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Abraham A, Hart A, Bozzorg A, Pothineni S, Wolf SL, Schuh K, Caughlan M, Parker J, Blackwell A, Tharp Cianflona M, Asker C, Prusin T, Hackney ME. Comparison of externally and internally guided dance movement to address mobility, cognition, and psychosocial function in people with Parkinson's disease and freezing of gait: a case series. Front Aging Neurosci 2024; 16:1372894. [PMID: 38813534 PMCID: PMC11135342 DOI: 10.3389/fnagi.2024.1372894] [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: 01/18/2024] [Accepted: 03/20/2024] [Indexed: 05/31/2024] Open
Abstract
Objective The aim of this study is to explore the impact of internally guided (IG) versus externally guided (EG) adapted tango (AT) dance training (i.e., dancing the IG "Leader" role or the EG "Follower" role), on motor and non-motor functions in individuals with Parkinson's disease and freezing of gait (PD-FOG). The "Leader" role, a proxy for IG movements, conveys direction, timing, and amplitude of steps with tactile cues. The "Follower" role, a proxy for EG movements, detects and responds to the leader's tactile cues. Case description Six participants were randomly assigned to the IG ("Leader") or EG ("Follower") roles for 20, 90-min AT lessons over 12 weeks. Participants were assessed for PD-specific and non-PD-specific functions before and twice after the end of the 12-week intervention, at 1-week and 1-month post-intervention. Results EG participants improved and/or maintained performance on more outcomes across all domains than IG participants. Five participants improved in PD motor symptoms, dynamic gait, global cognitive function, and the FOG Questionnaire immediately or 1 month after intervention. All participants expressed positive attitudes toward the intervention, including improvements in walking, balance, and endurance. Conclusion AT training in the follower role may benefit individuals with PD-FOG to a greater extent compared to the leader role. Impact This case series study could inform additional research with the goal of enhancing physical therapy or music-based therapy approaches for addressing PD-FOG.
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Affiliation(s)
- Amit Abraham
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Navigation and Accessibility Research Center of Ariel University (NARCA), Ariel University, Ariel, Israel
| | - Ariel Hart
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, United States
- University of Georgia, Athens, GA, United States
| | - Ariyana Bozzorg
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Decatur, GA, United States
| | - Suraj Pothineni
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, United States
| | - Steven L. Wolf
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Decatur, GA, United States
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Kersey Schuh
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Molly Caughlan
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Jelani Parker
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Amanda Blackwell
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Megan Tharp Cianflona
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Courtney Asker
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
| | - Todd Prusin
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, United States
| | - Madeleine E. Hackney
- Emory University School of Medicine, Department of Medicine, Division of Geriatrics and Gerontology, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Decatur, GA, United States
- Emory University School of Medicine Department of Rehabilitation Medicine, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Decatur, GA, United States
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Tsang CSL, Lam FMH, Leung JCS, Kwok TCY. Balance Confidence Modulates the Association of Gait Speed With Falls in Older Fallers: A Prospective Cohort Study. J Am Med Dir Assoc 2023; 24:2002-2008. [PMID: 37393065 DOI: 10.1016/j.jamda.2023.05.025] [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: 02/07/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Self-perceived balance confidence (BC) and gait speed influence falls. Whether they modulate each other in fall prediction stays uncertain. This study examined whether and how BC modulated the association between gait speed and falls. DESIGN Prospective observational cohort study. SETTING AND PARTICIPANTS Older adults who were community-dwelling, ≥65 years old, able to walk for 10 meters independently, and had 1 or more falls in the past year were assessed at a research clinic. METHODS Participants were followed up trimonthly for 12 months after the baseline. Optimal cutoff values for gait speed for prospective falls were identified by classification and regression tree analysis. Associations among gait speed, BC, and falls were estimated with negative binomial regression models. Subgroup analyses for high and low BC were performed. Covariates such as basic demographics, generic cognition, fall histories, and other physical functions were adjusted. RESULTS During the follow-up period, 65 (14%) of the 461 included participants (median age 69.0 ± 10.0 years, range 60-92) reported 83 falls in total. In both the pooled and subgroup analyses for the low- and high-BC groups, the high-speed subgroup (≥1.30 m/s) showed an increased fall risk compared with the moderate-speed subgroup (≥0.81 and <1.30 m/s) [adjusted odds ratio (OR), 1.84-2.37; 95% CI, 1.26-3.09]. A statistically significant linear association between gait speed and falls was shown in the high-BC group. In the low-BC group, a u-shaped association was evident (adjusted OR, 2.19-2.44; 95% CI, 1.73-3.19) with elevated fall risks in both the high- and low-speed subgroups compared with the moderate-speed subgroup (adjusted OR, 1.84-3.29; 95% CI, 1.26-4.60). CONCLUSIONS AND IMPLICATIONS BC modulated the association between gait speed and falls. There were linear and nonlinear associations between gait speed and falls in people with high and low BC, respectively. Clinicians and researchers should consider the effects of BC when predicting falls with gait speed.
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Affiliation(s)
- Charlotte S L Tsang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Freddy M H Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jason C S Leung
- The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong; The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Baba T, Watanabe M, Ogihara H, Handa S, Sasamoto K, Okada S, Okuizumi H, Kimura T. Validity of temporo-spatial characteristics of gait as an index for fall risk screening in community-dwelling older people. J Phys Ther Sci 2023; 35:265-269. [PMID: 36866012 PMCID: PMC9974315 DOI: 10.1589/jpts.35.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023] Open
Abstract
[Purpose] This study aimed to identify kinematic gait indicators for a fall risk screening test through quantitative comparisons of gait characteristics measured using mobile inertial sensors between faller and non-faller groups in a population of community-dwelling older people. [Participants and Methods] We enrolled 50 people aged ≥65 years who used long-term care prevention services, interviewed them to determine their fall history during the past year, and divided them into faller and non-faller groups. Gait parameters (velocity, cadence, stride length, foot height, heel strike angle, ankle joint angle, knee joint angle, and hip joint angle) were assessed using the mobile inertial sensors. [Results] Gait velocity and left and right heel strike angles were significantly lower and smaller, respectively, in the faller versus non-faller group. Receiver operating characteristic curve analysis revealed areas under the curve of 0.686, 0.722, and 0.691 for gait velocity, left heel strike angle, and right heel strike angle, respectively. [Conclusion] Gait velocity and heel strike angle during gait assessed using mobile inertial sensors may be important kinematic indicators in a fall risk screening test to estimate the likelihood of falls among community-dwelling older people.
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Affiliation(s)
- Takahiro Baba
- Kakeyu-Misayama Rehabilitation Center Geriatric Health
Services Facility Izumino, Japan
| | | | - Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation,
Faculty of Health Sciences, Nagano University of Health and Medicine, Japan
| | - Shuichi Handa
- Physical Education and Medicine Research Foundation,
Japan
| | | | - Shinpei Okada
- Physical Education and Medicine Research Foundation,
Japan
| | | | - Teiji Kimura
- School of Health Sciences, Faculty of Medicine, Shinshu
University: 3-1-1 Asahi, Matsumoto City, Nagano 390-8621, Japan,Corresponding author. Teiji Kimura (E-mail: )
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Ohara A, Yasuhiro M, Mochizuki F, Shinohe T, Sasano Y, Suzuki K, Mikami K, Koizuka I. Effects of using cane and vestibular rehabilitation on the walking function in elderly patients with dizziness. Auris Nasus Larynx 2020; 48:571-576. [PMID: 33223340 DOI: 10.1016/j.anl.2020.10.010] [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: 06/28/2020] [Revised: 10/07/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Adults over the age of 65 years with balance disorders are at about twice the risk of falls, compared with those without balance disorders. Falls contribute to about 74% of the proximal femoral fractures commonly seen in the elderly. Since balance disorders are more prevalent in older adults than in younger adults, it is important to deal with balance disorders in older adults to prevent falls and the resulting deterioration in their ADL (activity of daily living). In this study, we investigated the effects of vestibular rehabilitation (VR) and cane use on improving gait and balance in patients aged over 65 years with balance disorder. METHODS Patients aged over 65 years presenting to the Department of Otolaryngology at St. Marianna University School of Medicine between July 1 and November 1, 2018, with symptoms of dizziness for ≥ 3 months and a Japanese translation of the Dizziness Handicap Inventory score of ≥ 26 were included in the study. We quantitatively analyzed their gait before and after VR, and with and without the use of a cane. RESULTS A total of 21 patients participated in the study (14 women; mean age 73.9 ± 6.9 years). Before VR, using a cane made no difference to step length or walking speed. After VR, using a cane increased step length from 50.5 cm (95% confidence interval [CI], 47.4-53.7 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.039). There was no change in walking speed. A comparison of walking assessment results while using a cane before and after VR showed that step length increased from 49.9 cm (95% CI, 46.6-53.2 cm) to 52.0 cm (95% CI, 48.9-55.1 cm) (p = 0.005), and walking speed increased from 90.5 cm/s (95% CI, 82.7-98.4 cm/s) to 96.1 cm/s (95% CI, 88.3-103.9 cm/s) (p = 0.005). CONCLUSIONS Walking speed and step length with the use of a cane significantly improved following VR. VR and cane use may act synergistically to improve walking.
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Affiliation(s)
- Akihiro Ohara
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan.
| | - Miyamoto Yasuhiro
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Fumihiro Mochizuki
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Tatsuya Shinohe
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Yoshiyuki Sasano
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Kaori Suzuki
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Koshi Mikami
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
| | - Izumi Koizuka
- Department of Otolaryngology, St. Marianna University School of Medicine, Japan
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Teoh RJJ, Mat S, Khor HM, Kamaruzzaman SB, Tan MP. Falls, frailty, and metabolic syndrome in urban dwellers aged 55 years and over in the Malaysian elders longitudinal research (MELoR) study - a cross-sectional Study. Postgrad Med 2020; 133:351-356. [PMID: 33143493 DOI: 10.1080/00325481.2020.1842026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES While metabolic syndrome, falls, and frailty are common health issues among older adults which are likely to be related, the potential interplay between these three conditions has not previously been investigated. We investigated the relationship between metabolic syndrome with falls, and the role of frailty markers in this potential relationship, among community-dwelling older adults. METHODS Data from the first wave Malaysian Elders Longitudinal Research (MELoR) study comprising urban dwellers aged 55 years and above were utilized. Twelve-month fall histories were established during home-based, computer-assisted interviews which physical performance, anthropometric and laboratory measures were obtained during a hospital-based health check. Gait speed, exhaustion, weakness, and weight loss were employed as frailty markers. RESULTS Data were available for 1415 participants, mean age of 68.56 ± 7.26 years, 57.2% women. Falls and metabolic syndrome were present in 22.8% and 44.2%, respectively. After adjusting for age, sex, and multiple comorbidities, metabolic syndrome was significantly associated with falls in the sample population [odds ratio (OR): 1.33, 95% confidence interval (CI): 1.03; 1.72]. This relationship was attenuated by the presence of slow gait speed, but not exhaustion, weakness, or weight loss. CONCLUSION Metabolic syndrome was independently associated with falls among older adults, and this relationship was accounted for by the presence of slow gait speed. Future studies should determine the value of screening for frailty and falls with gait speed in older adults with metabolic syndrome as a potential fall prevention measure.
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Affiliation(s)
- Ru Jian Jonathan Teoh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hui Min Khor
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, Faculty of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia
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Štefan L, Kasović M, Zvonar M. Gait Speed as a Screening Tool for Foot Pain and the Risk of Falls in Community-Dwelling Older Women: A Cross-Sectional Study. Clin Interv Aging 2020; 15:1569-1574. [PMID: 32943857 PMCID: PMC7481277 DOI: 10.2147/cia.s260931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The main purpose of the study was to establish a gait speed cut-off value to predict foot pain and the risk of falls among community-dwelling older adults. PATIENTS AND METHODS In this cross-sectional study, one-hundred and twenty White older women speaking Croatian (mean ± SD age 71.02 ± 6.78 years, height 161.77 ± 6.23 cm, weight 70.29 ± 12.97 kg, body mass index 26.79 ± 4.42 kg/m2) were recruited. The prevalence of foot pain was assessed by a single-item question and the risk of falls by the Downtown Fall Risk Index with a proposed cut-off value of "low risk" (<3 points) vs "high risk" (≥3 points) of falls. Self-selected gait speed (the independent variable) was estimated with a pressure platform (Zebris Company, Munich, Germany). RESULTS Mean gait speed was 0.95 m/s. Of the total sample, 53.30% and 33.30% reported foot pain and had higher risk of falls. For foot pain and the risk of falls, gait speed cut-off values were 0.88 m/s and 0.85 m/s (area under the curve = 0.80 and 0.83, standard error = 0.043 and 0.043, p < 0.001). Sensitivity for foot pain and the risk of falls was 66.20% and 85.90% and specificity was 84.80% and 69.00%. Slower gait speed was associated with higher prevalence of foot pain (OR = 10.92, 95% CI 4.28 to 27.89, p < 0.001) and higher risk of falls (OR = 13.59, 95% CI 5.45 to 33.87, p < 0.001). CONCLUSION Proposed gait speed values of 0.88 m/s and 0.85 m/s may be used in clinical settings to predict foot pain and the risk of falls among community-dwelling older women.
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Affiliation(s)
- Lovro Štefan
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Mario Kasović
- Faculty of Kinesiology, Department of General and Applied Kinesiology, University of Zagreb, Zagreb, Croatia
- Faculty of Sports Studies, Department of Sports Motorics, Masaryk University, Brno, Czech Republic
| | - Martin Zvonar
- Faculty of Sports Studies, Department of Sports Motorics, Masaryk University, Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Brno, Czech Republic
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Staples WH, Kays A, Richman R. Examination of the Correlation Between Physical and Psychological Measures in Community-Dwelling Older Adults. Clin Interv Aging 2020; 15:293-300. [PMID: 32184578 PMCID: PMC7060027 DOI: 10.2147/cia.s239053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The purpose of this study was to determine if correlations exist between strength and mobility and psychological measures of anxiety and depression in community-dwelling older adults. METHODS One hundred and eleven participants randomly completed trials of grip strength (GS), the Timed Up and Go (TUG), the 10-meter walk test (10MWT), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS) in a prospective, correlational study. RESULTS This study found significant correlations between and within physical measures of strength and mobility and psychological measures. Age, GS, GDS, and education were significant predictors of gait speed (10MWT). Age, GS, and GDS were predictors of TUG scores. Grip strength was found to be a significant predictor of fall status; fallers had significantly weaker GS than non-fallers. Symptoms of anxiety (GAS) were predictive of symptoms of depression. DISCUSSION Objective measures of physical performance can provide information regarding an individual's symptoms of anxiety and depression. Health professionals should understand the correlations between mood and physical ability to better treat their patients.
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Affiliation(s)
- William H Staples
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
| | - Adam Kays
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
| | - Rachel Richman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, IN, USA
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Yang CH, Conroy DE. Feasibility of an Outdoor Mindful Walking Program for Reducing Negative Affect in Older Adults. J Aging Phys Act 2018; 27:1-10. [PMID: 29485332 DOI: 10.1123/japa.2017-0390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mindful walking has emerged as a potential intervention strategy to improve mental health and promote well-being in adult and clinical populations. This strategy has not been implemented specifically with older adults to date. This study evaluated the feasibility, acceptability, sustainability, and preliminary efficacy of a mindful walking program for reducing negative affect in older adults. Community-dwelling older adults (n = 29) completed a 1-month, outdoor mindful walking program distributed across eight 30-min sessions. Responses from postprogram and follow-up questionnaires revealed that mindful walking was well-accepted, highly valued, and maintained after the program ended. Analysis from the pre- and postwalk surveys also suggested the preliminary efficacy of a mindful walking program for reducing negative affect. Positive results identified in the current feasibility study indicate readiness for randomized controlled trials to further examine the efficacy and effectiveness of a mindful walking intervention for promoting health and well-being in older populations.
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