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Kartal Özcan E, Karabulut M, Karakoç K, Müjdeci B. Is There an Association Between Self-Reported Dual-Task Performance and Fear of Falling in Older Adults? J Aging Phys Act 2024; 32:370-375. [PMID: 38262398 DOI: 10.1123/japa.2023-0267] [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: 08/02/2023] [Revised: 10/07/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Is there an association between self-reported dual-task performance and fear of falling in older adults? BACKGROUND/OBJECTIVES Fear of falling tends to increase with age and can negatively impact dual-task abilities, leading to potential declines in overall quality of life. Therefore, it becomes crucial to evaluate dual-task performance in older adults, particularly prior to the onset of fear of falling. This study aims to investigate the potential association between self-reported dual-task performance and fear of falling in older adults. METHODS A total of 51 individuals (19 females and 32 males) were recruited. The participants met the inclusion criteria were administered the Dual-Task Questionnaire (DTQ), Falls Efficiency Scale International, and Physical Activity Scale for the Elderly. Multiple linear regression was performed to predict DTQ scores based on age, body mass index, and Physical Activity Scale for the Elderly. RESULTS A moderate positive correlation was found between Falls Efficiency Scale International scores and self-reported DTQ scores (r: .448, p: .001). Age, body mass index, and Physical Activity Scale for the Elderly were not found to be significant predictors of DTQ scores. CONCLUSIONS Our study reveals a moderate positive association between fear of falling and self-reported dual-task performance in older adults. A direct relationship between physical activity performance, fear of falling, and self-reported dual-task performance was observed among older adults. Significance/Implications: Integrating self-reported measures like the DTQ in clinical evaluations can provide valuable insights into dual-task abilities of older adults.
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Affiliation(s)
- Ecem Kartal Özcan
- Department of Audiology, Gulhane Faculty of Health Sciences, University of Health Sciences, Ankara, Turkey
| | - Mustafa Karabulut
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kürşad Karakoç
- Audiology and Speech Pathology Doctoral Programme, Graduate School of Health Sciences, Ankara University, Ankara, Turkey
- Department of Audiology, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Banu Müjdeci
- Department of Audiology, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Tomita Y, Mullick AA, Feldman AG, Levin MF. Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke. Neurorehabil Neural Repair 2024; 38:176-186. [PMID: 38347695 DOI: 10.1177/15459683241231528] [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] [Indexed: 03/16/2024]
Abstract
BACKGROUND Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching. METHODS We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was "gain" (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping. RESULTS Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function. CONCLUSIONS Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Anatol G Feldman
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Suri A, Hubbard ZL, VanSwearingen J, Torres-Oviedo G, Brach JS, Redfern MS, Sejdic E, Rosso AL. Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:108001. [PMID: 38199138 PMCID: PMC11411449 DOI: 10.1016/j.cmpb.2023.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications. OBJECTIVE In this cross-sectional study, we examined the relationships between FOF and gait quality. METHODS Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC. RESULTS Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF. CONCLUSION Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary L Hubbard
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Chen Y, Tang H, Wang Y, Jin C, Wang L, Miao W, Wang X. The effect of complex cognitive context on the dynamic stability during gait initiation in older women. Front Aging Neurosci 2024; 15:1342570. [PMID: 38274990 PMCID: PMC10808313 DOI: 10.3389/fnagi.2023.1342570] [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: 11/22/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Background Changes in cognitive control are considered potential factors affecting voluntary motor movements during gait initiation (GI). Simulating environments with higher cognitive resource demands have an effect on the stability of GI task performance, which is of significant importance for assessing fall risk in the older adults and devising fall risk management measures in multiple environments. This study aims to reveal the influence of complex cognitive competitive environment with increased cognitive demands on the dynamic stability during GI in the older women. Methods Twenty-three older females and twenty-three younger females performed walking tests under three conditions: voluntary initiation (SI), visual light reaction time task (LRT), and cognitive interference + visual light reaction time task (C + LRT). Eight cameras (Qualisys, Sweden, model: Oqus 600) and three force plates (Kistler, Switzerland, model: 9287C) are used to obtain kinematic and kinetic data. To recorde the trajectory of center of pressure (CoP) and the position of the foot placement, and compute the anterior-posterior (A-P) and medio-lateral (M-L) dynamic stability at the onset and end moments of the single-leg support by means of center of mass (CoM) and gait spatiotemporal parameters. Results Older women responded to the effect of complex environments involving cognitive competition on body stability by prolonging the lateral displacement time of the CoP during the anticipatory postural adjustments (APAs) phase, reducing step length and velocity, and increasing step width and foot inclination angle. Conclusion Complex initiation environments lead to competition for cognitive resources in the brain, resulting in decreased stability of GI motor control in older adults. The higher the complexity of the cognitive resource demands environment, the lower the stability of GI in older adults, and the greater the effect on their M-L stability at the onset of stepping.
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Affiliation(s)
- Yuxia Chen
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- Henan Sports Science and Technology Center (Henan Anti-Doping Center), Zhengzhou, Henan, China
| | - Hongyuan Tang
- Henan Sports Science and Technology Center (Henan Anti-Doping Center), Zhengzhou, Henan, China
| | - Yuanxin Wang
- Henan Provincial Third People's Hospital, Zhengzhou, Henan, China
| | - Chunxia Jin
- Huanghe Science and Technology College, Zhengzhou, Henan, China
| | - Lihong Wang
- School of Physical Education, Zhengzhou University, Zhengzhou, Henan, China
| | | | - Xiangdong Wang
- School of Physical Education, Jimei University, Xiamen, Fujian, China
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Phanthanourak AL, Adkin AL, Carpenter MG, Tokuno CD. Effects of postural threat on the scaling of anticipatory postural adjustments in young and older adults. Front Hum Neurosci 2023; 17:1267093. [PMID: 37841075 PMCID: PMC10568077 DOI: 10.3389/fnhum.2023.1267093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The ability to scale anticipatory postural adjustments (APAs) according to the predicted size of the upcoming movement is reduced with aging. While age-related changes in central set may be one reason for this effect, an individual's emotional state might also contribute to changes in anticipatory postural control. Therefore, the purpose of this study was to determine whether an altered emotional state, as elicited through postural threat, alters the scaling of APAs during a handle pull movement in young and older adults. It was hypothesized that the presence of postural threat would lead to more homogenous APAs (i.e., less scaling of APAs) across a range of pulling forces. Methods Young (n = 23) and older adults (n = 16) stood on top of a force plate that was mounted to a motorized platform. From this position, participants performed a series of handle pull trials without (no threat) or with (threat) the possibility of receiving a postural perturbation in the form of an unpredictable surface translation. Handle pulls were performed at force levels between 50 and 90% of maximum force. For each trial, the magnitude and timing of the APA were quantified from center of pressure (COP) recordings as well as electromyographic (EMG) activity of the soleus and medial gastrocnemius. The scaling of APAs with respect to force exertion was then determined through regression analyses and by comparing APAs during pulls of lower versus higher force. Results and discussion As evidenced by their smaller slope of the regression line between various dependent measures (i.e., COP velocity, soleus EMG onset latency, and soleus EMG amplitude) and the pulled forces, older adults demonstrated less scaling of APAs than the young. However, increases in arousal, anxiety and fear of falling due to postural threat, only minimally altered the scaling of APAs. Regardless of age, the slope of the regressions for none of the measures were affected by threat while only the soleus and medial gastrocnemius EMG onsets demonstrated significant force × threat interaction effects. These results suggest that the decreased ability to scale APAs with aging is unlikely to be due to changes in emotional state.
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Affiliation(s)
| | - Allan L. Adkin
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Mark G. Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Craig D. Tokuno
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
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Melo RS, Cardeira CSF, Rezende DSA, Guimarães-do-Carmo VJ, Lemos A, de Moura-Filho AG. Effectiveness of the aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in healthy community-dwelling older adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0291193. [PMID: 37683025 PMCID: PMC10490910 DOI: 10.1371/journal.pone.0291193] [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: 03/20/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Opting to use aquatic or land-based physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in community-dwelling older adults (CDOAs) is still a questionable clinical decision for physiotherapists. OBJECTIVE Assess the quality of evidence from randomized or quasi-randomized controlled trials that used aquatic physical therapy exercises to improve balance, gait, quality of life and reduce fall-related outcomes in CDOAs. METHODS Articles were surveyed in the following databases: MEDLINE/PubMed, EMBASE, SCOPUS, LILACS, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, CINAHL, SciELO and Google Scholar, published in any language, up to July 31, 2023. Two independent reviewers extracted the data and assessed evidence quality. The risk of bias of the trials was evaluated by the Cochrane tool and evidence quality by GRADE approach. Review Manager software was used to conduct the meta-analyses. RESULTS 3007 articles were identified in the searches, remaining 33 studies to be read in full, with 11 trials being eligible for this systematic review. The trials included presented low evidence quality for the balance, gait, quality of life and fear of falling. Land-based and aquatic physical therapy exercises improved the outcomes analyzed; however, aquatic physical therapy exercises were more effective in improving balance, gait, quality of life and reducing fear of falling in CDOAs. The meta-analysis showed that engaging in aquatic physical therapy exercises increases the functional reach, through of the anterior displacement of the center of pressure of CDOAs by 6.36cm, compared to land-based physical therapy exercises, assessed by the Functional Reach test: [CI:5.22 to 7.50], (p<0.00001), presenting low quality evidence. CONCLUSIONS Aquatic physical therapy exercises are more effective than their land-based counterparts in enhancing balance, gait, quality of life and reducing the fear of falling in CDOAs. However, due to methodological limitations of the trials, this clinical decision remains inconclusive. It is suggested that new trials be conducted with greater methodological rigor, in order to provide high-quality evidence on the use of the aquatic physical therapy exercises to improve the outcomes analyzed in CDOAs.
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Affiliation(s)
- Renato S. Melo
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | | | | | - Andrea Lemos
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Alberto Galvão de Moura-Filho
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
- Post-Graduate Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Kakehi T, Zenta M, Ishimori T, Tamura N, Wada H, Bessho M, Kakuda W. Reliability and Validity of Caregivers' Fear of Falling Index When Caring for Home-Based Rehabilitation Patients With Fall-Related Fractures. Ann Rehabil Med 2023; 47:300-306. [PMID: 37644719 PMCID: PMC10475813 DOI: 10.5535/arm.23052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To evaluate the reliability and validity of this new measure, called the caregivers' fear of falling index (CFFI). METHODS The study surveyed home-based rehabilitation patients with fall-related fracture, and their primary caregivers. The characteristics of these patients were evaluated, and the caregivers were surveyed using the CFFI and Falls Efficacy Scale-International (FES-I). The reliability of the CFFI was assessed using item-total correlation, while the validity of the CFFI was evaluated through correlation coefficients calculated between the CFFI and the FES-I. RESULTS The participants were 51 patient-caregiver pairs. The internal consistency of the CFFI showed an alpha coefficient of 0.904. No items were excluded in the corrected item-total correlations. The CFFI showed a moderate correlation with FES-I (r=0.432, p=0.002). CONCLUSION This study found the CFFI to be a reliable and valid tool for measuring the primary caregivers' fear. The CFFI may be a useful tool for healthcare professionals to identify and supporting these primary caregivers.
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Affiliation(s)
- Tomohiro Kakehi
- Department of Rehabilitation Medicine, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
- Department of Occupational Therapy, School of Health and Sciences at Narita, International University of Health and Welfare, Narita, Japan
| | - Masashi Zenta
- Division of Rehabilitation Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
| | - Takuya Ishimori
- Department of Rehabilitation, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Japan
| | - Naoki Tamura
- Rehabilitation Center, Ushiku Aiwa General Hospital, Ushiku, Japan
| | - Hiromu Wada
- A Home-Visit Nursing Station of Ryugasaki, Ryugasaki, Japan
| | - Masahiko Bessho
- Department of Orthopaedic Surgery, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Wataru Kakuda
- Department of Rehabilitation Medicine, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
- Division of Rehabilitation Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Japan
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Castelblanco Toro SM, Jurado Delgado J, Meneses Bernal JF, Santacruz Escudero JM, Santamaria-García H. Fear of Falling as a Behavioral Symptom in Neurocognitive Impaired Patients: Evidence from an Underrepresented Population. J Alzheimers Dis 2023:JAD230266. [PMID: 37393502 DOI: 10.3233/jad-230266] [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: 07/03/2023]
Abstract
BACKGROUND Fear of falling (FoF) is a condition associated with falls, multi-morbidity, and functional impairment. To date it remains unknow which clinical, somatic, socio-demographic, behavioral, and emotional factors are associated with FoF and how these factors interact in people with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). OBJECTIVE Identify the association of FoF with clinical, socio-demographic, and neuropsychiatric factors in patients with AD and bvFTD. METHODS We evaluated 98 participants, 58 with AD and 40 with bvFTD at mild or moderate stages and assess FoF using the Falls Efficacy Scale-International. Additionally, we analyzed cognitive, physical performance variables, functional impairment, and affective and behavioral symptoms associated with FoF using standardized scales and a regression model analysis. RESULTS The prevalence of FoF in AD and bvFTD was 51% and 40%, respectively. In the AD group, physical performance [F (3, 53) = 4.318, p = 0.009], the behavioral symptoms model [F (19, 38) = 3.314, p = 0.001], and the anxiety model [F (1, 56) = 13.4, p≤0.01] showed statistically significant values. In addition, the presence of hallucinations assessed with the Neuropsychiatric Inventory and social behavior assessed with the Mild Behavioral Impairment Checklist were significant. In contrast, in the bvFTD group, a homologous group of models was evaluated but we did not find any significant results. CONCLUSION FoF in people with AD was related to physical performance, neuropsychiatric symptoms such as apathy and hallucinations, and affective symptoms such as anxiety. However, this pattern was not seen in the bvFTD group, and therefore further studies are required.
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Affiliation(s)
- Sandra Milena Castelblanco Toro
- Institute of Aging of the Faculty of Medicine of the Pontificia Universidad Javeriana, Bogotá, Colombia
- Psychiatry Department, Pontificia Universidad Javeriana, Bogotá, Colombia
- Intellectus Memory and Cognition Center, San Ignacio University Hospital, Bogotá, DC, Colombia
| | - Janeth Jurado Delgado
- Universidad del Valle (Univalle), Clínica alta complejidad Santa Bárbara, Palmira, Colombia
| | | | - José Manuel Santacruz Escudero
- Institute of Aging of the Faculty of Medicine of the Pontificia Universidad Javeriana, Bogotá, Colombia
- Intellectus Memory and Cognition Center, San Ignacio University Hospital, Bogotá, DC, Colombia
| | - Hernando Santamaria-García
- Psychiatry Department, Pontificia Universidad Javeriana, Bogotá, Colombia
- Intellectus Memory and Cognition Center, San Ignacio University Hospital, Bogotá, DC, Colombia
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Rum L, Russo Y, Vannozzi G, Macaluso A. "Posture first": Interaction between posture and locomotion in people with low back pain during unexpectedly cued modification of gait initiation motor command. Hum Mov Sci 2023; 89:103094. [PMID: 37148816 DOI: 10.1016/j.humov.2023.103094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Abstract
The ability to adapt anticipatory postural adjustments (APAs) in response to perturbations during single-joint movements is altered in people with chronic low back pain (LBP), but a comprehensive analysis during functional motor tasks is still missing. This study aimed to compare APAs and stepping characteristics during gait initiation between people with LBP and healthy controls, both in normal (without cue occurrence) condition and when an unexpected visual cue required to switch the stepping limb. Fourteen individuals with LPB and 10 healthy controls performed gait initiation in normal and switch conditions. The postural responses were evaluated through the analysis of center of pressure, propulsive ground reaction forces, trunk and whole-body kinematics, and activation onsets of leg and back muscles. During normal gait initiation, participants with LBP exhibited similar APAs and stepping characteristics to healthy controls. In the switch condition, individuals with LBP were characterized by greater mediolateral postural stability but decreased forward body motion and propulsion before stepping. The thorax motion was associated with forward propulsion parameters in both task conditions in people with LBP but not healthy controls. No between-group differences were found in muscle activation onsets. The results suggest that postural stability is prioritized over forward locomotion in individuals with LBP. Furthermore, the condition-invariant coupling between thorax and whole-body forward propulsion in LBP suggests an adaptation in the functional use of the thorax within the postural strategy, even in poor balance conditions.
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Affiliation(s)
- Lorenzo Rum
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy.
| | - Yuri Russo
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy; Department of Sport and Health Sciences, University of Exeter, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy
| | - Andrea Macaluso
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis 6, 00135 Rome, Italy
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Kung CF, Lai YR, Chiu WC, Lien CY, Huang CC, Cheng BC, Lin WC, Chen YS, Yu CC, Chiang YF, Guo YR, Chen YH, Lu CH. Effectiveness of Center of Pressure Trajectory as Anticipatory Postural Adjustment Measurement in Parkinson's Disease With Freezing of Gait History. Neurorehabil Neural Repair 2023; 37:240-250. [PMID: 37083157 DOI: 10.1177/15459683231166934] [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: 04/22/2023]
Abstract
BACKGROUND Evidence showed that patients with Parkinson's disease (PD) who have a history of freezing of gait (FOG) have hypometric anticipatory postural adjustment (APA) during gait initiation (GI) compared to PD without FOG. OBJECTIVES This study aimed to test the feasibility of center of pressure (COP) displacement during GI as the measure of APA in PD with and without a history of FOG. METHODS Patients with PD underwent COP trajectory measurements, including duration, length, velocity, and acceleration in different phases of APA (APA1, APA2a, APA2, and LOC), as well as evaluation of New Freezing of Gait Questionnaire (NFOG-Q), Tinetti balance and gait score, and Postural Instability and Gait Difficulty (PIGD) score in the on and off medication states. RESULTS The duration (seconds) of APA2a, APA2b, and LOC were highest while velocity in mediolateral direction (X) (m/s), including APA1, APA2a, APA2b, and LOC showed lowest in PD with FOG. Velocity in the mediolateral direction in different phases of APA increased in patients with FOG after dopaminergic therapy. APA2a (seconds) and APA2b (X) (m/s) were significantly associated with NFOG-Q part II, APA2b (X) (m/s) was significantly associated with NFOG-Q part III, and APA2a (seconds) was significantly associated with Tinetti balance and gait and PIGD score. CONCLUSIONS PD with FOG history showed a favorable response of APAs to dopaminergic replacement. The APA parameters by COP trajectory, especially lateral COP shift toward the stance foot (APA2b (X) (m/s) and APA2a (seconds)) are surrogate markers to assess PD with FOG history.
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Affiliation(s)
- Chien-Feng Kung
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Yun-Ru Lai
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
- Departments of Hyperbaric Oxygen Therapy Center, Chang Gung University College of Medicine, Kaohsiung
| | - Wen-Chan Chiu
- Departments of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung
| | - Chia-Yi Lien
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Chih-Cheng Huang
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Ben-Chung Cheng
- Departments of Internal Medicine, Chang Gung University College of Medicine, Kaohsiung
| | - Wei-Che Lin
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yueh-Sheng Chen
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chiun-Chieh Yu
- Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Yi-Fang Chiang
- Departments of Neurology, Chang Gung University College of Medicine, Kaohsiung
| | - Yan-Ru Guo
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Yin-Hong Chen
- Department of Intelligent Commerce, National Kaohsiung University of Science and Technology, Kaohsiung
| | - Cheng-Hsien Lu
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung
- Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
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11
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Song YH, Cho SN, Nam SM. Asymmetric Influence of Dual-Task Interference on Anticipatory Postural Adjustments in One-Leg Stance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11289. [PMID: 36141559 PMCID: PMC9517027 DOI: 10.3390/ijerph191811289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
This study investigated the differences of anticipatory postural adjustments (APAs) in a one-leg stance (OLS) that appear according to lower-extremity dominance and dual-task interference. Thirteen young, healthy, male volunteers performed the OLS task under the following six conditions: (1) dominant leg (DL), single-task; (2) DL, dual-task, with a low level of cognitive load (DT1/2); (3) DL, dual-task, with a high level of cognitive load (DT + 1); (4) non-dominant leg (NDL), single-task; (5) NDL, DT1/2; and (6) NDL, DT + 1. In order to measure the subjects' APA, we used the medial-lateral displacement of their centers of pressure and gravity from the force plate and the time-series data of joint angular motions, recorded using a 3D motion analysis system. In the NDL under the dual-task condition, the onset of APA was delayed and the amplitude declined, which resulted in an increase in the duration of the APA period. The number of components identified by principal component analysis differed according to the dominant foot, and the change caused by cognitive load was found only in the NDL. As the cognitive load increased, the variance of the principal component decreased. These findings show that dual-task interference asymmetrically influences APA according to limb dominance, which reorganizes the coordination strategy of joints' angular motion.
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Pichon R, Van Hove O, Ménard M, Hearing D, Crétual A. Impairment and characteristics of postural control sub-components in people with COPD: a scoping review. Disabil Rehabil 2022:1-16. [PMID: 36000464 DOI: 10.1080/09638288.2022.2107083] [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: 11/03/2022]
Abstract
Purpose: Impairment of postural control is common in people with COPD. However, the precise characteristics of this alteration are not clearly known. The "Systems Framework for Postural Control" which define postural control sub-components, represents an interesting tool to explore this field. The main aim of this review was to identify which postural control sub-components are impaired in people with COPD and to summarise characteristics for each sub-component. A secondary aim was to precise the relation between postural control and activities of daily living (ADL).Materials and methods: A scoping review was conducted, according to the JBI methodology. Medline, Cochrane Library, Scielo, Google Scholar, OpenGrey, and HAL were searched from inception to May 2022. The search was performed in English and French.Results: Eighty-nine articles were included. There was evidence of a potential impairment for most of the postural control sub-components. Characteristics of every sub-component alteration were heterogeneous. Reduced postural control could be associated with difficulties in ADL.Conclusions: People with COPD may have impairment in a wide range of postural control sub-components. Further research is needed to clarify if a common pattern of modification exits for this alteration and to precise the link with ADL.Implications for rehabilitationImpairment of postural control is a common extra-respiratory manifestation in people with COPD and so clinicians must include it in their clinical reasoning.Numerous postural control sub-components could be altered in people with COPD, suggesting that postural control assessment must be holistic.This scoping review shows that characteristics of postural control impairment are varied and that there may be no common pattern at the COPD population level.The relationship between impaired postural control and activities of daily living remains unclear, but clinicians should be alert to potential negative interactions between these two areas.
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Affiliation(s)
- Romain Pichon
- Institut de Formation en Pédicurie-Podologie, Ergothérapie et Kinésithérapie (IFPEK), Rennes, France.,M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | | | - Mathieu Ménard
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France.,Institut d'Ostéopathie de Rennes - Bretagne (IO-RB), Bruz, France
| | - Diane Hearing
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
| | - Armel Crétual
- M2S Laboratory - EA 7470, University Rennes 2, Rennes, France
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13
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Ebrahimabadi Z, Naimi S, Rahimi A, Yousefi M, Wikstrom E. Postural phase duration during self-generated and triggered gait initiation in patients with chronic ankle instability. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Russo Y, Stuart S, Silva-Batista C, Brumbach B, Vannozzi G, Mancini M. Does visual cueing improve gait initiation in people with Parkinson's disease? Hum Mov Sci 2022; 84:102970. [PMID: 35738211 DOI: 10.1016/j.humov.2022.102970] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/04/2022] [Accepted: 06/05/2022] [Indexed: 11/04/2022]
Abstract
Anticipatory postural adjustments (APAs) prior to gait initiation are impaired in people with Parkinson's disease (PD), particularly in those who report Freezing of Gait (FOG). External cues can improve gait parameters in people with PD, but the effects of visual cues on gait initiation are poorly known. The study aimed to (i) assess differences, during gait initiation, between people with PD with (FOG+) and without FOG (FOG-) and healthy controls (HC), (ii) explore the effect of disease severity on gait initiation and (iii) investigate the acute effect of visual cueing on gait initiation and straight-ahead gait. Twenty FOG- and twenty FOG+, and eighteen HC participated in this study. Participants were asked to perform self-initiated gait with and without visual cues presented as transverse taped lines on the floor. Gait initiation and gait were characterized with wireless inertial measurement units. Results showed that FOG+ had smaller APAs than HC and FOG-; although no differences were detected between FOG+ and FOG- when taking into account disease severity. Significant correlations between MDS-UPDRS III scores and gait initiation/straight-ahead gait variables confirmed that differences between FOG+ and FOG- were driven by disease severity. In gait initiation, visual cues elicited different behaviors in people with and without PD. Particularly, people with PD showed smaller and longer APAs, whereas HC showed longer first step durations, compared to baseline. However, the adopted visual cues improved gait speed and stride length in all individuals. These results suggest that people with PD, despite the presence of FOG, utilize different motor strategies, compared to HC, to adapt to the new biomechanical requirements of gait initiation dictated by the visual cues.
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Affiliation(s)
- Yuri Russo
- Department of Movement, Human and Health Sciences, University of Roma Foro Italico, Roma, Italy; Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Carla Silva-Batista
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Exercise Neuroscience Research Group, University of Sao Paulo, Sao Paulo, Brazil
| | - Barbara Brumbach
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
| | - Giuseppe Vannozzi
- Department of Movement, Human and Health Sciences, University of Roma Foro Italico, Roma, Italy
| | - Martina Mancini
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
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15
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Jayasinghe N, Backus S, Gibbons M, Sobel J, Spielman L, Ganz SB, Moallem BI, Ojie MJ, Kakoullis M, Hillstrom H. Brief training of gait and posture using a wearable sensory feedback device with older adults who have fears of falling: A feasibility study. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-021-00623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Massot C, Simoneau E, Peron D, Barbier F, Kwiatkowski A, Donze C, Leteneur S. Simplified stance limb kinetics patterns revealed during gait initiation in early stage of multiple sclerosis. Clin Biomech (Bristol, Avon) 2022; 91:105549. [PMID: 34922096 DOI: 10.1016/j.clinbiomech.2021.105549] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although patients with an early stage of Multiple Sclerosis (MS) commonly complain about balance and gait impairments, their troubles remain misunderstood. The objective was to compare body kinematics and lower limb kinetics during gait initiation between patients with MS with an EDSS score ≤ 4 and healthy participants. METHODS Sixteen patients with MS with a median EDSS score of 2.5 [0-4] and disease duration of 7.4 ± 4.2 years, as well as 16 healthy participants were included, and 3-D motion analysis was performed during gait initiation to calculate spatiotemporal, kinematic and kinetic parameters. FINDINGS The center of pressure position at the beginning of the gait initiation was more anterior (p = 0.02) in patients with MS than healthy participants. The kinetic parameters of the stance limb were highly affected in patients with MS compared to healthy participants during gait initiation. The net muscular moments for each joint were significantly different during the anticipatory postural adjustment phase with smoother variations for patients with MS compared to healthy participants. INTERPRETATION Early stage MS strongly affects the motor modulation of stance limb kinetics during the anticipatory postural adjustment of gait initiation, without alteration of the execution phase. The net muscular moments are sensitive in detecting unobservable balance impairments and can be used to assess disease progression at the early stage. These results suggest that early rehabilitation programs aimed at improving motor modulation and flexibility in gait initiation should be implemented.
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Affiliation(s)
- Caroline Massot
- Service de Médecine Physique et de Réadaptation, GHICL Hôpital Saint Philibert, Lomme, France; Service de Médecine Physique et de Réadaptation, Centre Hospitalier de Saint-Amand-les-Eaux, Saint-Amand-les-Eaux, France; Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France; INSA Hauts-de-France, F-59313 Valenciennes, France.
| | - Emilie Simoneau
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France; INSA Hauts-de-France, F-59313 Valenciennes, France
| | - David Peron
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier de Saint-Amand-les-Eaux, Saint-Amand-les-Eaux, France
| | - Franck Barbier
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France; INSA Hauts-de-France, F-59313 Valenciennes, France
| | - Arnaud Kwiatkowski
- Service de Neurologie, GHICL Hôpital Saint Vincent de Paul, Lille, France
| | - Cécile Donze
- Service de Médecine Physique et de Réadaptation, GHICL Hôpital Saint Philibert, Lomme, France
| | - Sébastien Leteneur
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France; INSA Hauts-de-France, F-59313 Valenciennes, France
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17
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Cognitive performances better identify fallers than mobility assessment among older adults with fear of falling. Aging Clin Exp Res 2021; 33:2709-2714. [PMID: 31576516 DOI: 10.1007/s40520-019-01338-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Half of the people with fear of falling (FoF) are non-fallers, and the reason why some people considered non-fallers are afraid of falling is unknown, but reduced mobility or cognition, or both concurrently must be considered as potential risk factors. AIM The study aimed to determine if mobility and/or cognitive abilities could identify people with a history of falls in older adults with FoF. METHODS Twenty-six older adults with FoF participated in this study. Full cognitive and mobility assessments were performed assessing global cognitive impairments (MoCA score < 26), executive functions, memory, processing speed, visuospatial skills, mobility impairment (TUG time > 13.5 s), gait, balance and physical capacity. Information about falls occurring during the year prior to the inclusion was collected. Logistic regression analyses were performed to explore the association between falls and cognitive and mobility abilities. RESULTS No significant differences in age, sex, level of education or body mass index were detected between fallers and non-fallers. Cognitive impairments (MoCA score < 26) distinguished between fallers and non-fallers (p = 0.038; R2 = 0.247). Among specific cognitive functions, visuospatial skills distinguished between fallers and non-fallers (p = 0.027; R2 = 0.258). Mobility impairments (TUG time > 13.5 s), gait, balance and physical capacity were not related to past falls. DISCUSSION/CONCLUSION In older adults with FoF, global cognitive deficits detected by the MoCA are important factors related to falls and more particularly visuospatial skills seem to be among the most implicated functions. These functions could be targeted in multifactorial interventions.
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18
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Vieira MF, Rodrigues FB, de Oliveira Assis A, de Mendonça Mesquita E, Lemes TS, De Villa GAG, Baptista RR, de Oliveira Andrade A, Lobo da Costa PH. Effects of additional load at different heights on gait initiation: A statistical parametric mapping of center of pressure and center of mass behavior. PLoS One 2021; 16:e0242892. [PMID: 34115751 PMCID: PMC8195414 DOI: 10.1371/journal.pone.0242892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to investigate the effects of different vertical positions of an asymmetrical load on the anticipatory postural adjustments phase of gait initiation. Sixty-eight college students (32 males, 36 females; age: 23.65 ± 3.21 years old; weight: 69.98 ± 8.15 kg; height: 1.74 ± 0.08 m) were enrolled in the study. Ground reaction forces and moments were collected using two force platforms. The participants completed three trials under each of the following random conditions: no-load (NL), waist uniformly distributed load (WUD), shoulder uniformly distributed load (SUD), waist stance foot load (WST), shoulder stance foot load (SST), waist swing foot load (WSW), and shoulder swing foot load (SSW). The paired Hotelling's T-square test was used to compare the experimental conditions. The center of pressure (COP) time series were significantly different for the SUD vs. NL, SST vs. NL, WST vs. NL, and WSW vs. NL comparisons. Significant differences in COP time series were observed for all comparisons between waist vs. shoulder conditions. Overall, these differences were greater when the load was positioned at the shoulders. For the center of mass (COM) time series, significant differences were found for the WUD vs. NL and WSW vs. NL conditions. However, no differences were observed with the load positioned at the shoulders. In conclusion, only asymmetrical loading at the waist produced significant differences, and the higher the extra load, the greater the effects on COP behavior. By contrast, only minor changes were observed in COM behavior, suggesting that the changes in COP (the controller) behavior are adjustments to maintain the COM (controlled object) unaltered.
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Affiliation(s)
- Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Fábio Barbosa Rodrigues
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
- State University of Goiás – Unidade Trindade-GO, Brazil
| | | | | | - Thiago Santana Lemes
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | | | - Adriano de Oliveira Andrade
- Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
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19
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Neuromechanical response of the upper body to unexpected perturbations during gait initiation in young and older adults. Aging Clin Exp Res 2021; 33:909-919. [PMID: 32447739 DOI: 10.1007/s40520-020-01592-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Control of upper body motion deteriorates with ageing leading to impaired ability to preserve balance during gait, but little is known on the contribution of the upper body to preserve balance in response to unexpected perturbations during locomotor transitions, such as gait initiation. AIM To investigate differences between young and older adults in the ability to modify the trunk kinematics and muscle activity following unexpected waist lateral perturbations during gait initiation. METHODS Ten young (25 ± 2 years) and ten older adults (73 ± 5 years) initiated locomotion from stance while a lateral pull was randomly applied to the pelvis. Two force plates were used to define the feet centre-of-pressure displacement. Angular displacement of the trunk in the frontal plane was obtained through motion analysis. Surface electromyography of cervical and thoracic erector spinae muscles was recorded bilaterally. RESULTS A lower trunk lateral bending towards the stance leg side in the preparatory phase of gait initiation was observed in older participants following perturbation. Right thoracic muscle activity was increased in response to the perturbation during the initial phase of gait initiation in young (+ 68%) but not in older participants (+ 7%). CONCLUSIONS The age-related reduction in trunk movement could indicate a more rigid behaviour of the upper body employed by older compared to young individuals in response to unexpected perturbations preceding the initiation of stepping. Older adults' delayed activation of thoracic muscles could suggest impaired reactive mechanisms that may potentially lead to a fall in the early stages of the gait initiation.
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20
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Sakurai R, Montero-Odasso M, Hiroyuki S, Ogawa S, Fujiwara Y. Motor Imagery Deficits in High-Functioning Older Adults and its Impact on Fear of Falling and Falls. J Gerontol A Biol Sci Med Sci 2021; 76:e228-e234. [PMID: 33693722 DOI: 10.1093/gerona/glab073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Older adults at risk of falling or who have fear of falling (FoF) present a discrepancy between "imagined" and "performed" actions. Using the gait-related motor imagery (MI) paradigm, we investigated whether prediction accuracy in motor execution is associated with the onset of FoF and with prospective falls among older adults with FoF. METHODS A cohort of 184 community-dwelling older adults was tested for imaginary and executed Timed Up and Go (TUG) tests at a fast pace at baseline. They were first asked to imagine performing TUG and estimate the time taken to complete it (iTUG), and then, to perform the actual trial (aTUG); the difference between the two times was calculated. Prospective falls were monitored between baseline and 2-year follow-up of FoF assessment. RESULTS At follow-up, 27 of 85 participants without FoF at baseline (31.8%) had developed FoF. Twenty-seven of 99 participants (27.2%) with FoF at baseline experienced falls. A significantly shorter iTUG duration, when compared with aTUG, was observed in those who developed FoF or experienced multiple prospective falls, indicating overestimation of their TUG performance. The adjusted logistic regression model showed that a greater ΔTUG (i.e., tendency to overestimate) at baseline was associated with an increased risk of new-onset FoF among those without FoF at baseline and multiple prospective falls among those with FoF at baseline. CONCLUSIONS Deficits in MI (i.e., overestimation of physical capabilities), reflecting impairment in motor planning, could provide an additional explanation of the high risk of FoF and recurrent falls among people with FoF.
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Affiliation(s)
- Ryota Sakurai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Suzuki Hiroyuki
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Susumu Ogawa
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan
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21
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Postural Stability in Individuals with and without Sacroiliac Joint Dysfunction Before and After Pelvic Belt Application. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.106242] [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
Background: Sacroiliac Joint Dysfunction (SIJD) is considered an origin of low-back pain. It can change the motor control strategy and postural control (PC). Objectives: We aimed to find any probable differences in PC between subjects with and without SIJD and determine the effects of the pelvic belt (PB) on PC. Methods: Thirty-eight subjects were assigned into two equal groups with and without SIJD. They started to walk from the place marked on a force plate for 10 seconds after hearing an auditory signal and performed three attempts for each foot. They repeated six more ones with PB. Raw data were imported to an excel software (version 2007) spreadsheet to calculate the reaction time (RT) and anticipatory postural adjustment (APA) as the components of PC. Results: Our results showed a significant difference in RT between the SIJD-affected and non-affected sides (P = 0.035), but there was no significant difference in APA (P = 0.057). There were significant differences in RT and APAs between the control and SIJD-affected side groups (P = 0.001 and P = 0.010, respectively). The PB application showed a significant difference in RT and APAs of the SIJD-affected side (P = 0.001 and P = 0.047, respectively). Conclusions: It seems pain could lead to the postural sway into instability and change the motor control strategy. The proprioception signals from the neuromuscular system of SIJ improved after PB. Therefore, PB, as a feasible tool, can be recommended for PC improvement.
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22
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Zaback M, Luu MJ, Adkin AL, Carpenter MG. Selective preservation of changes to standing balance control despite psychological and autonomic habituation to a postural threat. Sci Rep 2021; 11:384. [PMID: 33431937 PMCID: PMC7801693 DOI: 10.1038/s41598-020-79417-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/30/2020] [Indexed: 01/29/2023] Open
Abstract
Humans exhibit changes in postural control when confronted with threats to stability. This study used a prolonged threat exposure protocol to manipulate emotional state within a threatening context to determine if any threat-induced standing behaviours are employed independent of emotional state. Retention of balance adaptations was also explored. Thirty-seven adults completed a series of 90-s standing trials at two surface heights (LOW: 0.8 m above ground, away from edge; HIGH: 3.2 m above ground, at edge) on two visits 2-4 weeks apart. Psychological and autonomic state was assessed using self-report and electrodermal measures. Balance control was assessed using centre of pressure (COP) and lower limb electromyographic recordings. Upon initial threat exposure, individuals leaned backward, reduced low-frequency centre of pressure (COP) power, and increased high-frequency COP power and plantar/dorsiflexor coactivation. Following repeated exposure, the psychological and autonomic response to threat was substantially reduced, yet only high-frequency COP power and plantar/dorsiflexor coactivation habituated. Upon re-exposure after 2-4 weeks, there was partial recovery of the emotional response to threat and few standing balance adaptations were retained. This study suggests that some threat-induced standing behaviours are coupled with the psychological and autonomic state changes induced by threat, while others may reflect context-appropriate adaptations resistant to habituation.
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Affiliation(s)
- Martin Zaback
- grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z4 Canada
| | - Minh John Luu
- grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z4 Canada
| | - Allan L. Adkin
- grid.411793.90000 0004 1936 9318Department of Kinesiology, Brock University, St. Catharines, ON Canada
| | - Mark G. Carpenter
- grid.17091.3e0000 0001 2288 9830School of Kinesiology, University of British Columbia, 6108 Thunderbird Blvd., Vancouver, BC V6T 1Z4 Canada ,grid.17091.3e0000 0001 2288 9830Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC Canada
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Mehdizadeh S, Van Ooteghem K, Gulka H, Nabavi H, Faieghi M, Taati B, Iaboni A. A systematic review of center of pressure measures to quantify gait changes in older adults. Exp Gerontol 2020; 143:111170. [PMID: 33238173 DOI: 10.1016/j.exger.2020.111170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
Measures of gait center of pressure (COP) can be recorded using simple available technologies in clinical settings and thus can be used to characterize gait quality in older adults and its relationship to falls. The aim of this systematic review was to investigate the association between measures of gait COP and aging and falls. A comprehensive search of electronic databases including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), Ageline (EBSCO) and Scopus was performed. The initial search yielded 2809 papers. After removing duplicates and applying study inclusion/exclusion criteria, 34 papers were included in the review. Gait COP has been examined during three tasks: normal walking, gait initiation, and obstacle negotiation. The majority of studies examined mean COP position and velocity as outcome measures. Overall, gait in older adults was characterized by more medial COP trajectory in normal walking and lower average anterior-posterior and medio-lateral COP displacements and velocity in both gait initiation and obstacle crossing. Moreover, findings suggest that Tai chi training can enhance older adults' balance control during gait initiation as demonstrated by greater COP backward, medial and forward shift in all three phases of gait initiation. These findings should be interpreted cautiously due to inadequacy of evidence as well as methodological limitations of the studies such as small sample size, limited numbers of 'fallers', lack of a control group, and lack of interpretation of COP outcomes with respect to fall risk. COP measures can be adopted to assess fall-related gait changes in older adults but more complex measures of COP that reveal the dynamic nature of COP behavior in step-to-step variations are needed to adequately characterize gait changes in older adults.
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Affiliation(s)
- Sina Mehdizadeh
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Karen Van Ooteghem
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Heidi Gulka
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hoda Nabavi
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mohammadreza Faieghi
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Babak Taati
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Department of Computer Science, University of Toronto, Toronto, ON, Canada; Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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24
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Stamenkovic A, van der Veen SM, Thomas JS. Fear Priming: A Method for Examining Postural Strategies Associated With Fear of Falling. Front Aging Neurosci 2020; 12:241. [PMID: 32848714 PMCID: PMC7419599 DOI: 10.3389/fnagi.2020.00241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/13/2020] [Indexed: 01/09/2023] Open
Abstract
Fear of falling influences postural strategies used for balance, and is key in the maintenance of independent living and quality of life as adults age. However, there is a distinct need for methodology that aims to specifically address and prime fear under dynamic conditions, and to better determine the role of fear in movement preparation. This preliminary study investigated how fear priming influences fear of falling in young and older individuals, and assessed how changes in fear of falling map to movement behavior. Young (21.5 ± 1.7 years, n = 10) and older (58.1 ± 2.2 years) participants matched for height, weight, and sex were repeatedly exposed to four different and incrementally challenging laboratory-based slipping perturbations during a self-initiated, goal-directed step and reach task. Both younger and older cohorts showed similar heightened perceptions in fear of falling after fear priming, and changes in peak joint excursions including reduced ankle flexion, and increased lumbar flexion after fear priming. Age-related changes were only evident in total mediolateral center of mass displacement, with younger participants showing greater displacement after fear priming. Despite clear differences in preparatory muscle onsets relative to reach onset seen in older participants, muscle timings or co-contraction indices were not significantly different. Methods utilizing repeated exposure to varying increases of a slip-based postural challenge can successfully prime fear of falling in individuals, regardless of age.
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Affiliation(s)
- Alexander Stamenkovic
- Motor Control Laboratory, Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States
| | - Susanne M van der Veen
- Motor Control Laboratory, Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
| | - James S Thomas
- Motor Control Laboratory, Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
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25
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Parr JVV, Foster RJ, Wood G, Hollands MA. Children With Developmental Coordination Disorder Exhibit Greater Stepping Error Despite Similar Gaze Patterns and State Anxiety Levels to Their Typically Developing Peers. Front Hum Neurosci 2020; 14:303. [PMID: 32848677 PMCID: PMC7399056 DOI: 10.3389/fnhum.2020.00303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022] Open
Abstract
This study examined stepping accuracy, gaze behavior, and state-anxiety in children with (N = 21, age M = 10.81, SD = 1.89) and without (N = 18, age M = 11.39, SD = 2.06) developmental coordination disorder (DCD) during an adaptive locomotion task. Participants walked at a self-selected pace along a pathway, placing their foot into a raised rectangular floor-based target box followed by either no obstacles, one obstacle, or two obstacles. Stepping kinematics and accuracy were determined using three-dimensional motion capture, whilst gaze was determined using mobile eye-tracking equipment. The children with DCD displayed greater foot placement error and variability when placing their foot within the target box and were more likely to make contact with its edges than their typically developing (TD) peers. The DCD group also displayed greater variability in the length and width of their steps in the approach to the target box. No differences were observed between groups in any of the gaze variables measured, in mediolateral velocity of the center of mass during the swing phase into the target box, or in the levels of self-reported state-anxiety experienced prior to facing each task. We therefore provide the first quantifiable evidence that deficits to foot placement accuracy and precision may be partially responsible for the increased incidence of trips and falls in DCD, and that these deficits are likely to occur independently from gaze behavior and state-anxiety.
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Affiliation(s)
- Johnny V V Parr
- Department of Sport and Exercise Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard J Foster
- Research to Improve Stair Climbing Safety, Faculty of Science, School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Greg Wood
- Department of Sport and Exercise Sciences, Research Centre for Musculoskeletal Science and Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom
| | - Mark A Hollands
- Research to Improve Stair Climbing Safety, Faculty of Science, School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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26
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Yousefi M, Sadeghi H, Ilbiegi S, Ebrahimabadi Z, Kakavand M, Wikstrom EA. Center of pressure excursion and muscle activation during gait initiation in individuals with and without chronic ankle instability. J Biomech 2020; 108:109904. [PMID: 32636013 DOI: 10.1016/j.jbiomech.2020.109904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/28/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
The aim of the current study was to determine differences in center of pressure (COP)excursion and muscle activation during gait initiation (GI) in those with and without chronic ankle instability (CAI). Thirty-four participants, 17 per group, volunteered to participate. Participants were asked to stand barefoot on a force plate before initiating gait upon hearing an auditory cue. Reaction time, anticipatory postural adjustment phase time, as well as normalized peak COP excursion during the anticipatory postural adjustment phase was calculated. Response time of Soleus and Tibialis Anterior muscles were concurrently recorded via electromyography. The results demonstrate a longer reaction time and shorter anticipatory postural adjustment phase time in the CAI group (p < 0.05). No significant between group differences in peak normalized COP excursion were noted (p > 0.05). Muscle onset patterns differed between groups as those with CAI demonstrated earlier Soleus activation compared to the control group (p < 0.05). The results suggest that those with CAI have an altered GI motor control strategy as evidenced by reduced or absent Soleus muscle inhibition during APA phase of GI relative to controls. The APA phase is controlled by the secondary motor area, therefore, the presence of motor control alterations in CAI patients may be due to a supra-spinal alterations.
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Affiliation(s)
- Mohammad Yousefi
- Sport Biomechanics, Faculty of Sport Sciences, University of Birjand, Birjand, Iran.
| | - Heydar Sadeghi
- Sport Biomechanics and injuries, Faculty of Physical Education & Sport Sciences, Kharazmi University of Tehran, Tehran, Iran; Kinsiology Research Center, Sport Biomechanics, Kharazmi University of Tehran, Tehran, Iran
| | - Saeed Ilbiegi
- Sport Biomechanics, Faculty of Sport Sciences, University of Birjand, Birjand, Iran
| | - Zahra Ebrahimabadi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Kakavand
- Master of Sport Biomechanics, Faculty of Physical Education, Kharazmi University of Tehran, Tehran, Iran
| | - Erik A Wikstrom
- MOTION Science Institute &Department of Exercise & Sport Science University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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27
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Ellmers TJ, Maslivec A, Young WR. Fear of Falling Alters Anticipatory Postural Control during Cued Gait Initiation. Neuroscience 2020; 438:41-49. [PMID: 32407974 DOI: 10.1016/j.neuroscience.2020.04.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
Fear of falling can have a profound influence on anticipatory postural control during dynamic balance tasks (e.g., rise-to-toes and leg-raise tasks), with fearful individuals typically exhibiting postural adjustments of smaller magnitudes prior to movement onset. However, very little is known about how fear of falling influences the generation of anticipatory postural adjustments (APAs) during gait initiation; a task in which producing smaller APAs may compromise stability. Sixteen young adults initiated gait as fast as possible following an auditory cue during two conditions: Baseline (ground level), and Threat (fear of falling induced via a platform raised 1.1 m). While the magnitude and duration of APAs did not change between conditions, participants executed steps of shorter lengths during Threat. As APAs during gait initiation are typically proportionate to the length of the first step, the APAs during Threat are therefore disproportionately large (given the shorter step length). We suggest that such failure to scale the APA to the magnitude of the motor output represents a fear-related 'overcompensation', whereby fearful participants sought to ensure that the APA was sufficient for ensuring that their centre of mass was positioned above the support leg prior to gait initiation. During conditions of threat, participants also exhibited greater postural sway prior to initiating gait (i.e., following the auditory cue) and took longer to generate the APA (i.e., impaired reaction). As greater reaction times during voluntary stepping is consistently associated with increased fall-risk, we suggest this as one mechanism through which fear of falling may reduce balance safety.
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Affiliation(s)
- Toby J Ellmers
- College of Health and Life Sciences, Brunel University London, UK; The Centre for Cognitive Neuroscience, Brunel University London, UK.
| | - Amy Maslivec
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, UK
| | - William R Young
- School of Sport and Health Sciences, University of Exeter, UK; College of Health and Life Sciences, Brunel University London, UK
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28
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Kang GE, Zhou H, Varghese V, Najafi B. Characteristics of the gait initiation phase in older adults with diabetic peripheral neuropathy compared to control older adults. Clin Biomech (Bristol, Avon) 2020; 72:155-160. [PMID: 31887482 PMCID: PMC7089822 DOI: 10.1016/j.clinbiomech.2019.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/19/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait is deteriorated in older adults with diabetic peripheral neuropathy; however, too little is known about the gait initiation phase. We aimed to determine if gait initiation variables are more sensitive in identifying the extent to which diabetic peripheral neuropathy impacts gait. METHODS We examined steps, distance, speed and dynamic balance in the gait initiation phase using a validated algorithm based on wearable sensors in 38 older adults with diabetic peripheral neuropathy and 33 non-diabetic, non-neurologic, non-orthopedic control older adults (≥65 years) under single-task and dual-task gait conditions. FINDINGS During the single-task gait condition, the largest differences between the two groups were found in gait initiation steps and dynamic balance (66.7% more steps and 57.2% poorer balance for the diabetic group; effect size = 1.08 and 1.11, respectively; all p < 0.05), while gait speed had a medium effect (10.9% slower for the diabetic group; effect size = 0.54; p < 0.05). Although gait deteriorated for both groups during the dual-task gait condition compared to the single-task gait condition, effect sizes of the between-group differences remained similar. The differences in gait initiation steps and dynamic balance between the two groups were independent of gait speed. INTERPRETATION Gait initiation steps and dynamic balance may be more sensitive than gait speed for detecting gait deterioration due to diabetic peripheral neuropathy. Given the association between gait initiation and risk for fall, our findings suggest that gait initiation variables may be important outcomes for clinical management of diabetic peripheral neuropathy.
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Affiliation(s)
- Gu Eon Kang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Varsha Varghese
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States.
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29
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Zaback M, Adkin AL, Carpenter MG. Adaptation of emotional state and standing balance parameters following repeated exposure to height-induced postural threat. Sci Rep 2019; 9:12449. [PMID: 31462652 PMCID: PMC6713771 DOI: 10.1038/s41598-019-48722-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/07/2019] [Indexed: 11/12/2022] Open
Abstract
Height-induced postural threat influences standing balance control. However, it is unknown if minimizing individuals’ emotional response to threat moderates this relationship. This study repeatedly exposed individuals to height-induced postural threat to determine if reducing the emotional response to threat influences standing balance control. Sixty-eight young adults completed a series of standing trials at LOW (0.8 m above ground, away from edge) and HIGH (3.2 m above ground, at edge) postural threat conditions. Emotional state was assessed using self-report and electrodermal measures. Standing balance was assessed through analysis of centre of pressure (COP) movement and lower leg electromyographic activity. Individuals’ emotional response to threat was attenuated following repeated threat exposure. However, threat-induced changes in standing balance were largely preserved. When initially threatened, individuals leaned backward and demonstrated smaller amplitude and higher frequency of COP adjustments; these balance outcomes did not change following repeated threat exposure. Only high frequency COP oscillations (>1.8 Hz) and ankle muscle co-contraction showed any adaptation; regression analyses showed that these behavioural adaptations were accounted for by a combination of emotional and cognitive state changes. This suggests that some threat-induced standing balance changes are more closely linked with the emotional response to threat than others, and are therefore amendable to intervention.
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Affiliation(s)
- Martin Zaback
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allan L Adkin
- Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Mark G Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada. .,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada. .,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
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30
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Peeters G, Feeney J, Carey D, Kennelly S, Kenny RA. Fear of falling: A manifestation of executive dysfunction? Int J Geriatr Psychiatry 2019; 34:1275-1282. [PMID: 31034696 DOI: 10.1002/gps.5133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/05/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Fear of falling (FoF) may be an early marker of decline in global cognitive functioning, but associations with specific domains of cognitive functioning are unclear. The aim was to examine associations between FoF and 4-year decline in memory, processing speed, and executive functioning in adults aged 50 years and older. METHODS Data were from 5174 participants (mean age = 62.6 ± 8.9 years, range = 50-91, 54.5% female) in The Irish Longitudinal Study on Ageing, a population-based study. MEASUREMENTS FoF was self-reported in 2009 to 2011. Immediate and delayed recall, Colour Trails 1 and 2, choice reaction time, sustained attention to response task, and verbal fluency were measured in 2009 to 2011 and 2014 to 2015. Prospective associations between FoF and domains of cognitive functioning were examined using linear mixed modelling. Adjustment was made for demographic and health factors. Interactions with age were examined. RESULTS In 2009 to 2011, 20.6% of participants reported FoF. No statistically significant interaction of FoF with age was found for any of the associations (P ≥ .06). Participants with FoF had greater decline on delayed recall (B = -0.19; 95% CI, -0.32 to -0.06), verbal fluency (B = -0.52; 95% CI, -0.88 to -0.18); and the ln-transformed scores for the Colour Trails 1 test (B = -0.04; 95% CI, -0.07 to -0.01) and the Colour Trails 2 test (B = -0.04; 95% CI, -0.06 to -0.02) than participants without FoF. No statistically significant associations were found for any of the other outcomes. CONCLUSIONS FoF may be an indicator of decline in domains of cognitive functioning, particularly those related to executive function and processing speed. However, studies with longer follow-up and/or higher average age are required to confirm this.
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Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Daniel Carey
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Sean Kennelly
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Age-Related Health Care, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - Rose Anne Kenny
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.,Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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31
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Zhang Z, Gao Y, Wang J. Effects of vision and cognitive load on anticipatory and compensatory postural control. Hum Mov Sci 2019; 64:398-408. [PMID: 30876761 DOI: 10.1016/j.humov.2019.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
This study assessed the effects of vision and cognitive load on anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs) in response to an externally triggered postural perturbation. A ball-hitting test was repeated under different visual conditions (eyes open, EO; eyes closed, EC) and cognitive loads (no load, 3-subtraction task, time-limited 3-subtraction task). Data were collected separately for I) surface electromyography from the right side of the biceps brachii (BIC) and erector spinae (ES) to detect the latency and response intensity (RI); and II) displacement of the centre of pressure (ΔCOP) to detect the standard deviation (ΔCOPSD) and maximum value (ΔCOPmax) in the anterior-posterior direction. Compared with the results under the EC condition, the ES latency was shorter and the RI of the BIC was lower under the EO condition. Accordingly, the ΔCOPSD and ΔCOPmax were increased in the APAs phase and decreased in the CPAs phase. Cognitive load had no effect on APAs and CPAs or on ΔCOP in the APAs phase. However, ΔCOPmax was decreased in the CPAs phase during the EC condition. In conclusion, vision played an important role in APAs and CPAs for muscle activation and ΔCOP. Cognitive load had no effect on neuromuscular APAs or CPAs except when the postural perturbation occurred when visually unexpected.
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Affiliation(s)
- Zhi Zhang
- Department of Investigation, Zhejiang Police College, China
| | - Ying Gao
- Education College, Zhejiang University, China
| | - Jian Wang
- Education College, Zhejiang University, China; Center for Psychological Sciences at Zhejiang University, Zhejiang University, China.
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32
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Holtzer R, Kraut R, Izzetoglu M, Ye K. The effect of fear of falling on prefrontal cortex activation and efficiency during walking in older adults. GeroScience 2019; 41:89-100. [PMID: 30737727 DOI: 10.1007/s11357-019-00056-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/24/2019] [Indexed: 11/25/2022] Open
Abstract
Neural inefficiency is inferred when higher brain activations are associated with similar or worse performance. Improved neural efficiency is achieved when task-related brain activations are reduced after practice. No information is available on the effect of fear-of-falling (FOF) on brain activation during walking. We hypothesized that the presence of FOF would be associated with neural inefficiency and with a delay in improving neural efficiency during dual-task walking. Task conditions included single-task walk (STW), Alpha (cognitive interference), and dual-task walk (DTW). Functional near-infrared spectroscopy (fNIRS)-derived HbO2 in the prefrontal cortex (PFC) was used to quantify task-related changes in brain activation. Practice included three repeated counterbalanced trials for each task. Participants with FOF (n = 19; mean age = 79.84 ± 6.01 years; %female = 68.42) and without FOF (n = 56; mean age = 76.73 ± 6.39 years; %female = 44.64) were included. The presence of FOF was associated with slower stride velocity (estimate = - 12.354; p = 0.0154) and with greater increases in PFC HbO2 from STW to DTW (estimate = 0.303, p = 0.0009) and from Alpha to DTW (estimate = 0.387, p < 0.0001). Compared to controls, participants reporting FOF demonstrated an attenuated decline in PFC HbO2 from the first to the second DTW trials (estimate = 0.264; p = 0.0173). In contrast, compared to controls, participants with FOF demonstrated greater decline in Alpha PFC HbO2 from trial 1 to trial 2 (estimate = - 0.419, p < 0.0001) and from trial 1 to 3 (estimate = - 0.281, p = 0.0006). The change in PFC HbO2 over repeated STW trials was not significant and was not moderated by FOF status. The presence of FOF was associated with higher and inefficient PFC activation during DTW in older adults.
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Affiliation(s)
- Roee Holtzer
- Albert Einstein College of Medicine Bronx, 1225 Morris Park Avenue, Van Etten Building, Bronx, NY, 10461, USA.
- Yeshiva University Bronx, New York, NY, USA.
| | | | - Meltem Izzetoglu
- Villanova University Electrical and Computer Engineering, Villanova, PA, USA
| | - Kenny Ye
- Albert Einstein College of Medicine Bronx, 1225 Morris Park Avenue, Van Etten Building, Bronx, NY, 10461, USA
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33
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Hirjaková Z, Šuttová K, Kimijanová J, Bzdúšková D, Hlavačka F. Postural changes during quiet stance and gait initiation in slightly obese adults. Physiol Res 2018; 67:985-992. [PMID: 30204472 DOI: 10.33549/physiolres.933870] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The study is aimed to examine balance control of slightly obese young adults during quiet stance and during gait initiation with and without crossing an obstacle. Forty-four young subjects were divided in two groups: control (BMI<25 kg/m(2)) and slightly obese (BMI from 25 to 35 kg/m(2)). Center of foot pressure (CoP) and kinematics of fifth lumbar vertebra (L5) were evaluated using a force plate and a motion capture system. During quiet stance with eyes open slightly obese group showed increased mean amplitude and velocity of CoP in anterior-posterior direction compared to normal weight subjects. During unloading phase of gait initiation significantly greater and faster lateral CoP shift was observed in slightly obese group compared to normal weight peers. Presence of an obstacle increased amplitude and velocity of the lateral CoP shift similarly in both groups. No BMI-related differences were found on L5 segment during gait initiation, which may indicate that postural control was already successfully performed in feet (CoP). We have shown that increased CoP parameters values and thus increased postural instability during quiet stance and during unloading phase of gait initiation is present not only in morbidly obese, but already in slightly obese subjects.
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Affiliation(s)
- Z Hirjaková
- Centre of Experimental Medicine Slovak Academy of Sciences, Institute of Normal and Pathological Physiology, Bratislava, Slovakia.
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34
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Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls 2018; 3:185-193. [PMID: 32300707 PMCID: PMC7155353 DOI: 10.22540/jfsf-03-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. METHODS 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. RESULTS Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. CONCLUSIONS Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.
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Affiliation(s)
- Jonathan M. Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, UK
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, UK
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35
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Brustio PR, Magistro D, Zecca M, Liubicich ME, Rabaglietti E. Fear of falling and activities of daily living function: mediation effect of dual-task ability. Aging Ment Health 2018; 22:856-861. [PMID: 28485621 DOI: 10.1080/13607863.2017.1318257] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of the study was to explore the association between fear of falling (FOF), dual-task ability during a mobility task, and the activities of daily living (ADL) in a sample of older adults. METHODS Seventy-six older adults (mean age M = 70.87 ± 5.16 years) participated in the study. Data on FOF (using the Falls Self-Efficacy Scale-International), walking ability during both single- and dual-task performances and ADL were collected. RESULTS Mediation analysis demonstrated the mediation effect of dual-task ability (β = 0.238, p = 0.011) between FOF and ADL level (β = 0.559, p < 0.001). Moreover, significantly lower performances were observed during dual-task condition [F (2, 73) = 7.386, p < 0.001], and lower ADL levels were also found in older adults with FOF [F (2, 73) = 13.734, p < 0.001]. CONCLUSION The study underlines the relationship between FOF, dual-task ability and ADL level. These results could be used to develop specific intervention programmes for successful ageing.
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Affiliation(s)
- Paolo R Brustio
- a Department of Psychology , University of Torino , Torino , Italy
| | - Daniele Magistro
- a Department of Psychology , University of Torino , Torino , Italy.,b School of Sport, Exercise, and Health Sciences , Loughborough University , Loughborough , UK.,c National Centre for Sport and Exercise Medicine (NCSEM) , Loughborough , UK
| | - Massimiliano Zecca
- c National Centre for Sport and Exercise Medicine (NCSEM) , Loughborough , UK.,d Wolfson School of Mechanical, Electrical and Manufacturing Engineering , Loughborough University , Loughborough , UK
| | | | - Emanuela Rabaglietti
- a Department of Psychology , University of Torino , Torino , Italy.,e SUISM, Centro Servizi , University of Torino , Torino , Italy
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36
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Ellmers TJ, Young WR. Conscious motor control impairs attentional processing efficiency during precision stepping. Gait Posture 2018; 63:58-62. [PMID: 29715607 DOI: 10.1016/j.gaitpost.2018.04.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Current evidence suggests that fall-related anxiety can impair attentional processing efficiency during gait in both young and older adults, reducing the cognitive resources available for carrying out concurrent tasks (i.e., holding a conversation whilst walking or planning the safest route for navigation). RESEARCH QUESTION It has been suggested that fall-related anxiety may impair processing efficiency by directing attention 'internally', towards consciously controlling and monitoring movement. The present study aimed to evaluate this interpretation. METHODS Fifteen healthy young adults performed a precision stepping task during both single- and dual-task (completing the stepping task while simultaneously performing an arithmetic task), under three conditions: (1) Baseline; (2) Threat (walking on a platform raised 1.1 m above ground), and; (3) Internal focus of attention (cues/instructions to direct attention towards movement processing). RESULTS We observed significantly greater cognitive dual-task costs (i.e., poorer performance on the arithmetic task) during Threat compared to Baseline, with the greatest costs observed in individuals reporting the highest levels of Threat-induced conscious motor processing. Significantly greater cognitive dual-task costs were also observed during the Internal condition, confirming the assumption that consciously attending to movement reduces cognitive resources available for carrying out a secondary task during gait. These results were accompanied with significantly poorer stepping accuracy in dual-task trials during both Threat and Internal. SIGNIFICANCE These findings support previous attempts to rationalise attentional processing inefficiencies observed in anxious walkers as being a consequence of an anxiety-induced internal focus of attention.
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Affiliation(s)
- Toby J Ellmers
- College of Health and Life Sciences, Brunel University, London, UK; Institute for Environment, Health and Societies, Brunel University, London, UK.
| | - William R Young
- College of Health and Life Sciences, Brunel University, London, UK; Institute for Environment, Health and Societies, Brunel University, London, UK
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Impact of age and obstacle negotiation on timing measures of gait initiation. J Bodyw Mov Ther 2018; 22:361-365. [DOI: 10.1016/j.jbmt.2017.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 01/08/2023]
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Takayanagi N, Sudo M, Fujii M, Sakai H, Morimoto K, Tomisaki M, Niki Y, Tokimitsu I. Foot pressure analysis of gait pattern in older Japanese females requiring different personal care support levels. J Phys Ther Sci 2018; 30:461-466. [PMID: 29581672 PMCID: PMC5857459 DOI: 10.1589/jpts.30.461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/22/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated gait parameters and foot pressure in two regions of the feet among older females with different personal care support needs to analyze factors that contribute to higher support requirements. [Subjects and Methods] Thirty-two older females were divided into support-need and care-need level groups. Gait parameters (speed, cadence, step length, step width, gait angle, toe angle, double support phase, swing phase, and stance phase) and foot pressure during a 5-m walk were measured and analyzed in the two groups. [Results] The percentage of the double support phase on both feet and the right stance phase were significantly higher in the care-need level group, while that of the right swing phase was significantly lower than that of the support-need level group. Additionally, the phase showing peak pressure on the left rear foot was significantly delayed and the left forefoot pressure in the terminal stance was significantly lower in the care-need level group than in the support-need level group. [Conclusion] These findings show that the temporal duration parameters and foot pressure on a particular side were significantly different between the two groups and suggest that these differences were associated with a higher care level.
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Affiliation(s)
- Naoto Takayanagi
- Tokyo Research Laboratories, Kao Corporation: 2-1-3 Bunka, Sumida-ku, Tokyo 131-8501, Japan
| | - Motoki Sudo
- Tokyo Research Laboratories, Kao Corporation: 2-1-3 Bunka, Sumida-ku, Tokyo 131-8501, Japan
| | | | - Hirokazu Sakai
- Himawari-no-kai Corporation, Japan.,Unebi-kai Social Welfare Organization, Japan
| | - Keiko Morimoto
- Department of Environmental Health, Nara Women's University, Japan
| | - Masumi Tomisaki
- Tokyo Research Laboratories, Kao Corporation: 2-1-3 Bunka, Sumida-ku, Tokyo 131-8501, Japan
| | - Yoshifumi Niki
- Tokyo Research Laboratories, Kao Corporation: 2-1-3 Bunka, Sumida-ku, Tokyo 131-8501, Japan
| | - Ichiro Tokimitsu
- Department of Health Food Sciences, University of Human Arts and Sciences, Japan
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Ebrahimabadi Z, Naimi SS, Rahimi A, Sadeghi H, Hosseini SM, Baghban AA, Arslan SA. Investigating the anticipatory postural adjustment phase of gait initiation in different directions in chronic ankle instability patients. J Bodyw Mov Ther 2018; 22:40-45. [PMID: 29332755 DOI: 10.1016/j.jbmt.2017.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The main objective of the present study was to analyze how supra spinal motor control mechanisms are altered in different directions during anticipatory postural phase of gait initiation in chronic ankle instability patients. It seems that supra spinal pathways modulate anticipatory postural adjustment phase of gait initiation. Yet, there is a dearth of research on the effect of chronic ankle instability on the anticipatory postural adjustment phase of gait initiation in different directions. METHOD A total of 20 chronic ankle instability participants and 20 healthy individuals initiated gait on a force plate in forward, 30° lateral, and 30° medial directions. RESULTS According to the results of the present study, the peak lateral center of pressure shift decreased in forward direction compared to that in other directions in both groups. Also, it was found that the peak lateral center of pressure shift and the vertical center of mass velocity decreased significantly in chronic ankle instability patients, as compared with those of the healthy individuals. CONCLUSION According to the results of the present study, it seems that chronic ankle instability patients modulate the anticipatory postural adjustment phase of gait initiation, compared with healthy control group, in order to maintain postural stability. These changes were observed in different directions, too.
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Affiliation(s)
- Zahra Ebrahimabadi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sedigheh Sadat Naimi
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Heydar Sadeghi
- Department of Kinesiology, School of Physical Education, Kharazmi University, Tehran, Iran.
| | - Seyed Majid Hosseini
- Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Alireza Akbarzadeh Baghban
- Physiotherapy Research Centre, Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Syed Asadullah Arslan
- Department of Physiotherapy, School of Rehabilitation, International Campus, Tehran University of Medical Sciences, Tehran, Iran.
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Sakurai R, Fujiwara Y, Yasunaga M, Suzuki H, Kanosue K, Montero-Odasso M, Ishii K. Association between Hypometabolism in the Supplementary Motor Area and Fear of Falling in Older Adults. Front Aging Neurosci 2017; 9:251. [PMID: 28804457 PMCID: PMC5532384 DOI: 10.3389/fnagi.2017.00251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/14/2017] [Indexed: 12/03/2022] Open
Abstract
Background: A better understanding of the neural mechanisms that underlie the development of fear of falling (FoF) in seniors may help to detect potential treatable factors and reduce future falls. We therefore investigate the neural correlates of FoF in older adults using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). Methods: This cohort study included 117 community-dwelling older adults. At baseline, participants were assessed for FoF, psychiatric symptoms, walking speed, global cognition and cerebral glucose metabolism with FDG-PET. The incidence of FoF in the participants who did not report FoF (N-FoF) at baseline was again ascertained 2 years later. FDG uptake was compared between the FoF and non-FoF groups. Logistic regression analyses to examine the predictors of newly developed FoF (D-FoF) using normalized regional FDG uptake were then performed. Results: At baseline, 50.4% (n = 59) of participants had FoF. The FoF group had significantly decreased glucose metabolism in the left superior frontal gyrus (supplementary motor area, SMA; BA6) compared to the non-FoF group. After 2 years, 19 out of the 58 participants in the non-FoF group developed FoF. Logistic regression analysis revealed that decreased cerebral glucose metabolism in the left SMA at the baseline was a significant predictor of the future development of FoF, independently of psychiatric symptoms and walking speed. Conclusion: In healthy older adults, hypometabolism in the left SMA, which is involved in motor planning and motor coordination, contributes to the development of FoF. Our result might help elucidate underlying mechanism of the association between deficits in motor control and FoF.
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Affiliation(s)
- Ryota Sakurai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
- Faculty of Sport Sciences, Waseda UniversitySaitama, Japan
- Japan Society for the Promotion of ScienceTokyo, Japan
- Gait and Brain Laboratory, Parkwood Institute, University of Western Ontario and Lawson Health Research InstituteLondon, ON, Canada
- *Correspondence: Ryota Sakurai
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
| | - Masashi Yasunaga
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
| | - Hiroyuki Suzuki
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
| | | | - Manuel Montero-Odasso
- Gait and Brain Laboratory, Parkwood Institute, University of Western Ontario and Lawson Health Research InstituteLondon, ON, Canada
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
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Vieira MF, de Brito AA, Lehnen GC, Rodrigues FB. Center of pressure and center of mass behavior during gait initiation on inclined surfaces: A statistical parametric mapping analysis. J Biomech 2017; 56:10-18. [PMID: 28284667 DOI: 10.1016/j.jbiomech.2017.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/23/2017] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
This study analyzed gait initiation (GI) on inclined surfaces with 68 young adult subjects of both sexes. Ground reaction forces and moments were collected using two AMTI force platforms, of which one was in a horizontal position and the other was inclined by 8% in relation to the horizontal plane. Departing from a standing position, each participant executed three trials in the following conditions: horizontal position (HOR), inclined position at ankle dorsi-flexion (UP), and inclined position at ankle plantar-flexion (DOWN). Statistical parametric mapping analysis was performed over the entire center of pressure (COP) and center of mass (COM) time series. COP excursion did not show significant differences in the medial-lateral (ML) direction in both inclined conditions, but it was greater in the anterior-posterior (AP) direction for both inclined conditions. COP velocities are smaller in discrete portions of GI for the UP and DOWN conditions. COM displacement was greater in the ML direction during anticipatory postural adjustments (APA) in the UP condition, and COM moves faster in the ML direction during APA in the UP condition but slower at the end of GI for both the UP and the DOWN conditions. The COP-COM vector showed a greater angle in the DOWN condition. We observed changes for COP and COM in GI in both the UP and the DOWN conditions, with the latter showing changes for a great extent of the task. Both the UP and the DOWN conditions showed increased COM displacement and velocity. The predominant characteristic during GI on inclined surfaces, including APA, appears to be the displacement of the COM.
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Affiliation(s)
- Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Ademir Alves de Brito
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Georgia Cristina Lehnen
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Fábio Barbosa Rodrigues
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Goiás, Brazil
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The Alteration of Neuromuscular Control Strategies During Gait Initiation in Individuals with Chronic Ankle Instability. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.44534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rajachandrakumar R, Fraser JE, Schinkel-Ivy A, Inness EL, Biasin L, Brunton K, McIlroy WE, Mansfield A. Atypical anticipatory postural adjustments during gait initiation among individuals with sub-acute stroke. Gait Posture 2017; 52:325-331. [PMID: 28038342 PMCID: PMC5218837 DOI: 10.1016/j.gaitpost.2016.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/14/2016] [Accepted: 12/18/2016] [Indexed: 02/02/2023]
Abstract
Anticipatory postural adjustments, executed prior to gait initiation, help preserve lateral stability when stepping. Atypical patterns of anticipatory activity prior to gait initiation may occur in individuals with unilateral impairment (e.g., stroke). This study aimed to determine the prevalence, correlates, and consequences of atypical anticipatory postural adjustment patterns prior to gait initiation in a sub-acute stroke population. Forty independently-ambulatory individuals with sub-acute stroke stood on two force plates and initiated gait at a self-selected speed. Medio-lateral centre of pressure displacement was calculated and used to define anticipatory postural adjustments (shift in medio-lateral centre of pressure >10mm from baseline). Stroke severity, motor recovery, and functional balance and mobility status were also obtained. Three patterns were identified: single (typical), absent (atypical), and multiple (atypical) anticipatory postural adjustments. Thirty-five percent of trials had atypical anticipatory postural adjustments (absent and multiple). Frequency of absent anticipatory postural adjustments was negatively correlated with walking speed. Multiple anticipatory postural adjustments were more prevalent when leading with the non-paretic than the paretic limb. Trials with multiple anticipatory postural adjustments had longer duration of anticipatory postural adjustment and time to foot-off, and shorter unloading time than trials with single anticipatory postural adjustments. A high prevalence of atypical anticipatory control prior to gait initiation was found in individuals with stroke. Temporal differences were identified with multiple anticipatory postural adjustments, indicating altered gait initiation. These findings provide insight into postural control during gait initiation in individuals with sub-acute stroke, and may inform interventions to improve ambulation in this population.
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Affiliation(s)
- Roshanth Rajachandrakumar
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Julia E Fraser
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada
| | - Alison Schinkel-Ivy
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Lou Biasin
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Karen Brunton
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - William E McIlroy
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; University of Waterloo, Waterloo, ON, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada.
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The relative and absolute reliability of center of pressure trajectory during gait initiation in older adults. Gait Posture 2017; 52:194-201. [PMID: 27915224 DOI: 10.1016/j.gaitpost.2016.11.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 10/17/2016] [Accepted: 11/26/2016] [Indexed: 02/02/2023]
Abstract
It has been thought that for scientific acceptance of a parameter, its psychometric properties such as reliability, validity and responsiveness have critical roles. Therefore, this study was conducted to estimate how many trials are required to obtain a reliable center of pressure (COP) parameter during gait initiation (GI) and to investigate the effect of number of trials on the relative and absolute reliability. Twenty older adults participated in the study. Subjects began stepping over the force platform in response to an auditory stimulus. Ten trials were collected in one session. The displacement, velocity, mean and median frequency of the COP in the mediolateral (ML) and anteroposterior (AP) directions were evaluated. Relative reliability was determined using the intraclass correlation coefficient (ICC), and absolute reliability was evaluated using the standard error of measurement (SEM) and minimal detectable change (MDC95). The results revealed with respect to parameter, one to five trials should be averaged to ensure excellent reliability. Moreover, ICC, SEM% and MDC95% values were between 0.39-0.89, 4.84-41.5% and 13.4-115% for single trial and 0.86-0.99, 1.74-19.7% and 4.83-54.7% for ten trials averaged, respectively. Moreover, the ML and AP COP displacement in locomotor phase had the most relative reliability as well as the ML and AP median frequency in locomotor phase had the most absolute reliability. In general, the results showed that the COP-related parameters in time and frequency domains, based on average of five trials, provide reliable outcome measures for evaluation of dynamic postural control in older adults.
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Sakurai R, Fujiwara Y, Yasunaga M, Suzuki H, Sakuma N, Imanaka K, Montero-Odasso M. Older Adults with Fear of Falling Show Deficits in Motor Imagery of Gait. J Nutr Health Aging 2017; 21:721-726. [PMID: 28537339 DOI: 10.1007/s12603-016-0811-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Understanding of the underlying mechanisms of Fear of Falling (FoF) could help to expand potential treatments. Given the nature of motor performance, the decline in the planning stage of motor execution may be associated with an expression of FoF. The aim of this study was to assess the planning/prediction accuracy in motor execution in people with FoF using gait-related motor imagery (MI). DESIGN Cross-sectional case/control study. SETTING Three health centers in Japan. PARTICIPANTS Two hundred and eighty-three community-dwelling older adults were recruited and stratified by presence of FoF as FoF group (n=178) or non-FoF group (n=107). MEASUREMENTS Participants were tested for both imagery and execution tasks of a Timed Up and Go (TUG) test. The participants were first asked to imagine the trial (iTUG) and estimate the time it would take, and then perform the actual trial (aTUG). The difference between iTUG and aTUG (Δ TUG) was calculated. RESULTS The FoF group was significantly slower in aTUG, but iTUG duration was almost identical between the two groups, resulting in significant overestimation in the FoF group. The adjusted logistic regression analysis showed that increased Δ TUG (i.e., tendency to overestimate) was significantly associated with FoF (OR = 1.05; 95% CI = 1.02-1.10). Low frequency of going outdoors was also associated with FoF (OR 2.95; 95% CI: 1.16-7.44). CONCLUSIONS Older adults with FoF overestimate their TUG performance, reflecting impairment in motor planning. Overestimation of physical capabilities can be an additional explanation of the high risk of falls in this population.
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Affiliation(s)
- R Sakurai
- Ryota Sakurai, Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan,
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Tisserand R, Robert T, Chabaud P, Bonnefoy M, Chèze L. Elderly Fallers Enhance Dynamic Stability Through Anticipatory Postural Adjustments during a Choice Stepping Reaction Time. Front Hum Neurosci 2016; 10:613. [PMID: 27965561 PMCID: PMC5126045 DOI: 10.3389/fnhum.2016.00613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022] Open
Abstract
In the case of disequilibrium, the capacity to step quickly is critical to avoid falling in elderly. This capacity can be simply assessed through the choice stepping reaction time test (CSRT), where elderly fallers (F) take longer to step than elderly non-fallers (NF). However, the reasons why elderly F elongate their stepping time remain unclear. The purpose of this study is to assess the characteristics of anticipated postural adjustments (APA) that elderly F develop in a stepping context and their consequences on the dynamic stability. Forty-four community-dwelling elderly subjects (20 F and 24 NF) performed a CSRT where kinematics and ground reaction forces were collected. Variables were analyzed using two-way repeated measures ANOVAs. Results for F compared to NF showed that stepping time is elongated, due to a longer APA phase. During APA, they seem to use two distinct balance strategies, depending on the axis: in the anteroposterior direction, we measured a smaller backward movement and slower peak velocity of the center of pressure (CoP); in the mediolateral direction, the CoP movement was similar in amplitude and peak velocity between groups but lasted longer. The biomechanical consequence of both strategies was an increased margin of stability (MoS) at foot-off, in the respective direction. By elongating their APA, elderly F use a safer balance strategy that prioritizes dynamic stability conditions instead of the objective of the task. Such a choice in balance strategy probably comes from muscular limitations and/or a higher fear of falling and paradoxically indicates an increased risk of fall.
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Affiliation(s)
- Romain Tisserand
- IFSTTAR, UMR_T9406, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC), Université de Lyon, Université Claude Bernard Lyon 1 Lyon, France
| | - Thomas Robert
- IFSTTAR, UMR_T9406, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC), Université de Lyon, Université Claude Bernard Lyon 1 Lyon, France
| | - Pascal Chabaud
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM), Université de Lyon, Université Claude Bernard Lyon 1 Villeurbanne, France
| | - Marc Bonnefoy
- Service de Médecine Gériatrique, Centre Hospitalier Lyon Sud Pierre-Bénite, France
| | - Laurence Chèze
- IFSTTAR, UMR_T9406, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC), Université de Lyon, Université Claude Bernard Lyon 1 Lyon, France
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To dance or not to dance? A comparison of balance, physical fitness and quality of life in older Irish set dancers and age-matched controls. Public Health 2016; 141:56-62. [PMID: 27932016 DOI: 10.1016/j.puhe.2016.07.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to determine if older adults regularly participating in Irish set dancing have superior balance, physical fitness and quality of life compared to age-matched controls. STUDY DESIGN This study used a community-based, observational cross-sectional design. METHODS Regular set dancers (n = 39) and age-matched controls (n = 33) were recruited. Participants were assessed using the physical activity scale for the elderly (physical activity levels), mini-BESTest (balance) and senior fitness test (battery of functional fitness tests). Quality of life was also assessed using the EuroQol EQ visual analogue scale. RESULTS When controlling for between-group differences in levels of physical activity (ANCOVA analysis), the dancers had significantly better balance, functional capacity and quality of life (all P < 0.05) compared to controls. No differences between the groups were observed in other measures of functional fitness. CONCLUSION The findings of this study suggest regular participation in set dancing is associated with health benefits for older adults. These results may inform future studies prospectively examining the role of set dancing for falls prevention, emotional well-being and cognitive function in community-dwelling older adults.
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Toosizadeh N, Stocker H, Thiede R, Mohler J, Mills JL, Najafi B. Alterations in gait parameters with peripheral artery disease: The importance of pre-frailty as a confounding variable. Vasc Med 2016; 21:520-527. [PMID: 27634957 DOI: 10.1177/1358863x16660626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although poor walking is the most common symptom of peripheral artery disease (PAD), reported results are inconsistent when comparing gait parameters between PAD patients and healthy controls. This inconsistency may be due to frailty, which is highly prevalent among PAD patients. To address this hypothesis, 41 participants, 17 PAD (74±8 years) and 24 aged-matched controls (76±7 years), were recruited. Gait was objectively assessed using validated wearable sensors. Analysis of covariate (ANCOVA) tests were used to compare gait parameters between PAD and non-PAD groups, considering age, gender, and body mass index as covariates, while stratified based on frailty status. According to the Fried frailty index, 47% of PAD and 50% of control participants were non-frail and the rest were classified as pre-frail. Within non-frail participants, gait speed, body sway during walking, stride length, gait cycle time, double-support, knee range of motion, speed variability, mid-swing speed, and gait initiation were significantly different between PAD and control groups (effect size d = 0.75±0.43). In the pre-frail group, however, most of the gait differences were diminished except for gait initiation and gait variability. Results suggest that gait initiation is the most sensitive parameter for detecting gait impairment in PAD participants when compared to controls, regardless of frailty status (d = 1.30-1.41; p<0.050). The observed interaction effect between frailty and PAD on gait parameters confirms the importance of assessing functionality in addition to age to provide more consistency in detecting motor performance impairments due to PAD.
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Affiliation(s)
- Nima Toosizadeh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA.,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hannah Stocker
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Rebecca Thiede
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Jane Mohler
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA.,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Joseph L Mills
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA.,Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, University of Arizona, Tucson, AZ, USA .,Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA.,Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Tournier I, Dommes A, Cavallo V. Review of safety and mobility issues among older pedestrians. ACCIDENT; ANALYSIS AND PREVENTION 2016; 91:24-35. [PMID: 26950033 DOI: 10.1016/j.aap.2016.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 02/09/2016] [Accepted: 02/29/2016] [Indexed: 06/05/2023]
Abstract
Although old people make up an extremely vulnerable road-user group, older pedestrians' difficulties have been studied less extensively than those of older drivers, and more knowledge of this issue is still required. The present paper reviews current knowledge of older-adult problems with the main components of pedestrian activity, i.e., walking and obstacle negotiation, wayfinding, and road crossing. Compared to younger ones, old pedestrians exhibit declining walking skills, with a walking speed decrease, less stable balance, less efficient wayfinding strategies, and a greater number of unsafe road crossing behaviors. These difficulties are linked to age-related changes in sensorial, cognitive, physical, and self-perception abilities. It is now known that visual impairment, physical frailty, and attention deficits have a major negative impact on older pedestrians' safety and mobility, whereas the roles of self-evaluation and self-regulation are still poorly understood. All these elements must be taken into consideration, not only in developing effective safety interventions targeting older pedestrians, but also in designing roads and cars. Recent initiatives are presented here and some recommendations are proposed.
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Affiliation(s)
- Isabelle Tournier
- INSIDE, University of Luxembourg, 11 porte des sciences, L-4366 Esch-sur-Alzette, Luxembourg; LEPSIS, IFSTTAR, 25 allée des Marronniers, F-78000 Versailles, France.
| | - Aurélie Dommes
- LEPSIS, IFSTTAR, 25 allée des Marronniers, F-78000 Versailles, France
| | - Viola Cavallo
- LEPSIS, IFSTTAR, 25 allée des Marronniers, F-78000 Versailles, France
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Plate A, Klein K, Pelykh O, Singh A, Bötzel K. Anticipatory postural adjustments are unaffected by age and are not absent in patients with the freezing of gait phenomenon. Exp Brain Res 2016; 234:2609-18. [PMID: 27173496 DOI: 10.1007/s00221-016-4665-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 04/27/2016] [Indexed: 12/26/2022]
Abstract
In bipedal gait, the initiation of the first step is preceded by a complex sequence of movements which shift the centre of mass of the body towards the stance foot to allow for a step of the swing foot. These anticipatory postural adjustments (APAs) have been investigated in order to elucidate movement strategies in healthy and diseased persons. We studied the influence of several external parameters (age, type of step initiation) on APAs and investigated whether Parkinsonian patients may have different APAs. As a result, we found that externally elicited steps were preceded by faster and larger APAs than self-timed steps. Parkinsonian patients without the freezing of gait (FOG) phenomenon showed overall slightly reduced APAs but did not clearly differ from patients with FOG. Multiple APAs were seen in up to 25 % of the steps of the patients and in a much lower percentage of the steps of control subjects. The results indicate that APAs are significantly influenced by the timing of a step, i.e. are larger in externally elicited steps. The patients showed an overall preserved APA pattern but slowed movements and amplitude, indicating that increased bradykinesia due to progressive illness is a plausible explanation for these findings. The freezing phenomenon is not explained by a general absence or massive reduction in APA measures.
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Affiliation(s)
- A Plate
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - K Klein
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - O Pelykh
- Department of Orthopedics, Physical Medicine and Rehabilitation, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Singh
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - K Bötzel
- Department of Neurology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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