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Lara KEA, Linares JCC, Montilla JAP, Román PÁL. Factors influencing gait performance in older adults in a dual-task paradigm. GeroScience 2024; 46:3071-3083. [PMID: 38190081 PMCID: PMC11009214 DOI: 10.1007/s11357-023-01052-5] [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: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
The aim of this study was to determine the effect of cognitive interference through a dual-task (DT) paradigm on gait parameters by sex or other predictive variables, such as physical fitness, health status, and cognition. A total of 125 older adults joined in this study (age, 72.42 ± 5.56 years old; 28 men and 97 women). The DT paradigm was evaluated through Comfortable Linear Gait (CLG) and Complex Gait Test (CGT). The gait parameters between single task (ST) vs. DT condition in men showed a significant reduction in speed (p < 0.001), cadence (p < 0.001), and step length (p = 0.049) and increased time to execute the CGT (p < 0.001), while women showed a decreased speed (p = 0.014), cadence (p < 0.001), and double support coefficient variation (CV) (p = 0.024) and increased single support time (p < 0.001) and CV step length (p < 0.05). In addition, women increased CGT time (p < 0.001). Furthermore, correlations between DT cost (DTC) cadence vs. Physical Activity for Elderly questionnaire (PASE) (r = - 0.399; p = 0.008), DTC single support vs. 30 s Sit to Stand Test (r = - 0.356; 0.016), DTC single support vs. Rey Auditory Verbal Learning Test-Learning curve (r = - 0.335; p = 0.023), DTC double support vs. 30 s Sit to Stand Test (r = - 0.590; p < 0.001), DTC CV step length vs. 30 s Sit to Stand (r = - 0.545; p = 0.003), and DTC CGT vs. 30 s Sit to Stand Test (r = - 0.377; p = 0.048) were found. The results of our study indicate that the gait parameters within the DT condition decreased speed and cadence, while increasing CV step length and CGT time, causing slower gait with shortened steps in men and women.
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Affiliation(s)
- Karina Elizabeth Andrade Lara
- Department of Musical, Plastic and Corporal Expression, University of Jaén, Paraje Las Lagunillas, S/N.,, 23071, Jaén, Spain
| | - José Carlos Cabrera Linares
- Department of Musical, Plastic and Corporal Expression, University of Jaén, Paraje Las Lagunillas, S/N.,, 23071, Jaén, Spain.
| | - Juan Antonio Párraga Montilla
- Department of Musical, Plastic and Corporal Expression, University of Jaén, Paraje Las Lagunillas, S/N.,, 23071, Jaén, Spain
| | - Pedro Ángel Latorre Román
- Department of Musical, Plastic and Corporal Expression, University of Jaén, Paraje Las Lagunillas, S/N.,, 23071, Jaén, Spain
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Raffegeau TE, Brinkerhoff SA, Clark M, McBride AD, Mark Williams A, Fino PC, Fawver B. Walking (and talking) the plank: dual-task performance costs in a virtual balance-threatening environment. Exp Brain Res 2024; 242:1237-1250. [PMID: 38536454 PMCID: PMC11078829 DOI: 10.1007/s00221-024-06807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings.
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Affiliation(s)
- Tiphanie E Raffegeau
- George Mason University, School of Kinesiology, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA.
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.
| | - Sarah A Brinkerhoff
- George Mason University, School of Kinesiology, 10890 George Mason Circle, Katherine Johnson Hall 201G, MSN 4E5, Manassas, VA, 20110, USA
| | - Mindie Clark
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Department of Health and Human Performance, Rocky Mountain College, Billings, MT, USA
| | - Ashlee D McBride
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - A Mark Williams
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
- Institute for Human and Machine Cognition, Human Health, Resilience and Performance, Pensacola, FL, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Bradley Fawver
- Walter Reed Army Institute of Research-West, Joint Base Lewis-McChord, Tacoma, WA, USA
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Melo-Alonso M, Murillo-Garcia A, Leon-Llamas JL, Villafaina S, Gomez-Alvaro MC, Morcillo-Parras FA, Gusi N. Classification and Definitions of Compensatory Protective Step Strategies in Older Adults: A Scoping Review. J Clin Med 2024; 13:635. [PMID: 38276141 PMCID: PMC10816706 DOI: 10.3390/jcm13020635] [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: 11/21/2023] [Revised: 12/14/2023] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The risk for an unexpected fall can be due to increasing age, health conditions, and loss of cognitive, sensory, or musculoskeletal functions. Falls have personal and economic consequences in many countries. Different disturbances can occur during gait, such as tripping, slipping, or other unexpected circumstances that can generate a loss of balance. The strategies used to recover balance depend on many factors, but selecting a correct response strategy influences the success of balance recovery. OBJECTIVES (1) To collect and clarify the definitions of compensatory protective step strategies to recover balance in older adults; (2) to identify the most used methods to induce loss of balance; and (3) to identify the most used spatiotemporal variables in analyzing these actions. METHODS The present review has followed the PRISMA guideline extension for Scoping Review (PRISMA-ScR) and the phases proposed by Askery and O'Malley. The search was conducted in three databases: PubMed, Web of Science, and Scopus. RESULTS A total of 525 articles were identified, and 53 studies were included. Forty-five articles were quasi-experimental studies, six articles were randomized controlled trials, and two studies had an observational design. In total, 12 compensatory protective step strategies have been identified. CONCLUSIONS There are 12 compensatory protective step strategies: lowering and elevating strategy, short- and long-step strategy, backward and forward stepping for slip, single step, multiple steps, lateral sidesteps or loaded leg sidestep unloaded leg sidestep, crossover step (behind and front), and medial sidestep. To standardize the terminology applied in future studies, we recommend collecting these strategies under the term of compensatory protective step strategies. The most used methods to induce loss of balance are the tether-release, trip, waist-pull, and slip methods. The variables analyzed by articles are the number of steps, the acceleration phase and deceleration phase, COM displacement, the step initiation or step duration, stance phase time, swing phase time and double-stance duration, stride length, step length, speed step, speed gait and the type of step.
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Affiliation(s)
- Maria Melo-Alonso
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Alvaro Murillo-Garcia
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Juan Luis Leon-Llamas
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Mari Carmen Gomez-Alvaro
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Felipe Alejandro Morcillo-Parras
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
| | - Narcis Gusi
- Physical Activity and Quality of Life Research Group (AFYCAV), Facultad de Ciencias del Deporte, Universidad de Extremadura, 10003 Caceres, Spain; (M.M.-A.); (A.M.-G.); (J.L.L.-L.); (S.V.); (M.C.G.-A.); (F.A.M.-P.)
- International Institute for Innovation in Aging, Universidad de Extremadura, 10003 Caceres, Spain
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Kunimune S, Okada S. Sex Differences in the Visuomotor Control of Obstacle Crossing When Walking are not Age-Related. Percept Mot Skills 2022; 129:362-377. [DOI: 10.1177/00315125221077566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To ensure stable obstacle crossing when walking, visual information is required two steps before reaching the obstacle. As possible age-related sex differences in visuomotor control have not been investigated, we assessed sex differences in obstacle crossing while walking, as examined by toe clearance (TC) and postural stability. Participants were 14 younger and 14 older adults (equal numbers of men and women) who wore goggles for visual field adjustment while obstacle crossing during gait. We manipulated three visual field occlusion conditions (total, lower, and no visual field occlusions) two steps before the obstacle and analyzed the TC of the lead limb, and the participants’ step width and root mean square of trunk acceleration as indices of postural stability. We found a significant interaction between sex and visual condition in step width, with men showing larger step width values than women in all visual field conditions. Moreover, while women showed no step-width differences across visual field conditions, men had a larger step width with the lower visual field occluded than in the other visual conditions. We found no other significant sex differences. Our results suggest that men may be more dependent than women on the upper visual field for postural stability during obstacle crossing. Sex differences in visuomotor control were not affected by age.
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Affiliation(s)
- Sho Kunimune
- Department of Physical Therapy, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Shuichi Okada
- Graduate School of Human Development and Environment, Kobe University, Hyogo, Japan
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Özden F, Özkeskin M, Bakırhan S, Şahin S. The test–retest reliability and concurrent validity of the 3-m backward walk test and 50-ft walk test in community-dwelling older adults. Ir J Med Sci 2022; 191:921-928. [DOI: https:/doi.org/10.1007/s11845-021-02596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 08/30/2023]
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Amaya V, Moulaert T, Gwiazdzinski L, Vuillerme N. Assessing and Qualifying Neighborhood Walkability for Older Adults: Construction and Initial Testing of a Multivariate Spatial Accessibility Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031808. [PMID: 35162830 PMCID: PMC8834981 DOI: 10.3390/ijerph19031808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/10/2022]
Abstract
Population aging and urban development pose major challenges for societies today. Joining the literature assessing urban accessibility, the present exploratory research developed a multivariate accessibility model based on four independent variables—related to formal and structural urban space—that influence walkability for older adults (pedestrian network; facilities and shops; public benches; and slopes and gradients). The model used ArcGIS software. For the accessibility calculations, we selected two suburban neighborhoods in the conurbation of Grenoble (France) and selected three types of older adults’ profiles to reflect the variety of aging: an older adult in good health, an older adult with a chronic disease, and an older adult with reduced mobility. The results suggest that the accessibility of a neighborhood depends not only on its physical and urban characteristics, but it is also influenced by the physical and health characteristics of its inhabitants. The originality of the model lies mainly in its ability to estimate the spatial accessibility of a territory by taking into account, firstly, objective data such as the physical characteristics and the built environment of the neighborhood through objectification variables that consider such original variables as the presence of benches or the slopes and gradients and, secondly, specific data such as the physical and/or health characteristics of the study population. The measurement of geospatial accessibility could be of great value for public health in urban contexts, which is why relevant tools and methodologies are needed to objectively examine and intervene in public spaces in order to make them age-friendly.
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Affiliation(s)
- Valkiria Amaya
- AGEIS (Autonomie, Gérontologie, E-santé, Imagerie et Société), Université Grenoble Alpes, 38000 Grenoble, France;
- PACTE (Laboratoire de Sciences Sociales), Sciences Po Grenoble, Université Grenoble Alpes, CNRS, 38000 Grenoble, France
- Correspondence: (V.A.); (T.M.)
| | - Thibauld Moulaert
- PACTE (Laboratoire de Sciences Sociales), Sciences Po Grenoble, Université Grenoble Alpes, CNRS, 38000 Grenoble, France
- Correspondence: (V.A.); (T.M.)
| | - Luc Gwiazdzinski
- LRA (Laboratoire de Recherche en Architecture), École Nationale Supérieure d’Architecture de Toulouse, Université Fédérale de Toulouse, 31106 Toulouse, France;
| | - Nicolas Vuillerme
- AGEIS (Autonomie, Gérontologie, E-santé, Imagerie et Société), Université Grenoble Alpes, 38000 Grenoble, France;
- Institut Universitaire de France, 75005 Paris, France
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Šarabon N, Kozinc Ž, Marković G. Effects of age, sex and task on postural sway during quiet stance. Gait Posture 2022; 92:60-64. [PMID: 34826694 DOI: 10.1016/j.gaitpost.2021.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/16/2021] [Accepted: 11/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural sway during quiet standing has been shown as a useful task to assess risk of falling in older adults. While the risk of falling is consistently reported to be higher in older females than males, the sex-related differences in postural sway are not consistent across the studies. RESEARCH QUESTION What are the effects of age and sex on postural sway during quiet standing during different stance conditions? METHODS We examined the effects of age (40 young and 34 older adults), sex (37 males and 37 females), and their interaction on the postural sway during different stance conditions. We compared the center of pressure (CoP) velocity, amplitude and frequency during parallel (eyes open and eyes closed) and semi-tandem (eyes open) stances. RESULTS Our results suggest that postural sway is similar between sexes in young participants, while older males exhibit larger postural sway than older female participants (10/21 outcomes). Older female participants exhibited lower CoP amplitude (but larger total and anterior-posterior CoP velocity) compared to young female participants. We also found that the increase in the postural sway with increasing task difficulty is more pronounced in older vs. young adults. SIGNIFICANCE This study shows that ageing-related changes in postural sway are sex- and task-specific. Researchers and clinicians need to be aware of these effects when comparing groups or monitoring changes in time.
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Affiliation(s)
- Nejc Šarabon
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia; InnoRenew CoE, Human Health Department, Livade 6, SI-6310 Izola, Slovenia; S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behavior, Tehnološki park 19, SI-1000 Ljubljana, Slovenia.
| | - Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Goran Marković
- Faculty of Kinesiology, University of Zagreb, 10110 Zagreb, Croatia; Motus Melior Ltd., Hektorovićeva 2, 10000 Zagreb, Croatia
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Luo Y, Yang F, Yerebakan MO, Zhang J, Hu B. Load Carriage Modes and Limb Crossing Patterns Altered Gait during Obstacle Negotiation. J Mot Behav 2022; 54:525-536. [PMID: 35021959 DOI: 10.1080/00222895.2021.2017837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Personal and environmental factors both increase the likelihood of falling injuries while negotiating obstacles. Eighteen male participants (seven older, eleven young) were recruited to walk over an obstacle with and without loads on their hands to study the effects of age, load carriage modes, and limb crossing patterns on gait during obstacle negotiation. Participants initiated tasks with either their dominant or non-dominant leg. Step length (SL), toe clearance (TC), step velocity (V), and step width (SW) were extracted from four critical steps. Results showed that during obstacle negotiation (1) older adults had more TC than younger adults, (2) hand loads affected SL and TC, (3) gait parameters are dissimilar between the dominant limb and non-dominant limb.
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Affiliation(s)
- Yue Luo
- Human System Engineering Laboratory, Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
| | - Fang Yang
- School of Mechanical Engineering, Tianjin University of Science and Technology, Tianjin, China
| | - Mustafa Ozkan Yerebakan
- Human System Engineering Laboratory, Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
| | - Junxia Zhang
- School of Mechanical Engineering, Tianjin University of Science and Technology, Tianjin, China
| | - Boyi Hu
- Human System Engineering Laboratory, Department of Industrial and Systems Engineering, University of Florida, Gainesville, Florida
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Raffegeau TE, Brinkerhoff SA, Kellaher GK, Baudendistel S, Terza MJ, Roper JA, Hass CJ. Changes to margins of stability from walking to obstacle crossing in older adults while walking fast and during a dual-task. Exp Gerontol 2022; 161:111710. [PMID: 35090973 PMCID: PMC8920466 DOI: 10.1016/j.exger.2022.111710] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
It is not well understood how older adults meet the combined locomotor demands of obstacle avoidance at fast speeds as compared to obstacle avoidance under cognitive loads. The purpose of this study was to quantify changes in locomotor stability (margin of stability, MOS) from walking to crossing obstacles at fast speeds versus with added cognitive demands in older adults. Community-dwelling older adults walked on an unobstructed and obstructed path at their preferred speed (preferred); during a dualtask (verbal fluency); and at their 'fastest comfortable' speed (fast). We used motion capture to calculate MOS in the anteroposterior direction, and compared minimum MOS between crossing foot and support phase (lead single support, lead double support, trail single support, trail double support) and tested for within subject changes using a linear mixed effect regression model [Condition (preferred, fluency, fast) x Walkway (unobstructed, obstructed) x Phase (single support, double support) x Foot (lead, trail)]. We examined crossing kinematics (approach distance, toe clearance, and recovery distance) between conditions. A significant omnibus effect partially supported our predictions. A Condition x Walkway x Phase interaction supported that older adults increased stability under a cognitive load and prioritized stability, demonstrated by not changing MOS from walking to obstacle crossing. During fast obstacle crossing they decreased stability during double support and exhibit more stability in single support, when vulnerable to external perturbations (contacting the obstacle). During a dual-task, older adults took shorter and higher steps over the obstacle to ensure they cleared it safely, but at fast speeds they increased the length of their crossing step without higher toe clearance. The results suggest older adults attempt to preserve stability when crossing obstacles under both cognitive and speed demands, but may be unable to ensure a safer limb elevation to avoid obstacles at fast speeds as they do under cognitive demands.
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Affiliation(s)
- Tiphanie E Raffegeau
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America; Ohio University, Division of Exercise Physiology, United States of America.
| | - Sarah A Brinkerhoff
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America; Auburn University, School of Kinesiology, United States of America
| | - Grace K Kellaher
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America; University of Delaware, Department of Kinesiology & Applied Physiology, United States of America
| | - Sidney Baudendistel
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America
| | - Matthew J Terza
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America
| | - Jaimie A Roper
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America; Auburn University, School of Kinesiology, United States of America
| | - Chris J Hass
- University of Florida, Department of Applied Physiology and Kinesiology, United States of America
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Baudendistel ST, Schmitt AC, Stone AE, Raffegeau TE, Roper JA, Hass CJ. Faster or longer steps: Maintaining fast walking in older adults at risk for mobility disability. Gait Posture 2021; 89:86-91. [PMID: 34256264 PMCID: PMC9277656 DOI: 10.1016/j.gaitpost.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/01/2021] [Accepted: 07/01/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The ability to walk at various speeds is essential to independence for older adults. Maintaining fast walking requires changes in spatial-temporal measures, increasing step length and/or decreasing step time. It is unknown how mobility affects the parameters that change between preferred and fast walking. RESEARCH QUESTION How does preferred walking performance and measures of strength and mobility relate to the approach (decreasing step time or increasing step length) older adults at risk for mobility disability use to maintain fast walking speeds?. METHODS Peak isokinetic dynamometry of knee and ankle and several mobility evaluations, including the Timed Up-and-Go, Short Physical Performance Battery, and Dynamic Gait Index, assessed mobility and strength in 57 participants, aged 65-80. Biomechanical gait analysis was used to analyze step length, step time, gait speed at preferred and fast gait speeds and ground reaction force during preferred walking. A score combining the differences between step length and time at fast and preferred speeds (Length-Time Difference) separated participants into two groups: (1) Length, representing a predominant increase in step length to walk fast and (2) Time, a predominant decrease in step time. RESULTS Those who decreased step time to produce increased speed performed worse during repeated chair stands (p = .006) with no difference in isokinetic strength (p ≥ .15). During preferred walking, the Time group displayed increased propulsive impulse compared to the Length group (p = .007), despite no differences in preferred speed, step length, or time (p ≥ .50). SIGNIFICANCE While kinetics of preferred walking differed between groups separated by Length-Time Difference, basic spatial-temporals of preferred walking did not in this homogenous population. Length-Time Difference relates to a common mobility assessment and could be easily calculated by clinicians to provide a quantitative and more sensitive measure of ambulatory performance.
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Affiliation(s)
- Sidney T. Baudendistel
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA,Corresponding author at: 1864 Stadium Rd, Gainesville, FL, 32608, USA. (S.T. Baudendistel)
| | - Abigail C. Schmitt
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA,Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, 72704, USA
| | - Amanda E. Stone
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA,RR&D Center for Limb Loss and MoBility, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA,Department of Mechanical Engineering, University of Washington, 3900 E Stevens Way NE, Seattle, WA, 98105, USA
| | - Tiphanie E. Raffegeau
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA,Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Jaimie A. Roper
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA,School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Chris J. Hass
- Applied Neuromechanics Laboratory, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, USA
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Özden F, Özkeskin M, Bakırhan S, Şahin S. The test-retest reliability and concurrent validity of the 3-m backward walk test and 50-ft walk test in community-dwelling older adults. Ir J Med Sci 2021; 191:921-928. [PMID: 33715071 DOI: 10.1007/s11845-021-02596-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Three-meter backward walk test (3MBWT) and 50-ft walk test (50FWT) are frequent physical performance tests in clinical practice. AIMS The aim of the study was to determine the test-retest reliability and concurrent validity of the 3MBWT and 50FWT in community-dwelling older adults. METHODS A cross-sectional study was carried out with 65 participants. 3MBWT, 50FWT, Timed Up and Go Test (TUG), and Five Times Sit to Stand Test (FTST) were evaluated in the first assessment. The test-retest reliability was evaluated by performing two repetitions of the 3MBWT and 50FWT with 1-h interval. The test-retest reliability and validity were assessed by the intraclass correlation coefficient (ICC) and the Spearman correlation coefficient, respectively. RESULTS The mean age of the participants was 68.9±3.7 years. The ICC score of 3MBWT and 50FWT were 0.940 and 0.820, respectively. The test-retest reliability of both tests was excellent (> 0.80). Both the test and retest assessment of the 3MBWT were strongly correlated with TUG (rtest = 0.649, rretest = 0.645, p < 0.01). 50FWT (test) was not significantly correlated with FTST (r = 0.215, p > 0.05). 50FWT (retest) were weakly correlated with FTST (r = 0.260, p < 0.05). Both the test and retest assessments of the 50FWT was strongly correlated with TUG (rtest = 0.550, rretest = 0.596, p < 0.01). CONCLUSIONS The 3MBWT and 50FWT are valid and reliable performance tests in community-dwelling older adults. MDC value of both tests provides an essential contribution to clinical practice.
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Affiliation(s)
- Fatih Özden
- Köyceğiz Vocational School of Health Services, Elderly Care Department, Muğla Sıtkı Koçman University, Muğla, 48800, Turkey.
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Physical Therapy and Rehabilitation Department, Ege University, İzmir, Turkey
| | - Serkan Bakırhan
- Faculty of Health Sciences, Physical Therapy and Rehabilitation Department, Ege University, İzmir, Turkey
| | - Sevnaz Şahin
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Ege University, İzmir, Turkey
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Huang SJ, Yu XM, Wang K, Wang LJ, Wu XB, Wu X, Niu WX. Short-Step Adjustment and Proximal Compensatory Strategies Adopted by Stroke Survivors With Knee Extensor Spasticity for Obstacle Crossing. Front Bioeng Biotechnol 2020; 8:939. [PMID: 32850762 PMCID: PMC7424008 DOI: 10.3389/fbioe.2020.00939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/20/2020] [Indexed: 11/18/2022] Open
Abstract
Stroke survivors adopt cautious or compensatory strategies for safe and successful obstacle crossing. Although knee extensor spasticity is a common independent secondary sensorimotor disorder post-stroke, few studies have examined the step adjustment and compensatory strategies used by stroke survivors with knee extensor spasticity during obstacle crossing. This study aimed to compare the differences in the kinematics and kinetics during obstacle crossing between stroke survivors with and without knee extensor spasticity, and to identify knee extensor spasticity-related differences in step adjustment and compensatory strategies. Twenty stroke subjects were divided into a spasticity group [n = 11, modified Ashworth scale (MAS) ≥ 1] and a non-spasticity group (n = 9, MAS = 0), based on the MAS score of the knee extensor. Subjects were instructed to walk at a self-selected speed on a 10-m walkway and step over a 15 cm obstacle. A ten-camera 3D motion analysis system and two force plates were used to collect the kinematic and kinetic data. During the pre-obstacle phase, stroke survivors with knee extensor spasticity adopted a short-step strategy to approach the obstacle, while the subjects without spasticity used long-step strategy. During the affected limb swing phase, the spasticity group exhibited increased values that were significantly higher than those seen in the non-spasticity group for the following measurements: pelvic lateral tilt angle, trunk lateral tilt angle, medio-lateral distance between the ankle and ipsilateral hip joint, hip work contributions, the inclination angles between center of mass and center of pressure in anterior–posterior and medio-lateral directions. These results indicate that the combined movement of the pelvic, trunk lateral tilt, and hip abduction is an important compensatory strategy for successful obstacle crossing, but it sacrifices some balance in the sideways direction. During the post-obstacle phase, short-step and increase step width strategy were adopted to reestablish the walking pattern and balance control. These results reveal the step adjustment and compensatory strategies for obstacle crossing and also provide insight into the design of rehabilitation interventions for fall prevention in stroke survivors with knee extensor spasticity.
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Affiliation(s)
- Shang-Jun Huang
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopaedic Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Ming Yu
- Department of Rehabilitation, Shanghai Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kuan Wang
- Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai, China
| | - Le-Jun Wang
- Sport and Health Research Center, Physical Education Department, Tongji University, Shanghai, China
| | - Xu-Bo Wu
- School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xie Wu
- Key Laboratory of Exercise and Health Sciences, Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Wen-Xin Niu
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopaedic Department, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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13
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Latorre Román PÁ, Muñoz Jiménez M, Salas Sánchez J, Consuegra González P, Moreno Del Castillo R, Herrador Sánchez JA, López Ivanco MDA, Linares Jiménez C, Navas Morales JF, Párraga Montilla JA. Complex Gait Is Related to Cognitive Functioning in Older People: A Cross-Sectional Study Providing an Innovative Test. Gerontology 2020; 66:401-408. [PMID: 32623430 DOI: 10.1159/000508245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies have demonstrated an inverse relationship between gait performance and cognitive impairment. The main purposes of this study were: (1) to design and validate a complex gait test (CGT) in older people, (2) to analyze the effects of age and sex on CGT, and (3) to analyze the association between CGT performance and physical functioning and cognitive measures. METHODS A total of 279 older people (60-97 years) were analyzed in 2019. Fitness tests, gait performance, and several cognitive measures such asthe Trail-Walking Test and Montreal Cognitive Assessment were used. RESULTS The CGT reported adequate reliability and validity parameters. In the test-retest analysis, the intra-class correlation coefficient was 0.868 (p < 0.001). There was a significant correlation between the CGT and Trail-Walking Test (r = 0.592; p < 0.001). The linear regression analysis showed that the CGT was associated with the Montreal Cognitive Assessment (R2 = 0.357; p =0.001). The binary logistic regression analysis revealed that a high CGT score was a risk factor for mild cognitive impairment (odds ratio 1.201, 95% CI 1.081-1.334; p = 0.001). The ROC curve of the mild cognitive impairment was predicted by the CGT performance (area under the curve = 0.768, 95% CI 0.647-0.889; p < 0.001), reaching the cut-off point at 20.25 s. CONCLUSIONS The CGT showed good reliability and validity and may serve as a potential biomarker in mild cognitive impairment prediction in older adults aged 60-97 years.
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Affiliation(s)
| | - Marcos Muñoz Jiménez
- Department of Didactic of Music, Plastic and Body Expression, University of Jaén, Jaén, Spain,
| | | | | | | | | | | | - Claudia Linares Jiménez
- Department of Didactic of Music, Plastic and Body Expression, University of Jaén, Jaén, Spain
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Lester PE, Dharmarajan TS, Weinstein E. The Looming Geriatrician Shortage: Ramifications and Solutions. J Aging Health 2019; 32:1052-1062. [DOI: 10.1177/0898264319879325] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: Geriatricians are skilled in the recognition of asymptomatic and atypical presentations that occur in the elderly and provide comprehensive medication management including recognizing adverse drug events, reducing polypharmacy, and de-prescribing. However, despite the increasing average age of the U.S. population, with the number of individuals above 65 years old predicted to increase 55% by 2030, the geriatric workforce capacity in the United States has actually decreased from 10,270 in 2000 to 8,502 in 2010. Method: We describe physiologic changes in older adults, historical trends in geriatric training, and propose solutions for this looming crisis. Results: Many factors are responsible for the shortage of skilled geriatric providers. Discussion: We discuss the historical context of the lack of geriatricians including changes to the training system, describe the impact of expert geriatric care on patient care and health system outcomes, and propose methods to improve recruitment and retention for geriatric medicine.
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Affiliation(s)
- Paula E. Lester
- NYU Winthrop Hospital, Mineola, USA
- State University of New York at Stony Brook, USA
| | - T. S. Dharmarajan
- Montefiore Medical Center (Wakefield Campus), Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eleanor Weinstein
- Albert Einstein College of Medicine, Bronx, NY, USA
- Jacobi Medical Center, Bronx, NY, USA
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