic anxiety (p = 0.007), reduced confidence (p = 0.021), and greater mental effort (p < 0.001) compared to the low elevation. CONCLUSION VR can safely induce mobility-related anxiety during dynamic motor tasks, and habituation effects from repeated exposure should be carefully considered in experimental designs and analysis.
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24
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The effects of temporal pressure on obstacle negotiation and gaze behaviour in young adults with simulated vision loss. Sci Rep 2019; 9:15409. [PMID: 31659214 PMCID: PMC6817899 DOI: 10.1038/s41598-019-51926-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/10/2019] [Indexed: 12/26/2022] Open
Abstract
Individuals with vision loss adapt their locomotion and gaze behaviour to safely negotiate objects in temporally unconstrained situations. However, everyday activities are often performed under time-pressure. We investigated the effects of blur on anxiety, movement kinematics and gaze behaviour during the negotiation of a floor-based obstacle under three amounts of pressure: 1) no-pressure; 2) tonal-pressure: an intermittent tone was played at a constant frequency; 3) tonal + time pressure: the intermittent tone increased in frequency and participants had to walk 20% faster to reach the end of the lab. Irrespective of the amount of pressure, the blurred vs. normal vision group reported 32% more anxiety, lifted the lead foot 43% higher and 10% slower over the obstacle, and looked 6% longer and 6% more frequently ahead of the obstacle. In the tonal + time pressure vs. no-pressure condition, both groups were more anxious, showed adaptations in movement kinematics related to walking faster, and adopted a ‘checking strategy’ by shortening their fixation durations at the obstacle. These results show that irrespective of temporal pressure, the blurred vision group remained more cautious as to how the lead foot negotiated the obstacle, in order to reduce the chance of tripping during crossing.
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van Schooten KS, Freiberger E, Sillevis Smitt M, Keppner V, Sieber C, Lord SR, Delbaere K. Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function. Phys Ther 2019; 99:989-997. [PMID: 30830212 DOI: 10.1093/ptj/pzz032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 11/12/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Higher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function. OBJECTIVE The aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function. DESIGN This was an observational, cross-sectional study. METHODS A total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n = 94; Australia, n = 110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale-International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function. RESULTS Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β = 0.18 ± 0.08; P = .037). LIMITATIONS The use of walking speed as a sole measure of gait was a limitation of this study. CONCLUSIONS Gait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.
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Affiliation(s)
| | - Ellen Freiberger
- Institute for Biomedicine on Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg, Koberger Strasse 60, 90408 Nürnberg, Germany
| | | | - Veronika Keppner
- Institute for Biomedicine on Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg
| | - Cornel Sieber
- Institute for Biomedicine on Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales
| | - Kim Delbaere
- Neuroscience Research Australia, Margarete Ainsworth Building, University of New South Wales, Barker Street, Randwick NSW 2031, Australia
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Johnson KJ, Zaback M, Tokuno CD, Carpenter MG, Adkin AL. Repeated exposure to the threat of perturbation induces emotional, cognitive, and postural adaptations in young and older adults. Exp Gerontol 2019; 122:109-115. [DOI: 10.1016/j.exger.2019.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/19/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
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Ellmers TJ, Cocks AJ, Young WR. Exploring attentional focus of older adult fallers during heightened postural threat. PSYCHOLOGICAL RESEARCH 2019; 84:1877-1889. [PMID: 31119367 PMCID: PMC7479009 DOI: 10.1007/s00426-019-01190-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/17/2019] [Indexed: 11/04/2022]
Abstract
Objectives Threats to balance, and subsequent increases in fall-related anxiety, can disrupt attentional processing during gait in older adults, leading to behavioral adaptations which may increase fall risk. However, limited research has investigated what changes in attention occur to contribute to these disruptions. The aim of this research was to describe changes in attention that occur during gait when older adults’ balance is threatened, while exploring how previous fall history and trait movement reinvestment (conscious monitoring and control of movement) also influence attention. Methods Forty older adults reported where they focus their attention when walking during two scenarios: (1) when they are relaxed and there is little risk of falling, and; (2) when their balance is threatened and they are anxious of falling. Results During the high-threat condition, participants reported greater attention towards movement processes, threats to balance, worries/disturbing thoughts and self-regulatory strategies, with less attention directed towards task-irrelevant thoughts. However, fall history influenced attentional focus, with fallers directing greater attention towards worries/disturbing thoughts. Contrary to predictions, trait movement reinvestment was not associated with attention directed towards movement processes. Discussion As processing worries/disturbing thoughts will likely reduce attentional resources available for effective postural control, we highlight this as one potential area to target interventions aimed at reducing the likelihood of repeated falling. Electronic supplementary material The online version of this article (10.1007/s00426-019-01190-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Toby J Ellmers
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK.
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK.
| | - Adam J Cocks
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
- Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, UK
| | - William R Young
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Older women take shorter steps during backwards walking and obstacle crossing. Exp Gerontol 2019; 122:60-66. [PMID: 31034865 DOI: 10.1016/j.exger.2019.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community ambulation requires the ability to adapt walking patterns to task demands. For example, complex walking tasks, such as obstacle crossing (OBS) and backwards walking (BW), require modification of gait kinematics to complete the task, maintain stability and prevent falling. More women than men fall each year, but few studies have investigated gender differences in performance of adaptive walking tasks. OBJECTIVE The purpose of this study was to determine gender differences in two common adaptive tasks. METHODS Walking performance was assessed from 54 age and gender matched participants (72 ± 5 yrs.) while they completed forward walking (FW), OBS and BW. Gait outcomes and the distance of the lead foot and the trail foot from the obstacle were normalized by leg length and assessed using multivariate analysis of variance. Additionally, performance in a battery of clinical physical and cognitive measures as well as self-reported activity levels were associated with adaptive gait behavior. RESULTS Gait speed and step width were not different between genders in any walking task. Compared to FW and OBS, women only decreased step length in BW, resulting in significantly shorter step lengths than men in OBS (p = 0.02) and BW (p = 0.04), a conservative walking strategy. Women crossed the obstacle in a manner that may limit recovery steps in case of a trip: stepping closer to the obstacle during approach without increasing trail toe-clearance. The Timed Up and Go mobility test, Short Physical Performance Battery, and Trail Making Test of processing speed and executive function were associated with gender differences in adaptive gait patterns. CONCLUSION The findings revealed that older adult women adapt walking in a way that might predispose them to tripping or falling (i.e. shorter steps and closer obstacle approach). Gender differences in adaptive walking are related to functional test performance and processing speed. Clinicians should consider targeting step length during adaptive walking tasks in women that may be at risk of mobility impairments.
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Castro P, Kaski D, Schieppati M, Furman M, Arshad Q, Bronstein A. Subjective stability perception is related to postural anxiety in older subjects. Gait Posture 2019; 68:538-544. [PMID: 30634135 DOI: 10.1016/j.gaitpost.2018.12.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/18/2018] [Accepted: 12/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Under static conditions, the objective and subjective measures of postural stability correlate well. However, age-related changes in postural control and task-related anxiety may modify the relationship between these subjective and objective measures. Ultimately, patients' symptoms represent subjective reports, thus understanding this relationship has clinical implications. AIMS This study investigates the relationship between subjective-objective measures of postural stability in dynamic conditions and whether this relationship is influenced by age or task-related anxiety. METHODS 50 healthy participants (aged 18-83 years) stood on a platform oscillating at variable amplitudes, with-without a fall-preventing harness to modulate task-related anxiety. Trunk sway path, hip velocity and foot lifts (objective measures) and subjective scores of instability and task-related anxiety were recorded. RESULTS The subjective perception of stability accurately matched objective body sway, following a logarithmic function profile (r2 = 0.72, p < 0.001). This function did not change significantly with age, harness or task presentation order. A strong relationship was observed between subjective measures of stability and task-related anxiety for all subjects (r = 0.81, p < 0.001). Task repetition reduced anxiety in the young, uncoupling anxiety changes from subjective instability, but not in the elderly who retained higher anxiety levels in line with subjective unsteadiness. DISCUSSION Subjects accurately rate their own instability during dynamic postural challenges, irrespective of age and actual fall risk. However, anxiety may selectively modulate the perception of instability in older subjects. The perception of stability relies upon the integration of sensory afferents but also recruits emotional-cognitive processes, particularly in older individuals. The use of a safety harness has no influence on subjective or objective postural stability.
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Affiliation(s)
- Patricia Castro
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK; Escuela de Fonoaudiologia, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Diego Kaski
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Marco Schieppati
- Department of Exercise & Sport Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
| | - Michael Furman
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Qadeer Arshad
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK
| | - Adolfo Bronstein
- Neuro-otology Unit, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College London, London, UK.
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Chow VWK, Ellmers TJ, Young WR, Mak TCT, Wong TWL. Revisiting the Relationship Between Internal Focus and Balance Control in Young and Older Adults. Front Neurol 2019; 9:1131. [PMID: 30687212 PMCID: PMC6333651 DOI: 10.3389/fneur.2018.01131] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
Research highlights the detrimental effect that directing too much conscious attention toward movement can have on postural control. While this concept has received support from many studies, recent evidence demonstrates that this principle does not always translate to aging clinical populations. Given the increasing clinical interest in this topic, the current study evaluated if the original notion (that an internal focus results in compromised balance performance) is upheld in young and older adults during a challenging balance task where we are able to objectively corroborate changes in attentional focus; using an electroencephalography (EEG) method previously identified as an objective indicator of conscious movement control. This method assesses the neural coherence, or "communication," between T3 (verbal-analytical) and Fz (motor-planning) regions of the brain. Thirty-nine young and 40 older adults performed a challenging balance task while holding a 2-meter pole under two randomized conditions: Baseline and Internal focus of attention (directing attention internally toward movement production). Results showed that young adults demonstrated increased EEG T3-Fz coherence in conjunction with increased sway path during the Internal focus condition. However, no significant differences were observed in older adults between conditions for any measure. The current study provides supporting evidence for the detrimental effect that adopting an Internal focus can have on postural control-especially in populations able to govern these processes in a relatively "automatic" manner (e.g., young adults). However, this work illustrates that such observations may not readily translate between populations and are not robust to age-related changes. Further work is necessary to examine mechanisms underlying this clear translational issue.
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Affiliation(s)
- Victoria W. K. Chow
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Toby J. Ellmers
- Department of Clinical Sciences, Brunel University London, London, United Kingdom
- Institute for Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - William R. Young
- Department of Clinical Sciences, Brunel University London, London, United Kingdom
- Institute for Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Toby C. T. Mak
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Thomson W. L. Wong
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
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31
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Bakkane Bendixen A, Engedal K, Selbæk G, Hartberg CB. Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality. Dement Geriatr Cogn Disord 2018; 45:180-189. [PMID: 29860257 DOI: 10.1159/000488480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/12/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Anxiety symptoms are common in older adults with depression, but whether severe anxiety is associated with poorer outcomes of depression is unknown. The objective of the present study was to examine the association between severity of anxiety and severity of depression and physical illness, suicidality, and physical and cognitive functioning in older adults with depression. METHODS We included 218 older adults with diagnoses of a depressive disorder according to the ICD-10 criteria; their mean age (SD) was 75.6 (7.2), and 67.0% were women. The Geriatric Anxiety Inventory (GAI) was used to measure the severity of anxiety symptoms. The Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess the severity of depression. We obtained information on the level of functioning with the Physical Self-Maintenance Scale (PSMS) by Lawton and Brody and on cognition with the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). Physical health was determined based on information regarding falls and weight loss and an assessment of each patient's general medical condition. The treating physician evaluated current suicidality in a comprehensive and standardized way. RESULTS Higher GAI scores were significantly associated with scores on the MADRS (β = 0.233, p = 0.002) and suicidality (β = 0.206, p = 0.006). Levels of physical or cognitive functioning were not associated with the GAI score. CONCLUSION The severity of anxiety symptoms was associated with the severity of depression and suicidality in older adults with depressive disorders. The results could indicate a need to focus greater attention on the treatment of anxiety and suicidality in older patients with depression.
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Affiliation(s)
- Anette Bakkane Bendixen
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
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32
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Ghai S, Ghai I, Effenberg AO. Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis. Aging Dis 2018; 9:901-923. [PMID: 30271666 PMCID: PMC6147584 DOI: 10.14336/ad.2017.1031] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 01/15/2023] Open
Abstract
Rhythmic auditory cueing has been widely used in gait rehabilitation over the past decade. The entrainment effect has been suggested to introduce neurophysiological changes, alleviate auditory-motor coupling and reduce cognitive-motor interferences. However, a consensus as to its influence over aging gait is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal gait parameters among healthy young and elderly participants. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until May 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 2789 records, 34 studies, involving 854 (499 young/355 elderly) participants met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e. gait velocity (Hedge's g: 0.85), stride length (0.61), and cadence (1.1), amongst both age groups. This review, for the first time, evaluates the effects of auditory entrainment on aging gait and discusses its implications under higher and lower information processing constraints. Clinical implications are discussed with respect to applications of auditory entrainment in rehabilitation settings.
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Affiliation(s)
- Shashank Ghai
- 1Institute for Sports Science, Leibniz University Hannover, Germany
| | - Ishan Ghai
- 2School of Life Sciences, Jacobs University Bremen, Germany
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Uiga L, Capio CM, Ryu D, Young WR, Wilson MR, Wong TWL, Tse ACY, Masters RSW. The Role of Movement-Specific Reinvestment in Visuomotor Control of Walking by Older Adults. J Gerontol B Psychol Sci Soc Sci 2018; 75:282-292. [DOI: 10.1093/geronb/gby078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/21/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Liis Uiga
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Te Huataki Waiora Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
| | - Catherine M Capio
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Te Huataki Waiora Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
| | - Donghyun Ryu
- Institute for the Psychology of Elite Performance, School of Sport, Health and Exercise Sciences, Bangor University, UK
| | - William R Young
- College of Health and Life Sciences, Brunel University, London, UK
| | - Mark R Wilson
- College of Life and Environmental Sciences, University of Exeter, UK
| | - Thomson W L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Andy C Y Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Rich S W Masters
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- Te Huataki Waiora Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
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Ellmers TJ, Young WR. Conscious motor control impairs attentional processing efficiency during precision stepping. Gait Posture 2018; 63:58-62. [PMID: 29715607 DOI: 10.1016/j.gaitpost.2018.04.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Current evidence suggests that fall-related anxiety can impair attentional processing efficiency during gait in both young and older adults, reducing the cognitive resources available for carrying out concurrent tasks (i.e., holding a conversation whilst walking or planning the safest route for navigation). RESEARCH QUESTION It has been suggested that fall-related anxiety may impair processing efficiency by directing attention 'internally', towards consciously controlling and monitoring movement. The present study aimed to evaluate this interpretation. METHODS Fifteen healthy young adults performed a precision stepping task during both single- and dual-task (completing the stepping task while simultaneously performing an arithmetic task), under three conditions: (1) Baseline; (2) Threat (walking on a platform raised 1.1 m above ground), and; (3) Internal focus of attention (cues/instructions to direct attention towards movement processing). RESULTS We observed significantly greater cognitive dual-task costs (i.e., poorer performance on the arithmetic task) during Threat compared to Baseline, with the greatest costs observed in individuals reporting the highest levels of Threat-induced conscious motor processing. Significantly greater cognitive dual-task costs were also observed during the Internal condition, confirming the assumption that consciously attending to movement reduces cognitive resources available for carrying out a secondary task during gait. These results were accompanied with significantly poorer stepping accuracy in dual-task trials during both Threat and Internal. SIGNIFICANCE These findings support previous attempts to rationalise attentional processing inefficiencies observed in anxious walkers as being a consequence of an anxiety-induced internal focus of attention.
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Affiliation(s)
- Toby J Ellmers
- College of Health and Life Sciences, Brunel University, London, UK; Institute for Environment, Health and Societies, Brunel University, London, UK.
| | - William R Young
- College of Health and Life Sciences, Brunel University, London, UK; Institute for Environment, Health and Societies, Brunel University, London, UK
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Denneman RPM, Kal EC, Houdijk H, Kamp JVD. Over-focused? The relation between patients' inclination for conscious control and single- and dual-task motor performance after stroke. Gait Posture 2018; 62:206-213. [PMID: 29571088 DOI: 10.1016/j.gaitpost.2018.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 02/14/2018] [Accepted: 03/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many stroke patients are inclined to consciously control their movements. This is thought to negatively affect patients' motor performance, as it disrupts movement automaticity. However, it has also been argued that conscious control may sometimes benefit motor performance, depending on the task or patientś motor or cognitive capacity. AIM To assess whether stroke patients' inclination for conscious control is associated with motor performance, and explore whether the putative association differs as a function of task (single- vs dual) or patientś motor and cognitive capacity. METHODS Univariate and multivariate linear regression analysis were used to assess associations between patients' disposition to conscious control (i.e., Conscious Motor Processing subscale of Movement-Specific Reinvestment Scale; MSRS-CMP) and single-task (Timed-up-and-go test; TuG) and motor dual-task costs (TuG while tone counting; motor DTC%). We determined whether these associations were influenced by patients' walking speed (i.e., 10-m-walk test) and cognitive capacity (i.e., working memory, attention, executive function). RESULTS Seventy-eight clinical stroke patients (<6 months post-stroke) participated. Patients' conscious control inclination was not associated with single-task TuG performance. However, patients with a strong inclination for conscious control showed higher motor DTC%. These associations were irrespective of patients' motor and cognitive abilities. CONCLUSION Patients' disposition for conscious control was not associated with single task motor performance, but was associated with higher motor dual task costs, regardless of patients' motor or cognitive abilities. CLINICAL RELEVANCE Therapists should be aware that patients' conscious control inclination can influence their dual-task performance while moving. Longitudinal studies are required to test whether reducing patients' disposition for conscious control would improve dual-tasking post-stroke.
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Affiliation(s)
- R P M Denneman
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands; Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
| | - E C Kal
- Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - H Houdijk
- Research & Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - J van der Kamp
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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36
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de Melker Worms JLA, Stins JF, van Wegen EEH, Loram ID, Beek PJ. Influence of focus of attention, reinvestment and fall history on elderly gait stability. Physiol Rep 2017; 5:e13061. [PMID: 28077603 PMCID: PMC5256154 DOI: 10.14814/phy2.13061] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022] Open
Abstract
Falls represent a substantial risk in the elderly. Previous studies have found that a focus on the outcome or effect of the movement (external focus of attention) leads to improved balance performance, whereas a focus on the movement execution itself (internal focus of attention) impairs balance performance in elderly. A shift toward more conscious, explicit forms of motor control occurs when existing declarative knowledge is recruited in motor control, a phenomenon called reinvestment. We investigated the effects of attentional focus and reinvestment on gait stability in elderly fallers and nonfallers. Full body kinematics was collected from twenty-eight healthy older adults walking on a treadmill, while focus of attention was manipulated through instruction. Participants also filled out the Movement Specific Reinvestment Scale (MSRS) and the Falls Efficacy Scale International (FES-I), and provided details about their fall history. Coefficients of Variation (CV) of spatiotemporal gait parameters and Local Divergence Exponents (LDE) were calculated as measures of gait variability and gait stability, respectively. Larger stance time CV and LDE (decreased gait stability) were found for fallers compared to nonfallers. No significant effect of attentional focus was found for the gait parameters, and no significant relation between MSRS score (reinvestment) and fall history was found. We conclude that external attention to the walking surface does not lead to improved gait stability in elderly. Potential benefits of an external focus of attention might not apply to gait, because walking movements are not geared toward achieving a distinct environmental effect.
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Affiliation(s)
- Jonathan L. A. de Melker Worms
- Department of Human Movement SciencesFaculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamMOVE Research Institute AmsterdamAmsterdamthe Netherlands
- Cognitive Motor Function research groupSchool of Healthcare ScienceManchester Metropolitan UniversityManchesterUnited Kingdom
| | - John F. Stins
- Department of Human Movement SciencesFaculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamMOVE Research Institute AmsterdamAmsterdamthe Netherlands
| | - Erwin E. H. van Wegen
- Department of Rehabilitation MedicineVU University Medical CenterMOVE Research Institute AmsterdamAmsterdamthe Netherlands
| | - Ian D. Loram
- Cognitive Motor Function research groupSchool of Healthcare ScienceManchester Metropolitan UniversityManchesterUnited Kingdom
| | - Peter J. Beek
- Department of Human Movement SciencesFaculty of Behavioural and Movement SciencesVrije Universiteit AmsterdamMOVE Research Institute AmsterdamAmsterdamthe Netherlands
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Ellmers TJ, Cocks AJ, Doumas M, Williams AM, Young WR. Gazing into Thin Air: The Dual-Task Costs of Movement Planning and Execution during Adaptive Gait. PLoS One 2016; 11:e0166063. [PMID: 27824937 PMCID: PMC5100909 DOI: 10.1371/journal.pone.0166063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
We examined the effect of increased cognitive load on visual search behavior and measures of gait performance during locomotion. Also, we investigated how personality traits, specifically the propensity to consciously control or monitor movements (trait movement ‘reinvestment’), impacted the ability to maintain effective gaze under conditions of cognitive load. Healthy young adults traversed a novel adaptive walking path while performing a secondary serial subtraction task. Performance was assessed using correct responses to the cognitive task, gaze behavior, stepping accuracy, and time to complete the walking task. When walking while simultaneously carrying out the secondary serial subtraction task, participants visually fixated on task-irrelevant areas ‘outside’ the walking path more often and for longer durations of time, and fixated on task-relevant areas ‘inside’ the walkway for shorter durations. These changes were most pronounced in high-trait-reinvesters. We speculate that reinvestment-related processes placed an additional cognitive demand upon working memory. These increased task-irrelevant ‘outside’ fixations were accompanied by slower completion rates on the walking task and greater gross stepping errors. Findings suggest that attention is important for the maintenance of effective gaze behaviors, supporting previous claims that the maladaptive changes in visual search observed in high-risk older adults may be a consequence of inefficiencies in attentional processing. Identifying the underlying attentional processes that disrupt effective gaze behaviour during locomotion is an essential step in the development of rehabilitation, with this information allowing for the emergence of interventions that reduce the risk of falling.
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Affiliation(s)
- Toby J. Ellmers
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
- * E-mail:
| | - Adam J. Cocks
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Michail Doumas
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - A. Mark Williams
- College of Heath, University of Utah, Salt Lake City, Utah, United States of America
| | - William R. Young
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Centre for Cognitive Neuroscience, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Institute of Environment, Health and Societies, Brunel University London, Uxbridge, United Kingdom
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Ellmers TJ, Machado G, Wong TWL, Zhu F, Williams AM, Young WR. A validation of neural co-activation as a measure of attentional focus in a postural task. Gait Posture 2016; 50:229-231. [PMID: 27653150 DOI: 10.1016/j.gaitpost.2016.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 07/25/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
Postural threat can induce conscious involvement in movement control. This internal focus has been implicated in compromising attentional processing efficiency during postural control, leading to behavioral adaptations that might increase the risk of falling in the elderly. It is suggested that electroencephalography (EEG) coherence, or 'communication', between T3 (verbal-analytical) and Fz (motor-planning) regions may provide an objective measure of internal focus in learned movement skills. However, it is currently unknown whether this experimental technique can be applied to the control of gait and posture; skills which develop early in life, without the use of declarative knowledge/explicit verbal cues to guide performance. We validate the utility of the EEG T3-Fz coherence analysis in a postural task. A total of 24 young adults produced small voluntary swaying movements in medial-lateral or anterior-posterior direction under conditions that directed their attentional focus either internally or externally. Although EEG coherence was sensitive to voluntary changes in attentional focus, the lack of observed between-group (High/Low-trait-reinvestment) difference in coherence may suggest that younger adults cannot be assumed to utilize explicit verbal cues to control voluntary postural sway unless explicitly instructed to do so. As a result, while these results indicate that EEG T3-Fz is a valid technique for assessing attentional focus in postural tasks, our data do not support the clinical application of this method of analysis in providing an objective indication of trait-reinvestment in tasks involving voluntary postural sway.
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Affiliation(s)
- Toby J Ellmers
- Department of Life Sciences, Brunel University London, UK.
| | - Guilherme Machado
- Centre of Research and Studies in Soccer, Universidade Federal de Viçosa, UFV, Brazil
| | | | - Frank Zhu
- Institute of Human Performance, The University of Hong Kong, PR China; Department of Orthopedics and Traumatology, The University of Hong Kong, PR China
| | | | - William R Young
- Department of Clinical Sciences, Brunel University London, UK
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