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Sterke B, Jabeen S, Baines P, Vallery H, Ribbers G, Heijenbrok-Kal M. Direct biomechanical manipulation of human gait stability: A systematic review. PLoS One 2024; 19:e0305564. [PMID: 38990959 PMCID: PMC11239080 DOI: 10.1371/journal.pone.0305564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
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Affiliation(s)
- Bram Sterke
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Patricia Baines
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Heike Vallery
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Gerard Ribbers
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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Tuzun S, Akarirmak U, Kulaksiz B, Keles A, Okutan D, Karsli P, Kurtoglu SS, Aygun E, Palamar D. The association of FRAX with predictors of falls in the assessment of postmenopausal osteoporosis in Turkey: the fracture study of Turkey (FRACT study). Arch Osteoporos 2024; 19:29. [PMID: 38642281 PMCID: PMC11032283 DOI: 10.1007/s11657-024-01387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
Although FRAX is used for fracture risk evaluation, this tool does not include balance and fall risk. The association between the predictors of falls and high FRAX scores we found in this study suggests that risk indicators for falls may add substantial value to FRAX by improving fracture risk prediction. PURPOSE This observational, descriptive, and cross-sectional study aimed to assess the fall risk predictors and explore their association with FRAX in Turkish patients with postmenopausal osteoporosis. METHODS Two hundred and nine (209) women with postmenopausal osteoporosis referred to the Fracture Liaison Service (FLS) at Istanbul University-Cerrahpaşa were enrolled in the FRACT study (The Fracture Study of Turkey). Clinical risk factors were assessed using the FRAX tool. Tandem stance, Tandem walking, Timed up and go (TUG), and Chair stand tests were performed to assess balance and fall risk. RESULTS Among patients with a mean age of 67.6 (± 9.7) years, 66 patients (31.6%) had osteoporosis without fractures and 143 patients (68.4%) had fragility fractures. The proportion of patients with poor performance of fall prediction tests was significantly higher in patients with a fragility fracture than those with osteoporosis alone. There was an inverse relationship between dynamic balance tests and the reported number of prior falls in the past year. FRAX score was higher in patients with impaired Tandem stance, Tandem walking, and TUG tests (p = 0.008, p = 0.035, p = 0.001, respectively). CONCLUSION Assessment of fall risk predictors should be one of the major pillars in the physical evaluation of osteoporotic patients in the FLS setting. FRAX is a useful tool to determine the fracture risk of patients with both static and dynamic balance impairments. Combining balance assessment with FRAX may be an important step to optimize osteoporosis risk assessment.
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Affiliation(s)
- Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey.
| | - Ulku Akarirmak
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Bilal Kulaksiz
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Aslinur Keles
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Dilara Okutan
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Pinar Karsli
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Sevgi Selin Kurtoglu
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Eren Aygun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
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Soubra R, Mourad-Chehade F, Chkeir A. Automation of the Timed Up and Go Test Using a Doppler Radar System for Gait and Balance Analysis in Elderly People. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:2016262. [PMID: 37426725 PMCID: PMC10325879 DOI: 10.1155/2023/2016262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 07/11/2023]
Abstract
The timed up and go (TUG) test is a simple, valid, and reliable clinical tool that is widely used to assess mobility in elderly people. Several research studies have been conducted to automate the TUG test using wearable sensors or motion-tracking systems. Despite their promising results, the adopted technological systems present inconveniences in terms of acceptability and privacy protection. In this work, we propose to overcome these problems by using a Doppler radar system set into the backrest of a chair in order to automate the TUG test and extract additional information from its phases (i.e., transfer, walk, and turn). We intend to segment its phases and extract spatiotemporal gait parameters automatically. Our methodology is mainly based on a multiresolution analysis of radar signals. We proposed a segmentation technique based on the extraction of limbs oscillations signals through a semisupervised machine learning approach, on the one hand, and the application of the DARC algorithm on the other hand. Once the speed signals of torso and limbs oscillations were detected, we suggested estimating 14 gait parameters. All our approaches were validated by comparing outcomes to those obtained from a reference Vicon system. High correlation coefficients were obtained by comparing the speed signals of the torso (ρ=0.8), the speed signals of limbs oscillations (ρ=0.91), the initial and final indices of TUG phases (ρ=0.95), and the extracted parameters (percentage error < 4.8) obtained after radar signal processing to those obtained from the Vicon system.
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Affiliation(s)
- Racha Soubra
- Laboratory of Computer Science and Digital Society (LIST3N), University of Technology of Troyes, Troyes, France
| | - Farah Mourad-Chehade
- Laboratory of Computer Science and Digital Society (LIST3N), University of Technology of Troyes, Troyes, France
| | - Aly Chkeir
- Laboratory of Computer Science and Digital Society (LIST3N), University of Technology of Troyes, Troyes, France
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Fraenkel L, Pack Q, Drager L, Patel J, Pontier P, Lindenauer PK. Stepped care versus center-based cardiopulmonary rehabilitation for older frail adults living in rural MA: Design of a feasibility randomized controlled trial. Contemp Clin Trials Commun 2023; 33:101147. [PMID: 37168819 PMCID: PMC10164764 DOI: 10.1016/j.conctc.2023.101147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/13/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023] Open
Abstract
Background Cardiac and pulmonary rehabilitation programs are grossly underutilized, and participation is particularly low in rural regions. Methods We are conducting a 2-arm, randomized controlled feasibility trial. Eligible participants include older frail adults with cardiac or pulmonary disease living in a predominantly rural county in western Massachusetts. Participants are randomized 1:1 to treatment as usual or stepped care. Patients randomized to treatment as usual participate in twice weekly center-based rehabilitation sessions over eight weeks and are encouraged to exercise at home in between sessions. Patients randomized to the stepped-care arm are offered/enrolled in the center-based rehabilitation program followed by possible step up to three interventions based on prespecified non-response criteria: 1) Transportation-assisted center-based rehabilitation, 2) Home-based telerehabilitation, and 3) Community health worker-supported home-based telerehabilitation. The primary feasibility outcomes are average number of eligible patients randomized per month, baseline measure completion, proportion attending at least 70% of the prescribed sessions, average number of sessions attended in the stepped-care arm, and proportion in the stepped-care arm completing patient reported outcome measures. Each of these process indicators is evaluated by preset "Stop" and "Go" thresholds. Conclusion The proposed stepped-care model is an efficient, patient-centered, approach to expanding access to cardiac and pulmonary rehabilitation. Meeting the "Go" thresholds for the prespecified process indicators will justify conducting a definitive full-scale randomized controlled trial to compare the effectiveness and value (cost-effectiveness) of stepped-care versus center-based rehabilitation in older frail adults living rural counties.
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Affiliation(s)
- Liana Fraenkel
- Berkshire Medical Center, Berkshire Health Systems, Pittsfield, MA, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Quinn Pack
- Department of Healthcare Delivery & Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Leslie Drager
- Berkshire Medical Center, Berkshire Health Systems, Pittsfield, MA, USA
| | - Jagruti Patel
- Berkshire Medical Center, Berkshire Health Systems, Pittsfield, MA, USA
| | - Paulette Pontier
- Fairview Hospital, Berkshire Health Systems, Great Barrington, MA, USA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery & Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
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Ramesh SH, Lemaire ED, Tu A, Cheung K, Baddour N. Automated Implementation of the Edinburgh Visual Gait Score (EVGS) Using OpenPose and Handheld Smartphone Video. SENSORS (BASEL, SWITZERLAND) 2023; 23:4839. [PMID: 37430751 DOI: 10.3390/s23104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/12/2023]
Abstract
Recent advancements in computing and artificial intelligence (AI) make it possible to quantitatively evaluate human movement using digital video, thereby opening the possibility of more accessible gait analysis. The Edinburgh Visual Gait Score (EVGS) is an effective tool for observational gait analysis, but human scoring of videos can take over 20 min and requires experienced observers. This research developed an algorithmic implementation of the EVGS from handheld smartphone video to enable automatic scoring. Participant walking was video recorded at 60 Hz using a smartphone, and body keypoints were identified using the OpenPose BODY25 pose estimation model. An algorithm was developed to identify foot events and strides, and EVGS parameters were determined at relevant gait events. Stride detection was accurate within two to five frames. The level of agreement between the algorithmic and human reviewer EVGS results was strong for 14 of 17 parameters, and the algorithmic EVGS results were highly correlated (r > 0.80, "r" represents the Pearson correlation coefficient) to the ground truth values for 8 of the 17 parameters. This approach could make gait analysis more accessible and cost-effective, particularly in areas without gait assessment expertise. These findings pave the way for future studies to explore the use of smartphone video and AI algorithms in remote gait analysis.
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Affiliation(s)
- Shri Harini Ramesh
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Edward D Lemaire
- The Ottawa Hospital Research Institute, Ottawa, ON K1H 8M2, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Albert Tu
- Department of Surgery, Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Kevin Cheung
- Department of Surgery, Division of Plastic Surgery, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Natalie Baddour
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Muhammad T, Srivastava S, Debnath P, Kumar P, Kumar M. Does tandem balance test predict cognitive impairment among older adults? Findings from Longitudinal Ageing Study in India, 2017-18. Aging Clin Exp Res 2023; 35:855-865. [PMID: 36757673 DOI: 10.1007/s40520-023-02359-1] [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: 12/17/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Ageing entails a decline in physical and functional abilities including a reduced body balance due to complex integration and coordination of sensory acuity, motor control, neural and cognitive functions. This study aimed to examine the association between tandem balance test and cognitive impairment among older Indian adults. The study also examined the gender differentials in the associations with an interaction analysis. METHODS Data for this study were drawn from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the present study included 26,539 older adults age 60 years and above. Descriptive statistics and bivariate analysis were used to present the preliminary results. Two sample proportion test was used to evaluate the significance for gender differences. Further, multivariable binary logistic regression analysis was used to evaluate the independent association of balance test performance and cognitive impairment among older adults. RESULTS Nearly 16% of male and 26% of female older adults could not finish full tandem test in this study. There were significant gender differences in cognitive impairment among older adults (male-6.5% and female-18.9%). The likelihood of cognitive impairment was significantly higher among older adults who could not finish the full tandem test compared to those who finished the tandem test [AOR: 1.22; CI: 1.09-1.36]. The interaction model revealed that older females who could not finish the full tandem test were 2.11 times significantly more likely to be cognitively impaired in reference to older males who finished the full tandem test [AOR: 2.11; CI: 1.81,2.45]. Similarly, older females who finished the full tandem test were 2.42 times significantly more likely to be cognitively impaired in reference to older males who finished the full tandem test [AOR: 2.42; CI: 2.02,2.88]. CONCLUSION The findings of the study suggest that healthcare professionals working with older adults should consider the results of a balance test to screen for their risk of cognitive impairment. Results from the relationship between failing to finish the tandem test and cognitive impairment may be helpful for identifying older men and women who are at higher risk of experiencing mobility decline and their progression to dementia.
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Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, Maharashtra, India.
| | | | | | | | - Manish Kumar
- Population Research Centre (PRC), Dharwad, India
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Vaz S, Hang JA, Codde J, Bruce D, Spilsbury K, Hill AM. Prescribing tailored home exercise program to older adults in the community using a tailored self-modeled video: A pre-post study. Front Public Health 2022; 10:974512. [PMID: 36620232 PMCID: PMC9815032 DOI: 10.3389/fpubh.2022.974512] [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: 06/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background Community rehabilitation for older people after hospital discharge is necessary to regain functional ability and independence. However, poor adherence to exercise programs continues to hinder achieving positive health outcomes in older people. This study aimed to evaluate the effectiveness of prescribing a tailored video self-modeled DVD-HEP for 6 weeks, on functional mobility, physical activity, exercise self-efficacy, and health-related quality of life, in a sample of frail older adults. Materials and methods A pre- and post-test intervention study design was conducted, with each participant acting as their own control. A convergent, parallel, mixed-methods approach involving quantitative, and qualitative data collection was used. Participants received an individualized assessment at baseline and subsequently were provided with a 30-min tailored 6-week self-modeled DVD-HEP that showed the physiotherapist instructing the participant. The physiotherapist phoned participants fortnightly to encourage engagement in the program and explore responses to it. Outcomes evaluated included functional mobility, balance, gait speed, and exercise self-efficacy. Results Participants (n = 15) showed clinically meaningful improvements at follow-up compared to baseline in functional mobility (TUGMCID = 3.4-3.5 s, 3-MWTMCID = 0.1-0.2 m/s) and gait speed (3-MWTMCID = 0.1-0.2 m/s). There were also significant improvements in balance and self-efficacy for exercise and a 2.5- and a 1.3-fold increase in moderate and light physical activity participation at follow-up compared to baseline. The deductive themes were: (i) Enjoyment, self-efficacy, and wellbeing; (ii) Achieving life goals; (iii) Background music as a motivator to adherence; and (iv) Enhanced motor performance and learning: Task goal mastery, multimodal feedback, autonomy to self-regulate learning. The new inductive theme was (v) Preference for in-person support for exercise. Conclusion Future studies are warranted to compare a tailored self-modeled video HEP to face-to-face programs and other digital health modalities to evaluate older adults' adherence levels and functional improvement.
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Affiliation(s)
- Sharmila Vaz
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia,*Correspondence: Sharmila Vaz, ✉
| | - Jo-Aine Hang
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
| | - Jim Codde
- Institute for Health Research, The University of Notre Dame, Fremantle, WA, Australia
| | - David Bruce
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Katrina Spilsbury
- Institute for Health Research, The University of Notre Dame, Fremantle, WA, Australia
| | - Anne-Marie Hill
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
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Ng YL, Hill KD, Jacques A, Burton E. Reliability and Validity of a Modified Version of the Community Balance and Mobility Scale (CBMS-Home) for Use in Home Assessment. Phys Ther 2021; 101:6290102. [PMID: 34077548 DOI: 10.1093/ptj/pzab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/09/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Community Balance and Mobility Scale (CBMS) has been shown to be a valid and reliable outcome measure for evaluating balance and mobility among older adults; however, some items cannot be conducted in all home environments, limiting its use in home-based assessments. The purpose of this study was to evaluate the accuracy and selected measurement properties of a modified 12-item CBMS-Home (8 original items and 4 modified items of the CBMS) feasible for use within the constraints of home assessments for older adults. METHODS Fifty-five people (mean [SD] age = 77.2 [6.0] years) were recruited for this validation study. Participants completed the full original CBMS, CBMS-Home (the modified items of the CBMS), the Functional Reach Test, and Step Test. Principal components analysis, internal consistency, test-retest and intermethod reliability, agreements within and between methods, and criterion validity were calculated. RESULTS Principal components analysis of CBMS and CBMS-Home both revealed 3 similar components and loadings. Bland-Altman and weighted κ analyses revealed that the CBMS-Home demonstrated moderate to almost perfect agreement (weighted κ = 0.45-0.84) with CBMS. The distribution of scores of CBMS-Home were satisfactory, and other results showed excellent test-retest (intraclass correlation coefficient [ICC] = 0.95) and intermethod reliability (ICC = 0.94) and internal consistency (Cronbach α = 0.94). There were no ceiling effects (0%) or floor (1.8%) effects. CBMS-Home demonstrated a low (Spearman ρ = 0.39) and moderate positive (Spearman ρ = 0.63) relationship with the Functional Reach Test and Step Test, respectively. CONCLUSIONS The CBMS-Home has good psychometric properties and provides a useful multidimensional assessment tool. IMPACT A modified version of the CBMS (CBMS-Home) can be confidently used to assess older adults-within their own home-who might have mild balance impairments.
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Affiliation(s)
- Yoke Leng Ng
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Angela Jacques
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Collimore AN, Aiello AJ, Pohlig RT, Awad LN. The Dynamic Motor Control Index as a Marker of Age-Related Neuromuscular Impairment. Front Aging Neurosci 2021; 13:678525. [PMID: 34366824 PMCID: PMC8339561 DOI: 10.3389/fnagi.2021.678525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/11/2021] [Indexed: 12/22/2022] Open
Abstract
Biomarkers that can identify age-related decline in walking function have potential to promote healthier aging by triggering timely interventions that can mitigate or reverse impairments. Recent evidence suggests that changes in neuromuscular control precede changes in walking function; however, it is unclear which measures are best suited for identifying age-related changes. In this study, non-negative matrix factorization of electromyography data collected during treadmill walking was used to calculate two measures of the complexity of muscle co-activations during walking for 36 adults: (1) the number of muscle synergies and (2) the dynamic motor control index. Study participants were grouped into young (18–35 years old), young-old (65–74 years old), and old–old (75+ years old) subsets. We found that the dynamic motor control index [χ2(2) = 9.41, p = 0.009], and not the number of muscle synergies [χ2(2) = 5.42, p = 0.067], differentiates between age groups [χ2(4) = 10.62, p = 0.031, Nagelkerke R2 = 0.297]. Moreover, an impairment threshold set at a dynamic motor control index of 90 (i.e., one standard deviation below the young adults) was able to differentiate between age groups [χ2(2) = 9.351, p = 0.009]. The dynamic motor control index identifies age-related differences in neuromuscular complexity not measured by the number of muscle synergies and may have clinical utility as a marker of neuromotor impairment.
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Affiliation(s)
- Ashley N Collimore
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Ashlyn J Aiello
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE, United States
| | - Louis N Awad
- Neuromotor Recovery Laboratory, Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
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Adamowicz L, Karahanoglu FI, Cicalo C, Zhang H, Demanuele C, Santamaria M, Cai X, Patel S. Assessment of Sit-to-Stand Transfers during Daily Life Using an Accelerometer on the Lower Back. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20226618. [PMID: 33228035 PMCID: PMC7699326 DOI: 10.3390/s20226618] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 06/11/2023]
Abstract
The ability to perform sit-to-stand (STS) transfers has a significant impact on the functional mobility of an individual. Wearable technology has the potential to enable the objective, long-term monitoring of STS transfers during daily life. However, despite several recent efforts, most algorithms for detecting STS transfers rely on multiple sensing modalities or device locations and have predominantly been used for assessment during the performance of prescribed tasks in a lab setting. A novel wavelet-based algorithm for detecting STS transfers from data recorded using an accelerometer on the lower back is presented herein. The proposed algorithm is independent of device orientation and was validated on data captured in the lab from younger and older healthy adults as well as in people with Parkinson's disease (PwPD). The algorithm was then used for processing data captured in free-living conditions to assess the ability of multiple features extracted from STS transfers to detect age-related group differences and assess the impact of monitoring duration on the reliability of measurements. The results show that performance of the proposed algorithm was comparable or significantly better than that of a commercially available system (precision: 0.990 vs. 0.868 in healthy adults) and a previously published algorithm (precision: 0.988 vs. 0.643 in persons with Parkinson's disease). Moreover, features extracted from STS transfers at home were able to detect age-related group differences at a higher level of significance compared to data captured in the lab during the performance of prescribed tasks. Finally, simulation results showed that a monitoring duration of 3 days was sufficient to achieve good reliability for measurement of STS features. These results point towards the feasibility of using a single accelerometer on the lower back for detection and assessment of STS transfers during daily life. Future work in different patient populations is needed to evaluate the performance of the proposed algorithm, as well as assess the sensitivity and reliability of the STS features.
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Baker J, de Laat D, Kruger E, McRae S, Trung S, Zottola C, Omaña H, Hunter SW. Reliable and valid measures for the clinical assessment of balance and gait in older adults with dementia: a systematic review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1788638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Jacqueline Baker
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Danielle de Laat
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Emily Kruger
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Sarah McRae
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Sabrina Trung
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Carly Zottola
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Humberto Omaña
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Susan W. Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
- Faculty of Health Sciences, University of Western Ontario, London, Canada
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Zadravec M, Olenšek A, Rudolf M, Bizovičar N, Goljar N, Matjačić Z. Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects. J Neuroeng Rehabil 2020; 17:85. [PMID: 32615990 PMCID: PMC7330998 DOI: 10.1186/s12984-020-00710-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/23/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects. METHODS Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group. RESULTS The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions. CONCLUSIONS Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Timed-Up-and-Go and Functional Independence Measure tests may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.
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Affiliation(s)
- Matjaž Zadravec
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Andrej Olenšek
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Marko Rudolf
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Nataša Bizovičar
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Nika Goljar
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia
| | - Zlatko Matjačić
- University rehabilitation institute Republic of Slovenia, Linhartova 51, SI-1000, Ljubljana, Slovenia.
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Staples WH, Kays A, Richman R. Examination of the Correlation Between Physical and Psychological Measures in Community-Dwelling Older Adults. Clin Interv Aging 2020; 15:293-300. [PMID: 32184578 PMCID: PMC7060027 DOI: 10.2147/cia.s239053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The purpose of this study was to determine if correlations exist between strength and mobility and psychological measures of anxiety and depression in community-dwelling older adults. METHODS One hundred and eleven participants randomly completed trials of grip strength (GS), the Timed Up and Go (TUG), the 10-meter walk test (10MWT), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS) in a prospective, correlational study. RESULTS This study found significant correlations between and within physical measures of strength and mobility and psychological measures. Age, GS, GDS, and education were significant predictors of gait speed (10MWT). Age, GS, and GDS were predictors of TUG scores. Grip strength was found to be a significant predictor of fall status; fallers had significantly weaker GS than non-fallers. Symptoms of anxiety (GAS) were predictive of symptoms of depression. DISCUSSION Objective measures of physical performance can provide information regarding an individual's symptoms of anxiety and depression. Health professionals should understand the correlations between mood and physical ability to better treat their patients.
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Affiliation(s)
- William H Staples
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
| | - Adam Kays
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
| | - Rachel Richman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
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14
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A Systematic Review of Thirty-One Assessment Tests to Evaluate Mobility in Older Adults. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1354362. [PMID: 31321227 PMCID: PMC6610744 DOI: 10.1155/2019/1354362] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/28/2019] [Accepted: 05/27/2019] [Indexed: 12/05/2022]
Abstract
Assessments of gait, balance, and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility. Several evaluation tools have been proposed; however, clinicians should select the most accurate ones wisely, based on numerous criteria. This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible. Initially, a broad search was performed. Articles were screened based on their titles and abstracts, and only studies published in English were considered. Based on our inclusion and exclusion criteria, 31 assessment tests evaluating the mobility of healthy elderly people were found. Then, further searches were completed to identify the measurement properties of each test. These characteristics include the origin and year of establishment, several practicality factors, and validity. The analysis of our outcomes illustrates the similarities and differences between the identified tests.
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Gerhardy T, Gordt K, Jansen CP, Schwenk M. Towards Using the Instrumented Timed Up-and-Go Test for Screening of Sensory System Performance for Balance Control in Older Adults. SENSORS 2019; 19:s19030622. [PMID: 30717202 PMCID: PMC6387355 DOI: 10.3390/s19030622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
Background: Decreasing performance of the sensory systems’ for balance control, including the visual, somatosensory and vestibular system, is associated with increased fall risk in older adults. A smartphone-based version of the Timed Up-and-Go (mTUG) may allow screening sensory balance impairments through mTUG subphases. The association between mTUG subphases and sensory system performance is examined. Methods: Functional mobility of forty-one community-dwelling older adults (>55 years) was measured using a validated mTUG. Duration of mTUG and its subphases ‘sit-to-walk’, ‘walking’, ‘turning’, ‘turn-to-sit’ and ‘sit-down’ were extracted. Sensory systems’ performance was quantified by validated posturography during standing (30 s) under different conditions. Visual, somatosensory and vestibular control ratios (CR) were calculated from posturography and correlated with mTUG subphases. Results: Vestibular CR correlated with mTUG total time (r = 0.54; p < 0.01), subphases ‘walking’ (r = 0.56; p < 0.01), and ‘turning’ (r = 0.43; p = 0.01). Somatosensory CR correlated with mTUG total time (r = 0.52; p = 0.01), subphases ‘walking’ (r = 0.52; p < 0.01) and ‘turning’ (r = 0.44; p < 0.01). Conclusions: Supporting the proposed approach, results indicate an association between specific mTUG subphases and sensory system performance. mTUG subphases ‘walking’ and ‘turning’ may allow screening for sensory system deterioration. This is a first step towards an objective, detailed and expeditious balance control assessment, however needing validation in a larger study.
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Affiliation(s)
- Thomas Gerhardy
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
| | - Katharina Gordt
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
| | - Carl-Philipp Jansen
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
| | - Michael Schwenk
- Network Aging Research; Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany.
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany.
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Zhang C, Talaber A, Truong M, Vargas BB. K-D Balance: An objective measure of balance in tandem and double leg stances. Digit Health 2019; 5:2055207619885573. [PMID: 31723434 PMCID: PMC6831964 DOI: 10.1177/2055207619885573] [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: 03/18/2019] [Accepted: 10/05/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Subjective grade-based scoring balance assessments tend to be lengthy and have demonstrated poor repeatability and reliability. This study examined the reliability of a mobile balance assessment tool and differences in balance measurements between individuals at risk for a balance deficit secondary to a diagnosed neurological or musculoskeletal condition and a control group of healthy individuals. METHODS Objective balance testing was measured using K-D Balance on a compatible iPhone. Seventy-seven participants were enrolled (control group, n = 44; group at risk for balance deficits, n = 33). Mean and standard deviation of K-D Balance were recorded for each stance. Intra-rater reliability was calculated by repeating the trial. RESULTS Overall balance scores were superior for the control group compared with the group at risk for balance deficits in double leg stance (mean (SD): 0.15 (0.12) versus 0.18 (0.13), p = 0.260), tandem stance right leg (mean (SD): 0.27 (0.17) versus 0.45 (0.49), p = 0.028), and tandem stance left leg (mean (SD): 0.26 (0.17) versus 0.35 (0.35), p = 0.136). Intra-rater reliability was good to excellent for K-D Balance double leg stance (intra-class correlation coefficient (ICC) = 0.80, 95% confidence interval (CI) 0.58-1.03), tandem stance right leg (ICC = 0.96, 95% CI 0.86-1.06) and tandem stance left leg (ICC = 0.98, 95% CI 0.95-1.0). CONCLUSIONS K-D Balance revealed differences in balance performance between healthy individuals compared with individuals with neurological or musculoskeletal impairment. Objective balance measures may improve the accuracy and reliability of clinical balance assessment by detecting subtle differences in balance and aid in early detection of diseases that impair balance.
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Affiliation(s)
- Chelsea Zhang
- Department of Neurology, University of Texas Southwestern
Medical Center, Dallas, USA
| | | | - Melanie Truong
- Department of Neurology, University of Texas Southwestern
Medical Center, Dallas, USA
| | - Bert B Vargas
- Department of Neurology, University of Texas Southwestern
Medical Center, Dallas, USA
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Choi HJ, Kim HS, Ryu J, Kim G, Ko CY. Variations in gait features in elderly adults during walking considering their balance. Biomed Eng Lett 2017; 7:333-338. [PMID: 30603184 DOI: 10.1007/s13534-017-0045-0] [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: 05/10/2017] [Revised: 07/06/2017] [Accepted: 08/04/2017] [Indexed: 10/18/2022] Open
Abstract
The aim of this study was to evaluate the influence of balance on the spatiotemporal features, lower-limb kinematics, and center of mass (COM) of the non-faller elderly during walking. In this study, 20 healthy elderly women (age, 76.2 ± 5.6 years; height, 150.1 ± 3.2 cm; weight, 55.8 ± 9.0 kg) were enrolled. Based on the Berg balance scale (BBS), the elderly were classified into two groups: poor balance (PB; BBS scores <46; n = 10; 43.8 ± 1.8) and good balance (GB; BBS scores ≥46; n = 10; 50.4 ± 2.5). The two groups had no differences in terms of the spatiotemporal features and range of motion (ROM) of the vertical COM (all p > 0.05). The ROM of the mediolateral COM was greater in PB than in GB. Hip transversal movements in the two groups were different. The impairment of the lateral balance function might contribute to an increase in the incidence of fall events in the elderly with poor balance.
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Affiliation(s)
- Hyuk-Jae Choi
- Rehabilitation Engineering Research Institute, 9-15 Gusan, Bupyeong, Incheon, 21417 Republic of Korea
| | - Han-Sung Kim
- 2Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, Republic of Korea
| | - Jeicheong Ryu
- Rehabilitation Engineering Research Institute, 9-15 Gusan, Bupyeong, Incheon, 21417 Republic of Korea
| | - Gyoosuk Kim
- Rehabilitation Engineering Research Institute, 9-15 Gusan, Bupyeong, Incheon, 21417 Republic of Korea
| | - Chang-Yong Ko
- Rehabilitation Engineering Research Institute, 9-15 Gusan, Bupyeong, Incheon, 21417 Republic of Korea
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