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Nishizawa K, Harato K, Hakukawa S, Okawara H, Sawada T, Ishida H, Nagura T. Turning and sitting movements during timed up and go tests predict deterioration of physical function in middle-aged adults. Gait Posture 2024; 108:329-334. [PMID: 38215635 DOI: 10.1016/j.gaitpost.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Deterioration of physical function in middle-aged adults is a significant challenge that can lead to increased risk of future falls. However, a screening method for the functional decline in middle-aged adults has not been established. RESEARCH QUESTION To evaluate the relationship between biomechanical parameters assessed by the timed up and go test (TUG) and locomotive syndrome (LS) in middle-aged adults. METHODS The inclusion criterion was: under 65 years of age. A total of 97 volunteers (mean age 51.1 years) participated in this study. An LS test was performed, including a 2-step test, a stand-up test, and a 25-question Geriatric Locomotive Function Scale. The TUG was measured using inertial measurement units (IMUs) at comfortable and fast speeds. We then determined the minimum values for anterior-posterior acceleration and angular velocity around the medial-lateral axis, as well as the maximum values of angular velocity around the vertical axis for the upper trunk and sacrum in a TUG phase. RESULTS Angular velocity around the vertical axis for upper trunk and sacrum were significantly smaller in LS than non-LS in the turn phase of both speed conditions. For the fast speed condition, the minimum anterior-posterior acceleration for sacrum was greater in LS than in the non-LS condition for the stand-to-sit phase. Angular velocity around the vertical axis for turning and anterior-posterior acceleration from sitting were associated with detection of LS. SIGNIFICANCE Turning and sitting movements during TUG should be observed using IMU to screen for physical function decline in middle aged adults.
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Affiliation(s)
- Kohei Nishizawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
| | - Satoshi Hakukawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hiroki Okawara
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Tomonori Sawada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hiroyuki Ishida
- Sports Medicine Research Center, Keio University, Kouhoku, Yokohama, Kanagawa, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Ghani HA, Alghwiri AA, Hisham H, Manaf H. Lower Limb Muscle Fatigue Alters Spatiotemporal Gait Parameters and Turning Difficulty Characteristics in Parkinson's Disease. Ann Rehabil Med 2023; 47:282-290. [PMID: 37558204 PMCID: PMC10475814 DOI: 10.5535/arm.23067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To determine the effects of lower limb muscle fatigue on spatiotemporal gait parameters and turning difficulty characteristics during the extended Timed Up and Go (extended TUG) test in individuals with different severity stages of Parkinson's disease (PD). METHODS Forty individuals with PD, classified as Hoehn and Yahr (H&Y) stages 2 and 3 participated in this pre- and post-experimental study design. The participants performed a continuous sit-to-stand task from a chair based on 30 cycles/min set-up to induce lower limb muscle fatigue. They performed extended TUG test immediately before and after completing the fatigue protocol. Spatiotemporal gait parameters and turning difficulty characteristics were recorded using two GoPro® Hero 4 Silver cameras. Data were subjected to a repeated-measure ANOVA. RESULTS Individuals with PD experience significant changes in spatiotemporal gait parameters, specifically stride velocity and length, under conditions of lower limb muscle fatigue (p=0.001). These changes were more pronounced in individuals with PD in the H&Y stage 3 group. Additionally, both PD groups exhibited difficulty with turning, requiring more than five steps to complete a 180° turn and taking more than 3 seconds to accomplish it. CONCLUSION These findings highlight the impact of muscle fatigue on gait performance in PD and suggest that individuals in later stages of the disease may be particularly affected. Further research is needed to explore interventions that can mitigate these gait impairments and improve mobility in individuals with PD.
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Affiliation(s)
- Halimatul Abd Ghani
- Physiotherapy Program, Institut Latihan Kementerian Kesihatan Malaysia, Johor, Malaysia
| | - Alia A. Alghwiri
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Hafifi Hisham
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Haidzir Manaf
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Malaysia
- Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Malaysia
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Ortega-Bastidas P, Gómez B, Aqueveque P, Luarte-Martínez S, Cano-de-la-Cuerda R. Instrumented Timed Up and Go Test (iTUG)-More Than Assessing Time to Predict Falls: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3426. [PMID: 37050485 PMCID: PMC10098780 DOI: 10.3390/s23073426] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
The Timed Up and Go (TUG) test is a widely used tool for assessing the risk of falls in older adults. However, to increase the test's predictive value, the instrumented Timed Up and Go (iTUG) test has been developed, incorporating different technological approaches. This systematic review aims to explore the evidence of the technological proposal for the segmentation and analysis of iTUG in elderlies with or without pathologies. A search was conducted in five major databases, following PRISMA guidelines. The review included 40 studies that met the eligibility criteria. The most used technology was inertial sensors (75% of the studies), with healthy elderlies (35%) and elderlies with Parkinson's disease (32.5%) being the most analyzed participants. In total, 97.5% of the studies applied automatic segmentation using rule-based algorithms. The iTUG test offers an economical and accessible alternative to increase the predictive value of TUG, identifying different variables, and can be used in clinical, community, and home settings.
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Affiliation(s)
- Paulina Ortega-Bastidas
- Health Sciences PhD Programme, International Doctoral School, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Britam Gómez
- Biomedical Engineering, Faculty of Engineering, Universidad de Santiago de Chile, Libertador Bernardo O’Higgins Av., Santiago 9170022, Chile
| | - Pablo Aqueveque
- Department of Electrical Engineering, Faculty of Engineering, Universidad de Concepción, 219 Edmundo Larenas St., Concepción 4030000, Chile
| | - Soledad Luarte-Martínez
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Roberto Cano-de-la-Cuerda
- Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Universidad Rey Juan Carlos, 28922 Madrid, Spain
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Mostile G, Contrafatto F, Terranova R, Terravecchia C, Luca A, Sinitò M, Donzuso G, Cicero CE, Sciacca G, Nicoletti A, Zappia M. Turning and Sitting in Early Parkinsonism: Differences Between Idiopathic Normal Pressure Hydrocephalus Associated with Parkinsonism and Parkinson's Disease. Mov Disord Clin Pract 2023; 10:466-471. [PMID: 36949785 PMCID: PMC10026280 DOI: 10.1002/mdc3.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
Background Differential diagnosis between idiopathic normal pressure hydrocephalus (iNPH) associated with parkinsonism (iNPH-P) and Parkinson's disease (PD) may prove difficult when evaluating patients with early parkinsonism. The objective of this study was to evaluate differences in mobility during standardized tasks between iNPH-P and PD. Methods We selected 21 iNPH-P and 21 pharmacologically untreated PD patients. They all performed the instrumented Timed Up and Go test at the time of diagnosis. Results Turning tasks showed longer duration and lower speed in iNPH-P than in PD. Vertical variation in acceleration during the sit-to-stand phase was lower in iNPH-P patients, whereas the duration of the stand-to-sit phase was longer. On walking, iNPH-P showed smaller stride length and a longer gait cycle duration. In multivariate analysis adjusting for age and cognitive status as potential confounders, average angular speed on turning before sitting was the discriminating parameter between the two groups. Conclusions Patients with iNPH-P showed specific abnormal mobility performances with respect to untreated PD, specifically during the turning-to-sitting transition.
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Affiliation(s)
- Giovanni Mostile
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
- Oasi Research Institute‐IRCCSTroinaItaly
| | - Federico Contrafatto
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Roberta Terranova
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Claudio Terravecchia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Antonina Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Martina Sinitò
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Giulia Donzuso
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Calogero E. Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Giorgia Sciacca
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia"University of CataniaCataniaItaly
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Transtibial prosthetic alignment has small effects on whole-body angular momentum during functional tasks. J Biomech 2023; 149:111485. [PMID: 36780733 DOI: 10.1016/j.jbiomech.2023.111485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Due to the loss of ankle function, many people with a transtibial amputation (TTA) have difficulty maintaining balance during functional tasks. Prosthetic alignment may affect how people with TTA maintain balance as it affects ground reaction forces (GRFs) and centers of pressure. We quantified the effect of prosthetic alignment on dynamic balance during several functional tasks. Ten people with TTA and 10 controls without TTA completed tasks including walking and transitioning from a chair. Participants with TTA completed all tasks with their prescribed alignment and six shifted alignments, including ±10 mm anterior/posterior, medial/lateral, and ±20 mm in the vertical direction. For each task, we quantified dynamic balance as the range of whole-body angular momentum (H→WB) and quantified trunk range of motion (ROM) and peak GRFs. Compared to controls, participants with TTA using their prescribed alignment had a greater range of H→WB in the sagittal plane during walking, in all planes during sit-to-stand, and in the transverse plane during stand-to-sit. These results were associated with GRF and trunk ROM differences between participant groups. Alignment only affected the range of H→WB in the frontal plane during walking. The larger range for the tall alignment coincided with a greater difference in vertical GRF between intact and amputated legs compared to other alignments. Our findings suggest that people with TTA can adapt to small, translational, alignment changes to maintain similar levels of dynamic balance during chair transitions. Future work should investigate alignment changes during other tasks and in lower functioning individuals.
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The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study. J Aging Phys Act 2022; 31:303-310. [PMID: 36216335 DOI: 10.1123/japa.2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.
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Quantification of the Link between Timed Up-and-Go Test Subtasks and Contractile Muscle Properties. SENSORS 2021; 21:s21196539. [PMID: 34640875 PMCID: PMC8512551 DOI: 10.3390/s21196539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/12/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Frailty and falls are a major public health problem in older adults. Muscle weakness of the lower and upper extremities are risk factors for any, as well as recurrent falls including injuries and fractures. While the Timed Up-and-Go (TUG) test is often used to identify frail members and fallers, tensiomyography (TMG) can be used as a non-invasive tool to assess the function of skeletal muscles. In a clinical study, we evaluated the correlation between the TMG parameters of the skeletal muscle contraction of 23 elderly participants (22 f, age 86.74 ± 7.88) and distance-based TUG test subtask times. TUG tests were recorded with an ultrasonic-based device. The sit-up and walking phases were significantly correlated to the contraction and delay time of the muscle vastus medialis (ρ = 0.55-0.80, p < 0.01). In addition, the delay time of the muscles vastus medialis (ρ = 0.45, p = 0.03) and gastrocnemius medialis (ρ = -0.44, p = 0.04) correlated to the sit-down phase. The maximal radial displacements of the biceps femoris showed significant correlations with the walk-forward times (ρ = -0.47, p = 0.021) and back (ρ = -0.43, p = 0.04). The association of TUG subtasks to muscle contractile parameters, therefore, could be utilized as a measure to improve the monitoring of elderly people's physical ability in general and during rehabilitation after a fall in particular. TUG test subtask measurements may be used as a proxy to monitor muscle properties in rehabilitation after long hospital stays and injuries or for fall prevention.
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Which functional tasks present the largest deficits for patients with total hip arthroplasty before and six months after surgery? A study of the timed up-and-go test phases. PLoS One 2021; 16:e0255037. [PMID: 34506498 PMCID: PMC8432811 DOI: 10.1371/journal.pone.0255037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/08/2021] [Indexed: 01/23/2023] Open
Abstract
Six to eight months after total hip arthroplasty, patients only attain 80% of the functional level of control groups. Understanding which functional tasks are most affected could help reduce this deficit by guiding rehabilitation towards them. The timed up-and-go test bundles multiple tasks together in one test and is a good indicator of a patient's overall level of function. Previously, biomechanical analysis of its phases was used to identify specific functional deficits in pathological populations. To the best of our knowledge, this analysis has never been performed in patients who have undergone total hip arthroplasty. Seventy-one total hip arthroplasty patients performed an instrumented timed up-and-go test in a gait laboratory before and six months after surgery; fifty-two controls performed it only once. Biomechanical features were selected to analyse the test's four phases (sit-to-stand, walking, turning, turn-to-sit) and mean differences between groups were evaluated for each phase. On average, six months after surgery, patients' overall test time rose to 80% of the mean of the control group. The walking phase was revealed as the main deficiency before and after surgery (-41 ± 47% and -22 ± 32% slower, respectively). High standard deviations indicated that variability between patients was high. On average, patients showed improved results in every phase of the timed up-and-go test six months after surgery, but residual deficits in function differed between those phases. This simple test could be appropriate for quantifying patient-specific deficits in function and hence guiding and monitoring post-operative rehabilitation in clinical settings.
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Cobo A, Villalba-Mora E, Pérez-Rodríguez R, Ferre X, Rodríguez-Mañas L. Unobtrusive Sensors for the Assessment of Older Adult's Frailty: A Scoping Review. SENSORS 2021; 21:s21092983. [PMID: 33922852 PMCID: PMC8123069 DOI: 10.3390/s21092983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults’ frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010–2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs.
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Affiliation(s)
- Antonio Cobo
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain;
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Correspondence: (A.C.); (E.V.-M.); Tel.: +34-910-679-275 (E.V.-M.)
| | - Elena Villalba-Mora
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain;
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
- Correspondence: (A.C.); (E.V.-M.); Tel.: +34-910-679-275 (E.V.-M.)
| | - Rodrigo Pérez-Rodríguez
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Hospital de Getafe, Getafe, 28905 Madrid, Spain;
| | - Xavier Ferre
- Centre for Biomedical Technology (CTB), Universidad Politécnica de Madrid (UPM), Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Leocadio Rodríguez-Mañas
- Servicio de Geriatría, Hospital de Getafe, Getafe, 28095 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBER-FES), 28029 Madrid, Spain
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Weng SC, Lin CS, Tarng DC, Lin SY. Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study. BMC Geriatr 2021; 21:92. [PMID: 33522908 PMCID: PMC7849094 DOI: 10.1186/s12877-020-01971-4] [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: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Frailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. This study aimed to evaluate the impact of frailty on outcomes in older patients with preserved and reduced cardiac function. METHODS In total, 811 adults aged ≥65 years were consecutively enrolled from 2009 to 2018. HF was diagnosed according to the ICD9 code and a 2D echocardiogram was categorized by reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The index date was registered at the time of HF. All patients received a comprehensive geriatric assessment, and clinical outcomes were examined with adjustment of the other prognostic variables. RESULTS Mean age was 80.5 ± 7.1 years. The prevalence of HF, HFpEF, HFrEF, Fried, and Rockwood frailty indicators was 28.5, 10.4, 9.7, 52.5, and 74.9%, respectively. At baseline, scores in the Timed Up and Go test was closely associated with the severity of HF, either with HFpEF or HFrEF. After a mean follow-up of 3.2 ± 2.0 years, we found that HF patients with low handgrip strength (HGS) had the poorest survival, followed by non-HF patients with decreased HGS, and HF with fair HGS in comparison with non-HF with fair HGS (p = 0.008) if participants were arbitrarily divided into two HGS groups. In all patients, a high Rockwood frailty index was independently associated with increased mortality (adjusted hazard ratio [aHR] = 1.05; 95% confidence interval [CI]: 1.0004 to 1.10). In addition, the adjusted mortality HR was 3.42 with decreased HGS (95% CI: 1.03 to 11.40), 7.65 with use of mineralocorticoid receptor antagonist (95% CI: 2.22 to 26.32), and 1.26 with associated multi-comorbidities assessed by Charlson comorbidity index (95% CI: 1.05 to 1.51). CONCLUSIONS Our study results indicate that frailty and decreased physical functions were associated with HF. Besides, frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival.
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Affiliation(s)
- Shuo-Chun Weng
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan.,Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yi Lin
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan. .,Center for Geriatrics and Gerontology, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No.1650 Boulevard Sect. 4, Taichung, Taiwan.
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Kurosawa C, Shimazu N, Yamamoto S. Where do healthy older adults take more time during the Timed Up and Go test? J Phys Ther Sci 2020; 32:663-668. [PMID: 33132527 PMCID: PMC7590852 DOI: 10.1589/jpts.32.663] [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: 05/13/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We need to regularly evaluate motor function to sustain the health of community-dwelling older adults. Our study aimed to identify the kinematic characteristics of healthy older adults in the Timed Up and Go test because the criteria for assessing the motor function of healthy older adults are unclear in the widely used clinical simple methods. [Participants and Methods] In total, 22 healthy younger and 28 healthy older adults participated in this study. Using a 3D motion analysis system, we measured the time ratios, trajectories, trajectory length per unit time, and body inclination angles during the Timed Up and Go test. We compared the kinematic characteristics of the older and younger adults. [Results] The older adults required a longer time ratio to complete the turn and sit subtasks. The trajectory of the older adults' turn subtask was longer than that of the younger adults. Older adults' body inclination angles during the turn subtask were smaller than that of the younger adults. [Conclusion] Healthy older adults had a different kinematic index from younger adults during the Timed Up and Go turn subtask. Therefore, we suggest the kinematic index of posture and turning radius be used to measure Timed Up and Go as a clinically useful index for understanding the motor characteristics of older adults.
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Affiliation(s)
- Chihiro Kurosawa
- School of Rehabilitation, Kanagawa University of Human Services: 1-10-1 Heisei-cho, Yokosuka, Kanagawa 238-8522, Japan
| | - Naoko Shimazu
- School of Rehabilitation, Kanagawa University of Human Services: 1-10-1 Heisei-cho, Yokosuka, Kanagawa 238-8522, Japan
| | - Sumiko Yamamoto
- Department of Assistive Technology Science, Graduate School of International University of Health and Welfare, Japan
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Figueiredo AI, Balbinot G, Brauner FO, Schiavo A, Baptista RR, Pagnussat AS, Hollands K, Mestriner RG. SPARC Metrics Provide Mobility Smoothness Assessment in Oldest-Old With and Without a History of Falls: A Case Control Study. Front Physiol 2020; 11:540. [PMID: 32587523 PMCID: PMC7298141 DOI: 10.3389/fphys.2020.00540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ −13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs.
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Affiliation(s)
- Anelise Ineu Figueiredo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Balbinot
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Fabiane Oliveira Brauner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Reimann Baptista
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Souza Pagnussat
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Kristen Hollands
- School of Health Sciences, University of Salford Manchester, Salford, United Kingdom
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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13
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Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, Fraser S, Muir-Hunter S, Li KZH, Liu-Ambrose T, McIlroy W, Middleton L, Morais JA, Sakurai R, Speechley M, Vasudev A, Beauchet O, Hausdorff JM, Rosano C, Studenski S, Verghese J. Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA). J Gerontol A Biol Sci Med Sci 2020; 74:897-909. [PMID: 30101279 PMCID: PMC6521916 DOI: 10.1093/gerona/gly148] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions. Methods Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects. Results From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the “Core-battery” of tests. The expert panel also recommended a “Minimum-battery” of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B. Conclusions A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Address correspondence to: Manuel Montero-Odasso MD, PhD, AGSF, FRCPC, FGSA, Gait and Brain Lab, Parkwood Institute, University of Western Ontario and Lawson Health Research Institute, 550 Wellington Road, London, Ontario N6C 0A7, Canada. E-mail:
| | - Quincy J Almeida
- Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
- Department of Medicine, University of Montreal, Quebec, Canada
- Montreal Heart Institute, Research Centre, Quebec, Canada
| | - Amer M Burhan
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Richard Camicioli
- Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Quebec, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Susan Muir-Hunter
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada
| | - Karen Z H Li
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - José A Morais
- Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada
| | - Ryota Sakurai
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
- RUIS McGill Centre of Excellence on Aging and Chronic Disease – CEViMaC, Montréal, Quebec, Canada
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Stephanie Studenski
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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14
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Mangano GR, Valle MS, Casabona A, Vagnini A, Cioni M. Age-Related Changes in Mobility Evaluated by the Timed Up and Go Test Instrumented through a Single Sensor. SENSORS 2020; 20:s20030719. [PMID: 32012930 PMCID: PMC7038469 DOI: 10.3390/s20030719] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 01/04/2023]
Abstract
Mobility across people with a large range of age was evaluated, for the first time, by using an instrumented timed up and go test (iTUG) based on signals acquired by a single wearable inertial sensor. Eighty healthy participants, from childhood to old age, performed the test, covering walking distances of 3 m and 7 m. Total time, temporal, and velocity parameters of linear and turning subcomponents of the test were quantified. While children, adults, and senior adults exhibited similar values for all the parameters, older adults showed increases in duration and reductions in velocity during the turning phases when compared with the other groups. an increase in velocity was observed during mid turning when the test was performed along the longer distance. Similarity across children, adults, and senior adults indicates that healthy individuals develop the abilities performed in the iTUG early, while the slowing down shown during the turning phases by the older adults may reflect the need to implement adaptive adjustments to face changes of direction. These results emphasize the idea that reducing equipment to a single sensor provides an appropriate quantification when the iTUG is used to investigate a broader age range or different levels of complexity.
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Affiliation(s)
- Giulia R.A. Mangano
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Residency Program of Physical Medicine and Rehabilitation, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Maria S. Valle
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Correspondence: ; Tel.: +39-095-7381328
| | - Antonino Casabona
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Residency Program of Physical Medicine and Rehabilitation, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | | | - Matteo Cioni
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy (A.C.); (M.C.)
- Residency Program of Physical Medicine and Rehabilitation, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
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15
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Buchman AS, Dawe RJ, Leurgans SE, Curran TA, Truty T, Yu L, Barnes LL, Hausdorff JM, Bennett DA. Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults. J Gerontol A Biol Sci Med Sci 2019; 75:1176-1183. [PMID: 31246244 PMCID: PMC8456516 DOI: 10.1093/gerona/glz160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes.
Methods
A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome.
Results
During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes.
Conclusions
When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
| | - Robert J Dawe
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Diagnostic Radiology and Nuclear Medicine, Chicago, Illinois
| | - Sue E Leurgans
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
| | | | | | - Lei Yu
- Rush Alzheimer’s Disease Center, Chicago, Illinois
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
- Department of Behavioral Sciences Rush University Medical Center, Chicago, Illinois
| | - Jeffrey M Hausdorff
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Tel Aviv University Medical School Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Sagol School of Neuroscience, Tel Aviv University, Israel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
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16
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Dawe RJ, Yu L, Leurgans SE, Truty T, Curran T, Hausdorff JM, Wimmer MA, Block JA, Bennett DA, Buchman AS. Expanding instrumented gait testing in the community setting: A portable, depth-sensing camera captures joint motion in older adults. PLoS One 2019; 14:e0215995. [PMID: 31091267 PMCID: PMC6519784 DOI: 10.1371/journal.pone.0215995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/11/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Currently, it is not feasible to obtain laboratory-based measures of joint motion in large numbers of older adults. We assessed the utility of a portable depth-sensing camera for quantifying hip and knee joint motion of older adults during mobility testing in the community. METHODS Participants were 52 older adults enrolled in the Rush Memory and Aging Project, a community-based cohort study of aging. In a subset, we compared dynamic hip and knee flexion/extension obtained via the depth-sensing camera with that obtained concurrently using a laboratory-based optoelectronic motion capture system. Then we recorded participants' annual instrumented gait assessment in the community setting with the depth-sensing camera and examined the inter-relationships of hip and knee range of motion (ROM) with mobility metrics derived from a wearable sensor and other mobility-related health measures. RESULTS In the community, we successfully acquired joint motion from 49/52 participants using the depth-sensing camera. Hip and knee ROMs were related to diverse sensor-derived metrics of mobility performance (hip: Pearson's r = 0.31 to 0.58; knee: Pearson's r = 0.29 to 0.51), as well as daily physical activity, conventional motor measures, self-report hip and knee pain and dysfunction, mobility disability, and falls. CONCLUSIONS The depth-sensing camera's high rate of successful data acquisition and correlations of its hip and knee ROMs with other mobility measures suggest that this device can provide a cost-efficient means of quantifying joint motion in large numbers of community-dwelling older adults who span the health spectrum.
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Affiliation(s)
- Robert J. Dawe
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lei Yu
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Timothy Truty
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Thomas Curran
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Jeffrey M. Hausdorff
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
- Center for Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Markus A. Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Joel A. Block
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, Illinois, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
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17
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Hillel I, Gazit E, Nieuwboer A, Avanzino L, Rochester L, Cereatti A, Croce UD, Rikkert MO, Bloem BR, Pelosin E, Del Din S, Ginis P, Giladi N, Mirelman A, Hausdorff JM. Is every-day walking in older adults more analogous to dual-task walking or to usual walking? Elucidating the gaps between gait performance in the lab and during 24/7 monitoring. Eur Rev Aging Phys Act 2019; 16:6. [PMID: 31073340 PMCID: PMC6498572 DOI: 10.1186/s11556-019-0214-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/11/2019] [Indexed: 01/22/2023] Open
Abstract
Background The traditional evaluation of gait in the laboratory during structured testing has provided important insights, but is limited by its “snapshot” character and observation in an unnatural environment. Wearables enable monitoring of gait in real-world environments over a week. Initial findings show that in-lab and real-world measures differ. As a step towards better understanding these gaps, we directly compared in-lab usual-walking (UW) and dual-task walking (DTW) to daily-living measures of gait. Methods In-lab gait features (e.g., gait speed, step regularity, and stride regularity) derived from UW and DTW were compared to the same gait features during daily-living in 150 elderly fallers (age: 76.5 ± 6.3 years, 37.6% men). In both settings, features were extracted from a lower-back accelerometer. In the real-world setting, subjects were asked to wear the device for 1 week and pre-processing detected 30-s daily-living walking bouts. A histogram of all walking bouts was determined for each walking feature for each subject and then each subject’s typical (percentile 50, median), worst (percentile 10) and the best (percentile 90) values over the week were determined for each feature. Statistics of reliability were assessed using Intra-Class correlations and Bland-Altman plots. Results As expected, in-lab gait speed, step regularity, and stride regularity were worse during DTW, compared to UW. In-lab gait speed, step regularity, and stride regularity during UW were significantly higher (i.e., better) than the typical daily-living values (p < 0.001) and different (p < 0.001) from the worst and best values. DTW values tended to be similar to typical daily-living values (p = 0.205, p = 0.053, p = 0.013 respectively). ICC assessment and Bland-Altman plots indicated that in-lab values do not reliably reflect the daily-walking values. Conclusions Gait values measured during relatively long (30-s) daily-living walking bouts are more similar to the corresponding values obtained in the lab during dual-task walking, as compared to usual walking. Still, gait performance during most daily-living walking bouts is worse than that measured during usual and dual-tasking in the lab. The values measured in the lab do not reliably reflect daily-living measures. That is, an older adult’s typical daily-living gait cannot be estimated by simply measuring walking in a structured, laboratory setting.
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Affiliation(s)
- Inbar Hillel
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eran Gazit
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Leuven, KU Belgium
| | - Laura Avanzino
- 3IRCCS San Martino Teaching Hospital, Genoa, Italy.,4Department of Experimental Medicine, Section of Human Physiology, University of Genova, Genoa, Italy
| | - Lynn Rochester
- 5Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK.,6The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrea Cereatti
- 7Department of Biomedical Sciences, Bioengineering unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Ugo Della Croce
- 7Department of Biomedical Sciences, Bioengineering unit, University of Sassari, Sassari, Italy.,Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| | - Marcel Olde Rikkert
- 9Department of Geriatric Medicine, Donders Centre for Medical Neuroscience, Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- 10Department of Neurology, Donders Centre for Medical Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| | - Elisa Pelosin
- 3IRCCS San Martino Teaching Hospital, Genoa, Italy.,4Department of Experimental Medicine, Section of Human Physiology, University of Genova, Genoa, Italy
| | - Silvia Del Din
- 5Institute of Neuroscience, Newcastle University Institute for Ageing, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Pieter Ginis
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, Leuven, KU Belgium
| | - Nir Giladi
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,11Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,12Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,11Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,12Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- 1Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,11Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,13Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, USA.,14Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Palmisano C, Brandt G, Pozzi NG, Leporini A, Maltese V, Canessa A, Volkmann J, Pezzoli G, Frigo CA, Isaias IU. Sit-to-walk performance in Parkinson's disease: A comparison between faller and non-faller patients. Clin Biomech (Bristol, Avon) 2019; 63:140-146. [PMID: 30889433 DOI: 10.1016/j.clinbiomech.2019.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Falls are one of the main concerns in people with Parkinson's disease, leading to poor quality of life and increased mortality. The sit-to-walk movement is the most frequent postural transition task during daily life and is highly demanding in terms of balance maintenance and muscular strength. METHODS With the aim of identifying biomechanical variables of high risk of falling, we investigated the sit-to-walk task performed by 9 Parkinson's disease patients with at least one fall episode in the six months preceding this study, 15 Parkinson's disease patients without previous falls, and 20 healthy controls. Motor performance was evaluated with an optoelectronic system and two dynamometric force plates after overnight suspension of all dopaminergic drugs and one hour after consumption of a standard dose of levodopa/benserazide. FINDINGS Poor trunk movements critically influenced the execution of the sit-to-walk movement in patients with a history of falling. The peak velocity of the trunk in the anterior-posterior direction discriminated faller from non-faller patients, with high specificity and sensitivity in both the medication-off and -on state. INTERPRETATION Our results confirm the difficulties in merging consecutive motor tasks in patients with Parkinson's disease. Trunk movements during the sit-to-walk can provide valuable measurements to monitor and possibly predict the risk of falling.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; Department of Electronic, Information and Bioengineering, MBMC Lab, Politecnico di Milano, via Colombo 40, 20133 Milan, Italy
| | - Gregor Brandt
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Nicoló Gabriele Pozzi
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Alice Leporini
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Virginia Maltese
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, via all'Opera Pia 13a, 16145 Genoa, Italy; Fondazione Europea di Ricerca Biomedica (FERB Onlus), Via Uboldo 18, 20063 Cernusco s/N, Milan, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Gianni Pezzoli
- Centro Parkinson ASST G. Pini-CTO, via Bignami 1, 20126 Milan, Italy
| | - Carlo Albino Frigo
- Department of Electronic, Information and Bioengineering, MBMC Lab, Politecnico di Milano, via Colombo 40, 20133 Milan, Italy
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital and Julius-Maximilian-University, Josef-Schneider-Str. 11, 97080 Würzburg, Germany; Centro Parkinson ASST G. Pini-CTO, via Bignami 1, 20126 Milan, Italy.
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The transition between turning and sitting in patients with Parkinson's disease: A wearable device detects an unexpected sequence of events. Gait Posture 2019; 67:224-229. [PMID: 30380506 PMCID: PMC6287952 DOI: 10.1016/j.gaitpost.2018.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/27/2018] [Accepted: 10/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND When older adults turn to sit, about 80% of the subjects complete the turn before starting to sit i.e., a distinct-strategy, while in about 20%, part of the turning and sitting take place concurrently, i.e., an overlapping-strategy. A prolonged duration of the separation between tasks in the distinct-strategy (D-interval) and a prolonged duration of the overlap interval in overlapping-strategy (O-interval) are related to worse motor symptoms and poorer cognition. In the present study, we evaluated what strategy is employed by patients with Parkinson's disease (PD) when they transition from turning to sitting. METHODS 96 participants with PD performed turn to sit as part of the Timed Up and Go test, both with and without medications, while wearing a body-fixed sensor. We quantified the turn-to-sit transition and determined which strategy (distinct or overlapping) was employed. We then stratified the cases and used regression models adjusted for age, gender, height, and weight to examine the associations of the D-interval or O-interval with parkinsonian features and cognition. RESULTS Most patients (66%) employed the overlapping-strategy, both off and on anti-parkinsonian medications. Longer O-intervals were associated with longer duration of PD, more severe PD motor symptoms, a higher postural-instability-gait-disturbance (PIGD) score, and worse freezing of gait. Longer D-intervals were not associated with disease duration or PD motor symptoms. Neither the D- nor O-intervals were related to cognitive function. Individuals who employed the overlapping-strategy had more severe postural instability (i.e., higher PIGD scores), as compared to those who used the distinct-strategy. SIGNIFICANCE In contrast to older adults without PD, most patients with PD utilize the overlapping strategy. Poorer postural and gait control are associated with the strategy choice and with the duration of concurrent performance of turning and sitting. Additional work is needed to further explicate the mechanisms underlying these strategies and their clinical implications.
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Bennett DA, Buchman AS, Boyle PA, Barnes LL, Wilson RS, Schneider JA. Religious Orders Study and Rush Memory and Aging Project. J Alzheimers Dis 2018; 64:S161-S189. [PMID: 29865057 PMCID: PMC6380522 DOI: 10.3233/jad-179939] [Citation(s) in RCA: 678] [Impact Index Per Article: 113.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Religious Orders Study and Rush Memory and Aging Project are both ongoing longitudinal clinical-pathologic cohort studies of aging and Alzheimer's disease (AD). OBJECTIVES To summarize progress over the past five years and its implications for understanding neurodegenerative diseases. METHODS Participants in both studies are older adults who enroll without dementia and agree to detailed longitudinal clinical evaluations and organ donation. The last review summarized findings through the end of 2011. Here we summarize progress and study findings over the past five years and discuss new directions for how these studies can inform on aging and AD in the future. RESULTS We summarize 1) findings on the relation of neurobiology to clinical AD; 2) neurobiologic pathways linking risk factors to clinical AD; 3) non-cognitive AD phenotypes including motor function and decision making; 4) the development of a novel drug discovery platform. CONCLUSION Complexity at multiple levels needs to be understood and overcome to develop effective treatments and preventions for cognitive decline and AD dementia.
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Affiliation(s)
- David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Patricia A. Boyle
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Robert S. Wilson
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL., USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL., USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL., USA
- Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL., USA
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Use of Wearable Inertial Sensor in the Assessment of Timed-Up-and-Go Test: Influence of Device Placement on Temporal Variable Estimation. LECTURE NOTES OF THE INSTITUTE FOR COMPUTER SCIENCES, SOCIAL INFORMATICS AND TELECOMMUNICATIONS ENGINEERING 2017. [DOI: 10.1007/978-3-319-58877-3_40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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