1
|
Schmidt L, Zieschang T, Koschate J, Stuckenschneider T. Impaired Standing Balance in Older Adults with Cognitive Impairment after a Severe Fall. Gerontology 2024; 70:755-763. [PMID: 38679005 DOI: 10.1159/000538598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Fall-related sequelae as well as balance and gait impairments are more pronounced in older adults who are cognitively impaired (OACI) compared to older adults who are cognitively healthy (OACH). Evidence is scarce about differences in standing balance and gait in OACH and OACI after a fall, even though these are major risks for recurrent falls. Thus, the aim of this study was to investigate early impairments in gait and balance, by adding inertial measurement units (IMUs) to a functional performance test in OACH and OACI after a severe fall with a presentation to the emergency department (ED) and immediate discharge. METHODS The study sample was stratified into participants with and without probable cognitive impairment using the result of the Montreal Cognitive Assessment total score (maximum of 30 points). The cutoff for probable cognitive impairment was set at ≤ 24. Standing balance and gait parameters were measured using three IMUs in n = 69 OACH (72.0 ± 8.2 years) and n = 76 OACI (78.7 ± 8.1 years). Data were collected at participants' homes as part of a comprehensive geriatric assessment in the "SeFallED" study within 4 weeks after presentation to the ED after a severe fall (German Clinical Trials Register ID: 00025949). ANCOVA was used for statistical analysis, adjusted for age. RESULTS The data indicated significantly more sway for OACI compared to OACH during balance tasks, whereas no differences in gait behavior were found. In detail, differences in standing balance were revealed for mean velocity (m/s) during parallel stance with eyes open (ηp2 = 0.190, p < 0.001) and eyes closed on a balance cushion (ηp2 = 0.059, p = 0.029), as well as during tandem stance (ηp2 = 0.034, p = 0.044) between OACI and OACH. Further differences between the two groups were detected for path length (m/s2) during parallel stance with eyes open (ηp2 = 0.144, p < 0.001) and eyes closed (ηp2 = 0.044, p < 0.027) and for range (m/s2) during tandem (ηp2 = 0.036, p = 0.036) and parallel stance with eyes closed (ηp2 = 0.045, p = 0.032). CONCLUSION Even though both groups have experienced a severe fall with presentation to the ED in the preceding 4 weeks, balance control among OACI indicated a higher fall risk than among OACH. Therefore, effective secondary fall prevention efforts have to be established, particularly for OACI.
Collapse
Affiliation(s)
- Laura Schmidt
- Department for Health Services Research, Geriatric Medicine/ School of Medicine and Health Services/Carl von Ossietzky University, Oldenburg, Germany
| | - Tania Zieschang
- Department for Health Services Research, Geriatric Medicine/ School of Medicine and Health Services/Carl von Ossietzky University, Oldenburg, Germany
| | - Jessica Koschate
- Department for Health Services Research, Geriatric Medicine/ School of Medicine and Health Services/Carl von Ossietzky University, Oldenburg, Germany
| | - Tim Stuckenschneider
- Department for Health Services Research, Geriatric Medicine/ School of Medicine and Health Services/Carl von Ossietzky University, Oldenburg, Germany
| |
Collapse
|
2
|
Sterke BT, Poggensee KL, Ribbers GM, Lemus D, Vallery H. Light-Weight Wearable Gyroscopic Actuators Can Modulate Balance Performance and Gait Characteristics: A Proof-of-Concept Study. Healthcare (Basel) 2023; 11:2841. [PMID: 37957986 PMCID: PMC10647239 DOI: 10.3390/healthcare11212841] [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: 07/31/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Falling is a major cause of morbidity, and is often caused by a decrease in postural stability. A key component of postural stability is whole-body centroidal angular momentum, which can be influenced by control moment gyroscopes. In this proof-of-concept study, we explore the influence of our wearable robotic gyroscopic actuator "GyroPack" on the balance performance and gait characteristics of non-impaired individuals (seven female/eight male, 30 ± 7 years, 68.8 ± 8.4 kg). Participants performed a series of balance and walking tasks with and without wearing the GyroPack. The device displayed various control modes, which were hypothesised to positively, negatively, or neutrally impact postural control. When configured as a damper, the GyroPack increased mediolateral standing time and walking distance, on a balance beam, and decreased trunk angular velocity variability, while walking on a treadmill. When configured as a negative damper, both peak trunk angular rate and trunk angular velocity variability increased during treadmill walking. This exploratory study shows that gyroscopic actuators can influence balance and gait kinematics. Our results mirror the findings of our earlier studies; though, with more than 50% mass reduction of the device, practical and clinical applicability now appears within reach.
Collapse
Affiliation(s)
- Bram T. Sterke
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Katherine L. Poggensee
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Rijndam Revalidatie, Westersingel 300, 3015 LJ Rotterdam, The Netherlands
| | - Daniel Lemus
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Heike Vallery
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
- Faculty of Mechanical Engineering, Rhine-Westphalia Technical University of Aachen, 52062 Aachen, Germany
| |
Collapse
|
3
|
Liao MC, Yen CC, Lin YT, Huang FD, Chang YT. Sarcopenia is associated with mortality in non-critical elderly patients visiting the emergency department. Front Med (Lausanne) 2023; 9:1027503. [PMID: 36714126 PMCID: PMC9874113 DOI: 10.3389/fmed.2022.1027503] [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: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Geriatric syndrome (GS) increases risk of disability and mortality in older adults. Sarcopenia is a predominant illness of GS and accelerate its progression. This study aimed to investigate associations between mortality, emergency department (ED) re-visits and GS-related illnesses among older adults who visited the ED. Method This retrospective observational study enrolled elderly patients who visited the ED in our hospital between January 2018 and October 2020. Patients were evaluated for potential sarcopenia, which was defined by both low handgrip strength and calf circumference. Follow-up was at least 6 months. Data of age, gender, mortality, ED re-visits, and GS-related illnesses were collected and analyzed for associations. Results A total of 273 older adults aged 74 years or older were included, of whom 194 were diagnosed with possible sarcopenia. Older adults with possible sarcopenia also had significantly lower body mass index (BMI); a higher proportion needed assistance with daily activities; more had malnutrition, frailty, and history of falls (all p < 0.001) and acute decline in activities of daily living (p = 0.027). Multivariate analysis showed that possible sarcopenia [adjusted hazard ratio, aHR): 9.89, 95% confidence interval (CI): 1.17-83.81, p = 0.036], living in residential institutions (aHR: 2.85, 95% CI: 1.08-7.50, p = 0.034), and frailty (aHR: 7.30, 95% CI: 1.20-44.62, p = 0.031) were associated with mortality. Aged over 85 years (adjusted odds ratio: 2.44, 95% CI: 1.25-4.80, p = 0.02) was associated with ED re-visits. Conclusion Sarcopenia is associated with mortality among older adults who visit ED. Initial screening for sarcopenia and relevant risk factors among older adults in the ED may help with early intervention for those at high-risk and may improve their prognosis.
Collapse
Affiliation(s)
- Mei-Chen Liao
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Cheng-Chang Yen
- Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Yuh-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Fong-Dee Huang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Yun-Te Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan,School of Medicine, National Yang-Ming University, Taipei City, Taiwan,Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan,Department of Emergency & Critical Care Medicine, Pingtung Veterans General Hospital, Pingtung City, Taiwan,*Correspondence: Yun-Te Chang, ,
| |
Collapse
|
4
|
Kudelka J, Geritz J, Welzel J, Hildesheim H, Maetzler C, Emmert K, Niemann K, Hobert MA, Pilotto A, Bergmann P, Maetzler W. What contributes most to the SPPB and its subscores in hospitalized geriatric patients: an ICF model-based approach. BMC Geriatr 2022; 22:668. [PMID: 35963992 PMCID: PMC9375907 DOI: 10.1186/s12877-022-03358-z] [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: 04/23/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mobility deficits are highly prevalent among geriatric patients and have serious impact on quality of life, hospitalizations, and mortality. This study aims to capture predictors of mobility deficits in hospitalized geriatric patients using the International Classification of Functioning, Disability and Health (ICF) model as a framework. Methods Data were obtained from n = 397 patients (78 ± 7 years, 15 ± 7 ICD-11 diagnoses) on a geriatric ward at time of admission. Mobility was assessed using the Short Physical Performance Battery (SPPB) total score and gait, static balance and transfer subscores. Parameters from an extensive assessment including medical history, neuropsychological and motor examination, and questionnaires were assigned to the five components of the ICF model. Spearman’s Correlation and multiple linear regression analyses were calculated to identify predictors for the SPPB total score and subscores. Results Use of walking aid, fear of falling (FOF, but not occurrence of previous falls), participation in society, ADL and grip strength were strongly associated with the SPPB total score and all subscores (p < .001). FOF and grip strength were significant predictors for the SPPB total score as well as for gait and transfer subscores. FOF also showed a strong association with the static balance subscore. The clinical parameters of the ICF model could only partially explain the variance in the SPPB total score (24%) and subscores (12–23%), with no parameter from the activities and participation component being significantly predictive. Conclusions FOF and reduced grip strength are associated with mobility deficits in a hospitalized geriatric cohort. Further research should focus on interventions to reduce FOF and increase muscle strength in geriatric patients. Moreover, there is a need for ICF-based assessments instruments (especially in the activities and participation components) that allow a holistic view on mobility and further daily life-relevant health aspects in geriatric patients.
Collapse
Affiliation(s)
- Jennifer Kudelka
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hanna Hildesheim
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Katharina Niemann
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Philipp Bergmann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| |
Collapse
|
5
|
Zhou J, Chen Y, Gin T, Bao D, Zhou J. The effects of repetitive transcranial magnetic stimulation on standing balance and walking in older adults with age-related neurological disorders: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2022; 78:842-852. [PMID: 35921153 PMCID: PMC10172986 DOI: 10.1093/gerona/glac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Considerable evidence showed that repetitive transcranial magnetic stimulation (rTMS) can improve standing balance and walking performance in older adults with age-related neurological disorders. We here thus completed a systematic review and meta-analysis to quantitatively examine such benefits of rTMS. METHODS A search strategy based on the PICOS principle was used to obtain the literature in four databases. The screening and assessments of quality and risk of bias in the included studies were independently completed by two researchers. Outcomes included scales related to standing balance, Timed Up and Go (TUG) time, and walking speed/time/distance. RESULTS Twenty-three studies consisting of 532 participants were included, and the meta-analysis was completed on 21 of these studies. The study quality was good. Compared to control, rTMS induced both short-term (≤3 days after last intervention session) and long-term (≥1 month following last intervention session) significant improvements in balance scales (e.g., Berg Balance Scale), TUG time, and walking speed/time/distance (short-term: standardized mean difference [SMD]=0.26~0.34, 95% confidence interval [CI]=0.05~0.62; long-term: SMD=0.40~0.44, 95% CI=0.04~0.79) for both PD and stroke cohorts. Subgroup analyses suggested that greater than nine sessions of high-frequency rTMS targeting primary motor cortex with greater than 3000 pulses per week can maximize such benefits. Only few mild-to-moderate adverse events/side effects were reported, which were similar between rTMS and control group. CONCLUSION The results suggest that rTMS holds promise to improve balance and walking performance in older adults with age-related neurological disorders. Future studies with more rigorous design are needed to confirm the observations in this work.
Collapse
Affiliation(s)
- Jun Zhou
- China Athletics College, Beijing Sport University, Beijing, China
| | - Yan Chen
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Trenton Gin
- Cornell University, Ithaca, New York, NY, United States
| | - Dapeng Bao
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Junhong Zhou
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
6
|
Li X, Chen Z, Yue Y, Zhou X, Gu S, Tao J, Guo H, Zhu M, Du Q. Effect of Wearable Sensor-Based Exercise on Musculoskeletal Disorders in Individuals With Neurodegenerative Diseases: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:934844. [PMID: 35959298 PMCID: PMC9360755 DOI: 10.3389/fnagi.2022.934844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background The application of wearable sensor technology in an exercise intervention provides a new method for the standardization and accuracy of intervention. Considering that the deterioration of musculoskeletal conditions is of serious concern in patients with neurodegenerative diseases, it is worthwhile to clarify the effect of wearable sensor-based exercise on musculoskeletal disorders in such patients compared with traditional exercise. Methods Five health science-related databases, including PubMed, Cochrane Library, Embase, Web of Science, and Ebsco Cumulative Index to Nursing and Allied Health, were systematically searched. The protocol number of the study is PROSPERO CRD42022319763. Randomized controlled trials (RCTs) that were published up to March 2022 and written in English were included. Balance was the primary outcome measure, comprising questionnaires on postural stability and computerized dynamic posturography. The secondary outcome measures are motor symptoms, mobility ability, functional gait abilities, fall-associated self-efficacy, and adverse events. Stata version 16.0 was used for statistical analysis, and the weighted mean difference (WMD) was selected as the effect size with a 95% confidence interval (CI). Results Fifteen RCTs involving 488 participants with mean ages ranging from 58.6 to 81.6 years were included in this review, with 14 of them being pooled in a quantitative meta-analysis. Only five included studies showed a low risk of bias. The Berg balance scale (BBS) was used in nine studies, and the pooled data showed a significant improvement in the wearable sensor-based exercise group compared with the traditional exercise group after 3–12-week intervention (WMD = 1.43; 95% CI, 0.50 to 2.36, P = 0.003). A significant change in visual score was found both post-assessment and at 1-month follow-up assessment (WMD = 4.38; 95% CI, 1.69 to 7.07, P = 0.001; I2 = 0.0%). However, no significant differences were found between the two groups in the secondary outcome measures (all p > 0.05). No major adverse events were reported. Conclusion The wearable sensor-based exercise had advantages in improving balance in patients with neurodegenerative diseases, while there was a lack of evidence in motor symptoms, mobility, and functional gait ability enhancement. Future studies are recommended to construct a comprehensive rehabilitation treatment system for the improvement in both postural control and quality of life. Systematic Review Registration http://www.crd.york.ac.uk/prospero/, identifier CRD42022319763.
Collapse
Affiliation(s)
- Xin Li
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengquan Chen
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Yue
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Xuan Zhou
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuangyu Gu
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Tao
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibin Guo
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meiwen Zhu
- Chongming Branch of Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Meiwen Zhu,
| | - Qing Du
- Department of Rehabilitation, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Chongming Branch of Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Qing Du,
| |
Collapse
|
7
|
Ansorge C, Miocic JM, Schauer F. Skin diseases in hospitalized geriatrics: a 9-year analysis from a University Dermatology Center in Germany. Arch Dermatol Res 2022; 314:427-437. [PMID: 34076756 PMCID: PMC9163006 DOI: 10.1007/s00403-021-02244-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
The demographic trend of an ageing society is mirrored in the rising number of hospitalized geriatric patients in Germany. However, there is still a wide gap of knowledge regarding the dermatological diseases, comorbidities and performed procedures within this growingly important group of patients. The study was conducted as a retrospective monocentric data analysis of all patients 65 years or older from the Department of Dermatology, Medical Center-University of Freiburg, Germany. In total, 10,009 individual hospitalisations were included from 2009 to 2017, and there was a notable increase of geriatric patients in the study period. This study illustrates the following: leading major diagnoses included malignant neoplasm of the head and neck, ulcerated and non-ulcerated inflammatory spectrum of chronic venous insufficiency, whereas angina pectoris, type 2 diabetes and cardiac diseases were noted most frequently as secondary diagnoses. Patients with venous diseases had considerably more often cardiopulmonary minor diagnoses, whereas endocrine diagnoses peaked in the cohort of patients with psoriasis and psychiatric and muscululoskeletal disorders in patients with bullous dieseases. Moh's surgery, dressings and multimodal dermatological treatments were the most often encoded procedures.
Collapse
Affiliation(s)
- Claudia Ansorge
- Department of Dermatology and Venereology, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 7, 79104, Freiburg, Germany
| | - Johannes M Miocic
- Institute of Earth and Environmental Sciences, University of Freiburg, Freiburg, Germany
- Geo-Energy, Energy and Sustainability Research Institute Groningen, University of Groningen, Nijenborgh 6, 9747 AG, Groningen, The Netherlands
| | - Franziska Schauer
- Department of Dermatology and Venereology, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße 7, 79104, Freiburg, Germany.
| |
Collapse
|
8
|
Kahya M, Hackman D, Jacobs L, Nilsson D, Rumsey Y, Oddsson LIE. Wearable Technologies Using Peripheral Neuromodulation to Enhance Mobility and Gait Function in Older Adults - A Narrative Review. J Gerontol A Biol Sci Med Sci 2022; 78:831-841. [PMID: 35179580 PMCID: PMC10172983 DOI: 10.1093/gerona/glac045] [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: 11/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mounting evidence suggests that wearable technologies using peripheral neuromodulation can provide novel ways of improving mobility and gait function in various patient populations including older adults. The purpose of this narrative review is to provide an overview of wearable technologies/devices to improve mobility and gait function through noninvasive peripheral neuromodulation in older adults over the age of 65 and to indicate the suggested mechanism of action behind these technologies. METHODS We performed searches for articles and conference abstracts written in English, using the following databases: Embase Classic+Embase from 1947 to July 15, 2021; Ovid MEDLINE®; Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions® from 1946 to July 15, 2021; PubMed; and Scopus. RESULTS Forty-one technologies met the inclusion/exclusion criteria. We found that the primary implementation of the 41 technologies can be divided into three main categories: sensory substitution, sensory augmentation (open loop, closed loop), and motor stimulation. Using these technologies, various aspects of mobility are treated or addressed, including e.g., gait function, fall risk, foot drop, navigating environment, postural control. CONCLUSIONS This narrative review summarizes wearable technologies that are currently commercially available and in stages of research and development. Overall, studies suggest that wearable peripheral neuromodulation technologies can improve aspects of mobility for older adults. Existing literature suggests that these technologies may lead to physiological changes in the brain through sensory re-weighting or other neuroplastic mechanisms to enhance the performance of mobility and gait function in older adults over the age of 65.
Collapse
Affiliation(s)
- Melike Kahya
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, MA, USA
| | | | | | | | | | - Lars I E Oddsson
- University of Minnesota, MN, USA.,RxFunction Inc. MN, USA.,Ben Gurion University of the Negev, Israel
| |
Collapse
|
9
|
IS THERE A RELATIONSHIP BETWEEN PAIN, LIMITS OF STABILITY AND SENSORY INTERACTION BALANCE IN PATIENTS WITH LUMBAR DISC HERNIATION? A CROSS-SECTIONAL STUDY. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2021. [DOI: 10.33457/ijhsrp.942729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
10
|
Hirase T, Okubo Y, Sturnieks DL, Lord SR. Pain Is Associated With Poor Balance in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2021; 21:597-603.e8. [PMID: 32334772 DOI: 10.1016/j.jamda.2020.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/13/2020] [Accepted: 02/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Pain is a risk factor for falls in older adults, but the mechanisms are not well understood, limiting our ability to implement effective preventive strategies. The aim of this study was to systematically review and synthesize the literature that has examined the impact of pain on static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS Studies from inception to March 2019 were identified from electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL), contact with the primary authors, and reference lists of included articles. METHODS Cross-sectional and case-control studies that compared objective balance measures between older (minimum age 60 years) adults with and without pain were included. RESULTS Thirty-nine eligible studies (n = 17,626) were identified. All balance modalities (static, dynamic, multicomponent, and reactive) were significantly poorer in participants with pain compared to those without pain. Subgroup analyses revealed that chronic pain (pain persisting ≥3 months) impaired balance more than pain of unspecified duration. The effects of pain at specific sites (neck, lower back, hip, knee, and foot) on balance were not significantly different. CONCLUSIONS AND IMPLICATIONS Pain is associated with poor static, dynamic, multicomponent, and reactive balance in community-dwelling older adults. Pain in the neck, lower back, hip, knee, and foot all contribute to poor balance, and this is even more pronounced for chronic pain. Comprehensive balance and pain characteristic assessments may reveal mechanisms underlying the contribution of pain to instability and increased fall risk in older people.
Collapse
Affiliation(s)
- Tatsuya Hirase
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia.
| | - Yoshiro Okubo
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daina L Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
11
|
张 季, 马 鑫, 苏 林, 余 力, 静 媛. [Screening for bilateral vestibulopathy in outpatients with unsteadiness]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:116-119. [PMID: 33540991 PMCID: PMC10127874 DOI: 10.13201/j.issn.2096-7993.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Indexed: 06/12/2023]
Abstract
Objective:This study aimed to find bilateral vestibulopathy(BVP) patients in outpatients with unsteadiness and investigate their clinical characteristics. Methods:According to the common manifestation and etiologies of BVP, 2075 outpatients who were diagnosed as imbalance, follow up on chemotherapy, bilateral Menière's disease, systemic lupus erythematosus(SLE) and vasculitis from January 2018 to October 2019 were searched based on the hospital information system. After completing a telephone screening interview, eligible individuals whose symptoms were in consistent with the diagnostic criteria of BVP were scheduled for questionnaires and video head impulse test(vHIT). Results:A total of 131 patients replied and complained chronic unsteadiness. The response rates of patients with bilateral Menière's disease, chemotherapy, SLE and vasculitis were 10.0%, 0%, 0.3% and 1.2%, respectively. Unsteadiness is uncommon or mild in outpatients with vasculitis, SLE and chemotherapy. Twenty-nine patients presented with typical symptoms of BVP and only 3 were diagnosed as BVP after vHIT. The horizontal vHIT gain was significantly lower among patients who reported very severe life impact than those reported mild to severe impact in older patients, as well as in male patients(both P<0.01). However, no significant differences were noted in younger and female patients(P=0.396, 0.180, respectively). Conclusion:BVP accounts for 2.3% in outpatients with unsteadiness, and only 10.3% of patients who presents with typical symptoms meet the diagnostic criteria, suggesting vestibular function test is of great significance in making diagnosis.
Collapse
Affiliation(s)
- 季蕾 张
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - 鑫 马
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - 林 苏
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - 力生 余
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - 媛媛 静
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)Department of Otorhinolaryngology Head and Neck Surgery, Peking University People's Hospital, Beijing, 100044, China
| |
Collapse
|
12
|
Calderón-Garcidueñas L, Torres-Solorio AK, Kulesza RJ, Torres-Jardón R, González-González LO, García-Arreola B, Chávez-Franco DA, Luévano-Castro SC, Hernández-Castillo A, Carlos-Hernández E, Solorio-López E, Crespo-Cortés CN, García-Rojas E, Mukherjee PS. Gait and balance disturbances are common in young urbanites and associated with cognitive impairment. Air pollution and the historical development of Alzheimer's disease in the young. ENVIRONMENTAL RESEARCH 2020; 191:110087. [PMID: 32890478 PMCID: PMC7467072 DOI: 10.1016/j.envres.2020.110087] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 05/03/2023]
Abstract
To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0 ± 5.7 y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3 ± 9.1 y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD.
Collapse
Affiliation(s)
| | | | - Randy J Kulesza
- Auditory Research Center, Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Jacobs AH, Emmert K, Baron R, Bartsch T, Bauer J, Becker C, Berg D, Bergmann P, Boetzel K, Bollheimer C, Deuschl G, Djukic M, Drey M, Durwen H, Ebersbach G, Elshehabi M, Geritz J, Gisinger C, Guennewig T, Hauptmann B, Heppner HJ, Hobert MA, Hofmann W, Huellemann P, Jahn K, Klucken J, Kurth R, Lindner R, Lingor P, Lukas A, Maetzold S, Mokrusch T, Mollenhauer B, Nau R, Plate A, Polidori MC, Prell T, Schellinger P, Spira D, Stephani U, Studt S, Trenkwalder C, Unger HL, Urban P, von Arnim CAF, Warnecke T, Weiss M, Wiedemann A, Wirth R, Witt K, Dodel R, Maetzler W. Neurogeriatrics-a vision for improved care and research for geriatric patients with predominating neurological disabilities. Z Gerontol Geriatr 2020; 53:340-346. [PMID: 32430766 PMCID: PMC7311516 DOI: 10.1007/s00391-020-01734-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/20/2020] [Indexed: 01/06/2023]
Abstract
Geriatric medicine is a rapidly evolving field that addresses diagnostic, therapeutic and care aspects of older adults. Some disabilities and disorders affecting cognition (e.g. dementia), motor function (e.g. stroke, Parkinson’s disease, neuropathies), mood (e.g. depression), behavior (e.g. delirium) and chronic pain disorders are particularly frequent in old subjects. As knowledge about these age-associated conditions and disabilities is steadily increasing, the integral implementation of neurogeriatric knowledge in geriatric medicine and specific neurogeriatric research is essential to develop the field. This article discusses how neurological know-how could be integrated in academic geriatric medicine to improve care of neurogeriatric patients, to foster neurogeriatric research and training concepts and to provide innovative care concepts for geriatric patients with predominant neurological conditions and disabilities.
Collapse
Affiliation(s)
- Andreas H Jacobs
- Department for Geriatric Medicine and Neurology, Johanniter Hospital, Bonn and European Institute for Molecular Imaging (EIMI), University of Münster, Münster, Germany
| | - Kirsten Emmert
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Ralf Baron
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Juergen Bauer
- Center for Geriatric Medicine, University of Heidelberg and Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Kiel, Germany
| | - Kai Boetzel
- Department of Neurology, University Hospital LMU Munich, Munich, Germany
| | - Cornelius Bollheimer
- Department of Geriatric Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Guenther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Marija Djukic
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Geriatrics, Protestant Hospital Göttingen-Weende, Göttingen, Germany
| | - Michael Drey
- Department of Medicine IV, University Hospital LMU Munich, Munich, Germany
| | - Herbert Durwen
- Department of Geriatric Medicine, St. Martinus Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Ebersbach
- Hospital for Movement Disorders/Parkinson's Disease, Beelitz-Heilstätten, Beelitz, Germany
| | - Morad Elshehabi
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Johanna Geritz
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Christoph Gisinger
- Center for Geriatric Medicine and Geriatric Nursing, Danube University Krems, Krems an der Donau, Austria
| | - Thomas Guennewig
- Department of Geriatrics and Neurology, Elisabeth Hospital Recklinghausen, Recklinghausen, Germany
| | - Bjoern Hauptmann
- Department of Neurology, Segeberger Kliniken, Bad Segeberg, Germany.,Department of Therapeutic Sciences, MSH Medical School Hamburg, Hamburg, Germany
| | - Hans-Juergen Heppner
- Department of Geriatrics, University Witten/Herdecke, Schwelm, Germany.,Helios Clinic Schwelm, Schwelm, Germany
| | - Markus A Hobert
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Werner Hofmann
- Geriatric Center Neumünster and Bad Bramstedt, Friedrich-Ebert-Hospital Neumünster, Neumünster, Germany
| | - Philipp Huellemann
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Klaus Jahn
- Schön Klinik Bad Aibling, Bad Aibling, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.,Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany
| | - Roland Kurth
- Neurological Practice Roland Kurth, Kiel, Germany
| | - Reinhard Lindner
- Institute for Social Work, University of Kassel, Kassel, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, Munich, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Albert Lukas
- Agaplesion Bethesda Clinic, Competence Centre of Geriatrics and Aging Research, University of Ulm, Ulm, Germany.,Malteser Hospital Bonn, Geriatric Centre, Academic Teaching Hospital, University of Bonn, Bonn, Germany
| | - Sara Maetzold
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany
| | - Thomas Mokrusch
- Department of Neurology and Early Neurological Rehabilitation, MediClin Hedon Klinik Lingen, Lingen, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik Kassel, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Roland Nau
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.,Department of Geriatrics, Protestant Hospital Göttingen-Weende, Göttingen, Germany
| | - Annika Plate
- Department of Neurology, University Hospital LMU Munich, Munich, Germany
| | - Maria Cristina Polidori
- Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, and Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases, Cologne, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Schellinger
- Departments of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Dominik Spira
- Department of Endocrinology and Metabolism, Charité-University Medical Center, Berlin, Germany
| | - Ulrich Stephani
- Department of Neuropediatrics, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Kiel, Germany
| | - Simone Studt
- Gerontopsychiatry, Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Kiel, Germany
| | - Claudia Trenkwalder
- Clinic of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.,Paracelsus-Elena Klinik, Kassel, Germany
| | - Heinz L Unger
- Department of Geriatrics and Early Rehabilitation, Evangelical Hospital Kalk Cologne, Cologne, Germany
| | - Peter Urban
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Tobias Warnecke
- Department of Neurology, University of Münster, Münster, Germany
| | - Michael Weiss
- Clinic for Neurology and Clinical Neurophysiology, Schön Klinik Neustadt, Neustadt, Germany
| | - Andreas Wiedemann
- Department of Urology, Evangelical Hospital Witten, Witten, Germany.,Department of Geriatrics, Witten-Herdecke University, Witten, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr University Bochum, Bochum, Germany
| | - Karsten Witt
- Department of Neurology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Richard Dodel
- Chair of Geriatrics, University Hospital Essen and Geriatriezentrum Haus Berge, Contilia Group, Essen, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein Campus Kiel, Kiel University, Arnold-Heller-Str. 3, House D, 24105, Kiel, Germany.
| |
Collapse
|