Balance screening of an inner city older adult population

Development of soft tissue asymmetry indicators to characterize aging and functional mobility

Introduction: The aging population poses significant challenges to healthcare systems globally, necessitating a comprehensive understanding of age-related changes affecting physical function. Age-related functional decline highlights the urgency of understanding how tissue composition changes impact mobility, independence, and quality of life in older adults. Previous research has emphasized the influence of muscle quality, but the role of tissue composition asymmetry across various tissue types remains understudied. This work develops asymmetry indicators based on muscle, connective and fat tissue extracted from cross-sectional CT scans, and shows their interplay with BMI and lower extremity function among community-dwelling older adults. Methods: We used data from 3157 older adults from 71 to 98 years of age (mean: 80.06). Tissue composition asymmetry was defined by the differences between the right and left sides using CT scans and the non-Linear Trimodal Regression Analysis (NTRA) parameters. Functional mobility was measured through a 6-meter gait (Normal-GAIT and Fast-GAIT) and the Timed Up and Go (TUG) performance test. Statistical analysis included paired t-tests, polynomial fitting curves, and regression analysis to uncover relationships between tissue asymmetry, age, and functional mobility. Results: Findings revealed an increase in tissue composition asymmetry with age. Notably, muscle and connective tissue width asymmetry showed significant variation across age groups. BMI classifications and gait tasks also influenced tissue asymmetry. The Fast-GAIT task demonstrated a substantial separation in tissue asymmetry between normal and slow groups, whereas the Normal-GAIT and the TUG task did not exhibit such distinction. Muscle quality, as reflected by asymmetry indicators, appears crucial in understanding age-related changes in muscle function, while fat and connective tissue play roles in body composition and mobility. Discussion: Our study emphasizes the importance of tissue asymmetry indicators in understanding how muscle function changes with age in older individuals, demonstrating their role as risk factor and their potential employment in clinical assessment. We also identified the influence of fat and connective tissue on body composition and functional mobility. Incorporating the NTRA technology into clinical evaluations could enable personalized interventions for older adults, promoting healthier aging and maintaining physical function.

Differential associations between simple physical performance tests with global and specific cognitive functions in cognitively normal and mild cognitive impairment: a cross-sectional cohort study of Asian community-dwelling older adults

Background

Physical performance declines and executive dysfunctions are predictors of dementia. However, their associations are not well understood in Asian older adults without dementia (cognitively normal [CN] and mild cognitive impairment [MCI]), especially in a single study.

Objective

Examine the associations between physical performance measures with executive function (EF)-based and non-EF-based neurocognitive tests and whether preclinical dementia cognitive status i.e., CN and MCI, moderated these associations.

Methods

We examined cross-sectional cohort of 716 community-dwelling older adults without dementia (CN = 562 and MCI = 154) using multivariable linear regression models. We associated three simple physical performance measures, namely timed-up-and-go (TUG), fast gait speed (FGS), and 30-s chair stand test (30 s-CST), with a comprehensive neurocognitive test battery measuring EF and non-EF cognitive functions. Moderating effects of cognitive status on the associations were examined. In all models, we controlled for pertinent covariates, including age, education, medical and psychiatric status.

Results

Upon controlling for covariates, TUG was most strongly and positively associated with multiple EF-based neurocognitive tests, followed by FGS, with 30 s-CST having the weakest associations. For all physical performance measures, no significant associations with non-EF-based neurocognitive tests were detected. Cognitive status significantly moderated the associations between all physical measures and several neurocognitive tests, with stronger associations in the MCI than CN.

Conclusion

Compared to FGS and 30 s-CST, TUG had the most robust associations with multiple EF-based cognitive functions. Given their differential associations with global and detailed neurocognitive tests and significant moderating effects of cognitive status, findings highlight a need to carefully consider the choices of simple physical performance tests when using these tests with a heterogenous group of community-dwelling older adults without dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03434-4.

Effectiveness of Activity-Based Therapy for Individuals With Spinal Cord Injury in Promoting Static and Dynamic Sitting Balance: Is Olfactory Mucosa Autograft a Factor?

Background

Activity-based therapy (ABT) appears to improve outcomes for individuals with spinal cord injury (SCI); however, few studies have examined sitting static and dynamic balance. It was unknown whether individuals after SCI who elected to undergo an olfactory mucosa autograft (OMA) would respond differently to ABT.

Objectives

The first objective was to assess changes in sitting strength (static) and dynamic balance in a group of individuals with SCI undergoing intensive ABT. The second objective was to determine whether sitting balance changes would be different for those who had participated in ABT after the OMA versus those who had ABT alone.

Methods

A handheld dynamometer measured peak force (sitting strength) and the multi-directional reach test measured dynamic balance (n = 16).

Results

ABT (average dose: 7 hours per week over 4.6 months) appeared to promote improvements in sitting strength in four directions (0.6-0.8 kg per month) and dynamic balance in four of five directions (0.7-1.3 cm per month). Individuals who had undergone an OMA had similar, but not greater, improvements in static and dynamic balance when compared with those who had ABT alone. It is unknown whether balance improvements resulted from natural or other factors.

Conclusion

ABT may have contributed to balance changes in individuals with SCI. Although small improvements in sitting static and dynamic balance did occur, future research documenting therapy intervention details and ABT dose-response in larger groups of individuals with SCI must be performed to provide guidance as to the optimal, effective ABT dose required to generate clinically meaningful functional improvements.

Can Smartphone-Derived Step Data Predict Laboratory-Induced Real-Life Like Fall-Risk in Community- Dwelling Older Adults?

Background: As age progresses, decline in physical function predisposes older adults to high fall-risk, especially on exposure to environmental perturbations such as slips and trips. However, there is limited evidence of association between daily community ambulation, an easily modifiable factor of physical activity (PA), and fall-risk. Smartphones, equipped with accelerometers, can quantify, and display daily ambulation-related PA simplistically in terms of number of steps. If any association between daily steps and fall-risks is established, smartphones due to its convenience and prevalence could provide health professionals with a meaningful outcome measure, in addition to existing clinical measurements, to identify older adults at high fall-risk. Objective: This study aimed to explore whether smartphone-derived step data during older adults' community ambulation alone or together with commonly used clinical fall-risk measurements could predict falls following laboratory-induced real-life like slips and trips. Relationship between step data and PA questionnaire and clinical fall-risk assessments were examined as well. Methods: Forty-nine community-dwelling older adults (age 60-90 years) completed Berg Balance Scale (BBS), Activities-specific Balance Confidence scale (ABC), Timed Up-and-Go (TUG), and Physical Activity Scale for the Elderly (PASE). One-week and 1-month smartphone steps data were retrieved. Participants' 1-year fall history was noted. All participants' fall outcomes to laboratory-induced slip-and-trip perturbations were recorded. Logistic regression was performed to identify a model that best predicts laboratory falls. Pearson correlations examined relationships between study variables. Results: A model including age, TUG, and fall history significantly predicted laboratory falls with a sensitivity of 94.3%, specificity of 58.3%, and an overall accuracy of 85.1%. Neither 1-week nor 1-month steps data could predict laboratory falls. One-month steps data significantly positively correlated with BBS (r = 0.386, p = 0.006) and ABC (r = 0.369, p = 0.012), and negatively correlated with fall history (r _p = -0.293, p = 0.041). Conclusion: Older participants with fall history and higher TUG scores were more likely to fall in the laboratory. No association between smartphone steps data and laboratory fall-risk was established in our study population of healthy community-dwelling older adults which calls for further studies on varied populations. Although modest, results do reveal a relationship between steps data and functional balance deficits and fear of falls.

Trunk exercise training improves muscle size, strength, and function in older adults: A randomized controlled trial

The aim of this study was to assess the effectiveness of a multimodal exercise program to increase trunk muscle morphology and strength in older individuals, and their associated changes in functional ability. Using a single-blinded parallel-group randomized controlled trial design, 64 older adults (≥60 years) were randomly allocated to a 12-week exercise program comprising walking and balance exercises with or without trunk strengthening/motor control exercises; followed by a 6-week walking-only program (detraining; 32 per group). Trunk muscle morphology (ultrasound imaging), strength (isokinetic dynamometer), and functional ability and balance (6-Minute Walk Test; 30 second Chair Stand Test; Sitting and Rising Test; Berg Balance Scale, Multi-Directional Reach Test; Timed Up and Go; Four Step Square Test) were the primary outcome measures. Sixty-four older adults (mean [SD]; age: 69.8 [7.5] years; 59.4% female) were randomized into two exercise groups. Trunk training relative to walking-balance training increased (mean difference [95% CI]) the size of the rectus abdominis (2.08 [1.29, 2.89] cm² ), lumbar multifidus (L4/L5:0.39 [0.16, 0.61] cm; L5/S1:0.31 [0.07, 0.55] cm), and the lateral abdominal musculature (0.63 [0.40, 0.85] cm); and increased trunk flexion (29.8 [4.40, 55.31] N), extension (37.71 [15.17, 60.25] N), and lateral flexion (52.30 [36.57, 68.02] N) strength. Trunk training relative to walking-balance training improved 30-second Chair Stand Test (5.90 [3.39, 8.42] repetitions), Sitting and Rising Test (1.23 [0.24, 2.23] points), Forward Reach Test (4.20 [1.89, 6.51] cm), Backward Reach Test (2.42 [0.33, 4.52] cm), and Timed Up and Go Test (-0.76 [-1.40, -0.13] seconds). Detraining led to some declines but all outcomes remained significantly improved when compared to pre-training. These findings support the inclusion of trunk strengthening/motor control exercises as part of a multimodal exercise program for older adults.

Active Video Games for Improving Physical Performance Measures in Older People: A Meta-analysis

Background and Purpose:

Participation in regular physical activity is associated with better physical function in older people (>65 years); however, older people are the least active of all age groups. Exercise-based active video games (AVGs) offer an alternative to traditional exercise programs aimed at maintaining or enhancing physical performance measures in older people. This review systematically evaluated whether AVGs could improve measures of physical performance in older people. Secondary measures of safety, game appeal, and usability were also considered.

Methods:

Electronic databases were searched for randomized controlled trials published up to April 2015. Included were trials with 2 or more arms that evaluated the effect of AVGs on outcome measures of physical performance in older people.

Results:

Eighteen randomized controlled trials (n = 765) were included. Most trials limited inclusion to healthy community-dwelling older people. With the exception of 1 trial, all AVG programs were supervised. Using meta-analyses, AVGs were found to be more effective than conventional exercise (mean difference [MD], 4.33; 95% confidence intervals [CIs], 2.93-5.73) or no intervention (MD, 0.73; 95% CI, 0.17-1.29) for improving Berg Balance scores in community-dwelling older people. Active video games were also more effective than control for improving 30-second sit-to-stand scores (MD, 3.99; 95% CI, 1.92-6.05). No significant differences in Timed Up and Go scores were found when AVGs were compared with no intervention or with conventional exercise.

Conclusions:

Active video games can improve measures of mobility and balance in older people when used either on their own or as part of an exercise program. It is not yet clear whether AVGs are equally suitable for older people with significant cognitive impairments or balance or mobility limitations. Given the positive findings to date, consideration could be given to further development of age-appropriate AVGs for use by older people with balance or mobility limitations.

Dynamic balance assessment using an unstable board in community-dwelling elderly people

[Purpose] A new method for measuring dynamic balance was developed. The aim of this study was to describe the use of a novel “unstable board” to evaluate the balance ability of community-dwelling elderly individuals. [Participants and Methods] The following balance outcomes were evaluated in 59 community-dwelling elderly people: anteroposterior and mediolateral stability indexes on the unstable board, Mini-Balance Evaluation Systems Test score, the Functional Reach Test score, Timed Up-and-Go time, and the Figure-8 Walk Test time. [Results] With respect to the relationship between the stability indexes and functional balance scales, the anteroposterior stability index significantly correlated with the anticipatory postural adjustment component (r=−0.422), stability in the gait component (r=−0.274), and total score of the Mini-Balance Evaluation Systems Test (r=−0.316); timed up-and-go time (r=0.320); and figure-8 walk test time (r=0.340). No correlation was found between the mediolateral stability index and the functional balance scale scores. [Conclusion] The anteroposterior stability index correlated with the declines in postural adjustments and performance in the dynamic balance assessments. Therefore, the anteroposterior stability index, evaluated on an unstable board, could provide an efficient tool for predicting changes in dynamic balance capacity, which could not be identified using the most commonly used balance assessment tools.

Posture-Motor and Posture-Ideomotor Dual-Tasking: A Putative Marker of Psychomotor Retardation and Depressive Rumination in Patients With Major Depressive Disorder

Background: Recent studies have demonstrated that the assessment of postural performance may be a potentially reliable and objective marker of the psychomotor retardation (PMR) in the major depressive disorder (MDD). One of the important facets of MDD-related PMR is reflected in disrupted central mechanisms of psychomotor control, heavily influenced by compelling maladaptive depressive rumination. In view of this we designed a research paradigm that included sequential execution of simple single-posture task followed by more challenging divided attention posture tasks, involving concurring motor and ideomotor workloads. Another difficulty dimension assumed executing of all the tasks with eyes open (EO) (easy) and closed (EC) (difficult) conditions. We aimed at investigating the interplay between the severity of MDD, depressive rumination, and efficiency of postural performance.

Methods: Compared with 24 age- and body mass index-matched healthy controls (HCs), 26 patients with MDD sequentially executed three experimental tasks: (1) single-posture task of maintaining a quiet stance (ST), (2) actual posture-motor dual task (AMT); and (3) mental/imaginary posture-motor dual task (MMT). All the tasks were performed in the EO and the EC conditions. The primary dependent variable was the amount of kinetic energy (E) expended for the center of pressure deviations (CoPDs), whereas the absolute divided attention cost index showed energy cost to the dual-tasking vs. the single-posture task according to the formula: ΔE = (E_Dual-task - E_Single-task).

Results: The signs of PMR in the MDD group were objectively indexed by deficient posture control in the EC condition along with overall slowness of fine motor and ideomotor activity. Another important and probably more challenging feature of the findings was that the posture deficit manifested in the ST condition was substantially and significantly attenuated in the MMT and AMT performance dual-tasking activity. A multiple linear regression analysis evidenced further that the dual-tasking energy cost (i.e., ΔE) significantly predicted clinical scores of severity of MDD and depressive rumination.

Conclusion: The findings allow to suggest that execution of concurrent actual or imaginary fine motor task with closed visual input deallocates attentional resources from compelling maladaptive depressive rumination thereby attenuating severity of absolute dual-tasking energy costs for balance maintenance in patients with MDD.

Significance: Quantitative assessment of PMR through measures of the postural performance in dual-tasking may be useful to capture the negative impact of past depressive episodes, optimize the personalized treatment selection, and improve the understanding of the pathophysiological mechanisms underlying MDD.

Analysis and comparison of the psychometric properties of two balance scales for elderly adults

Background/Aims:

The aim of this research was to verify psychometric properties of the Berg Balance Scale and the Fullerton Advanced Balance Scale, and compare the item difficulty between the two scales.

Methods:

A total of 97 community-dwelling older adults participated in this study. All participants were assessed on their degree of balance ability by the Berg Balance Scale and the Fullerton Advanced Balance Scale, respectively. We identified the psychometric properties and compared the item difficulty of the two scales using the Rasch analysis.

Findings:

Among the items on the Berg Balance Scale, the Standing to sitting and Transfers items showed misfit statistics. The most difficult item was Standing on one foot, whereas the easiest item was Sitting unsupported. In the case of the Fullerton Advanced Balance Scale, the Standing with feet together and eyes closed, Stand on foam, eyes closed and Walk with head turns items showed misfit statistics. Also, the most difficult item was Stand on one leg (logit value, 2.93), whereas the easiest item was Turn in full circle. Among the 24 items of the combined Berg Balance Scale and Fullerton Advanced Balance Scale, 13 items (nine items for the Fullerton Advanced Balance Scale and four items on the Berg Balance Scale) had positive logit values, and 11 items (one item on the FAB and 10 on the Berg Balance Scale) had negative logit values.

Conclusions:

Both the Berg Balance Scale and the Fullerton Advanced Balance appear to be reliable and valid tools to assess balance function in older adults. However, the Berg Balance Scale is suitable for assessing balance ability in a group of lower functioning older adults, whereas, the Fullerton Advanced Balance is suitable for assessing balance ability in a group of higher functioning older adults.

Association of perceived physical health and physical fitness in two Swedish national samples from 1990 and 2015

Perceived health and physical fitness have been shown to correlate, and low levels of either variable increase the risk for future illness and mortality. However, risk factors and their interrelationship may vary between societies and over time. In this study, the associations of physical fitness and perceived health were therefore assessed in two Swedish national samples 25 years apart. Perceived physical health, dichotomized as "good" or "bad," maximal oxygen uptake (VO₂ max), counter movement jump (CMJ), balance (one-legged 60 second stance), and self-reported demographics and lifestyle were recorded in two cross-sectional samples (sample size, number of eligible participants) of Swedish adults, aged 20-65 years, in 1990-1991 (2203, 1365), and 2013-2015 (3357, 422). The odds for good perceived physical health increased by 5% per mL·kg^-1 ·min^-1 of VO₂ max, 3% per cm CMJ height, and decreased by 4% per 1 time of overbalancing, in both samples. Mutually adjusted regression models showed that perceived physical health was best predicted by VO₂ max and chronic illness in 1990 and by age, BMI, and educational level in 2015.

CONCLUSION

Perceived physical health was related to physical fitness in two samples of Swedish adults from 1990 and 2015. However, multivariate and mutually adjusted models indicate that the most important covariates of perceived physical health may have changed from VO₂ max and chronic illness in 1990, to age, BMI, and educational level in 2015.

Balance and mobility training with or without concurrent cognitive training improves the timed up and go (TUG), TUG cognitive, and TUG manual in healthy older adults: an exploratory study

BACKGROUND AND AIMS

The purpose was to explore the impact of balance and mobility training (BMT), balance and mobility plus cognitive training (BMT + C) and no training on the timed up and go (TUG), TUG cognitive (TUGcog), and TUG manual (TUGman) in older adults. A preliminary experiment examined the stability of these TUG measures over a 5-week period in older adults.

METHODS

Fifteen participants in the BMT group (70.2 ± 3.2 years) and 14 participants in the BMT + C group (68.7 ± 5.5 years) trained one-on-one, 3×/week for 12 weeks on a balance obstacle course. The BMT group and the BMT + C group completed two or three tasks simultaneously, respectively. Fifteen participants in the control group received no training (66.7 ± 4.2 years). The TUG, TUGcog, and TUGman were measured in seconds at baseline, after the 12-week training, and after the 12-week follow-up. During the preliminary experiment, ten participants (67.0 ± 6.9 years) completed the three TUG measures 1/week for 5 weeks.

RESULTS

Both the BMT and BMT + C groups, but not the control group, exhibited significantly faster TUG, TUGcog, and TUGman after the intervention and maintained these improvements at the 12-week follow-up. No differences between the BMT and BMT + C groups emerged. The preliminary experiment showed that the three TUG measures were stable across five testing sessions.

DISCUSSION AND CONCLUSION

Both training groups improved functional mobility after the interventions and sustained these improvements over 12 weeks. This is likely not a function of repeating the TUG, TUGcog, and TUGman tests since no repeated exposure effect was shown.

Altered Functional Performance in Patients with Fibromyalgia

Fibromyalgia is a common chronic pain condition that exerts a considerable impact on patients' daily activities and quality of life.

Objectives: The main objective of the present study was to evaluate kinematic parameters of gait, functional performance, and balance in women with fibromyalgia syndrome.

Methods: The study included 26 female patients with fibromyalgia (49.2 ± 8.0 years) according to the criteria of the American College of Rheumatology, as well as 16 pain-free women (43.5 ± 8.5 years). Gait and balance parameters were extracted from video recordings of participants performing several motor tasks. Non-linear dynamic of body sway time series was also analyzed by computing the Hurst exponent. In addition, functional performance and clinical pain were obtained by using standardized motor tests (Berg's balance scale, 6-min walking test, timed up and go task, Romberg's balance test) and self-report questionnaires (Fibromyalgia Impact Questionnaire).

Results: Walking speed was significantly diminished (p < 0.001) in FM patients as compared to pain-free controls, probably due to significant reductions in stride length (p < 0.001) and cycle frequency (p < 0.001). Analyses of balance also revealed significant differences between fibromyalgia and pain-free controls on body sway in the medial-lateral and anterior-posterior axes (all ps < 0.01). Several parameters of gait and balance were significantly associated with high levels of pain, depression, stiffness, anxiety, and fatigue in fibromyalgia.

Conclusion: Our data revealed that both gait and balance were severely impaired in FM, and that subjective complaints associated with FM could contribute to functional disability in these patients. These findings suggest that optimal rehabilitation and fall prevention in fibromyalgia require a comprehensive assessment of both psychological responses to pain and physical impairments during postural control and gait.

Functional mobility and its contributing factors for older adults in different cities in Taiwan

BACKGROUND/PURPOSE

Impaired mobility is one of the primary causes of declined functional capacity in old age. The timed up-and-go test (TUG), a common mobility test, has been studied extensively in Western countries. The purposes of this study were to compare and identify factors associated with TUG performance in older adults with impaired mobility and living in different cities in Taiwan.

METHODS

Older adults living in Taipei, Tainan, and Niaosong cities were screened for mobility impairments and then recruited. A series of questionnaires and physical and functional tests were used to obtain information and measurements for potential contributing factors and TUG. Regression analysis was conducted to determine factors contributing to TUG.

RESULTS

A total of 413 older adults participated in the study. The mean TUG was 14.3 seconds for participants across the three cities, and was significantly shorter in Tainan. Age, number of medications, fear of falling, depression, high intensity activity time, reaction time, single leg stance time, and functional reach distance were found to have significant contribution. These factors accounted for approximately half of the variance in TUG. The regression equations were not equal for the different cities, with depression being the only common determinant.

CONCLUSION

Taiwanese older adults with mobility problems living in different cities performed differently in TUG and the contributing factors were also different. These findings indicate a need of further studies examining older adults in different environments.

Primary Sarcopenia in Older People with Normal Nutrition

OBJECTIVE

The aim of this study was to investigate the presence of primary sarcopenia in older patients with normal nutrition and to assess the relationships between the primary sarcopenia with anthropometric measurements.

DESIGN AND METHODS

In this prospective clinical cross-sectional study, six-hundred patients who applied to Polyclinic of Geriatrics between dates 2010 and 2011 have been evaluated. The 386 patients who were supposed to have potential secondary sarcopenia were excluded from the study. Age, gender, weight, height, BMI, calf and waist circumference, ongoing medications, additional diseases of the 214 patients included in the study have been surveyed. The sarcopenia criteria of EWSGOP have been applied.

RESULTS

Two hundred fourteen cases included in the study were composed of 148 female and 66 male subjects. Mean age was 71.8 ± 2.1 years. Sarcopenia was detected in 105 (49%) subjects while 109 (51%) were normal. Sixty-four female (61%) and 41 (39%) male subjects were sarcopenic. Normal group included 84 female (77%) and 25 male (23%) subjects. Incidence of sarcopenia was found higher in the female patients (p<0.001). No statistically significant difference was detected between sarcopenic and normal groups with respect to age, height, weight, calf circumference and evaluation tests. Waist circumference was higher in the sarcopenic group than the normal group (p=0.02). When both groups were analyzed for BMI; 53 (51%) of the 105 sarcopenic patients had BMI over 30 kg/m2 while 29 (27%) and 23 (22%) patients had BMI of 25-30 kg/m2 and below 25 kg/m2, respectively. Incidence of sarcopenia was significantly higher in the group with BMI over 30 kg/m2 when compared with the groups with BMI of 25-30 kg/m2 and below 25 kg/m2 (p=0.01).

CONCLUSION

Sarcopenia that makes older people physically dependent and decreases their quality of life that receive sufficient nutritional support and are also obese should be comprehensively investigated with respect to presence of sarcopenia.

Relationships among the Y balance test, Berg Balance Scale, and lower limb strength in middle-aged and older females

Background:

Older females have less dynamic postural control and muscle strength than do middle-aged females. Aging-related strength losses may limit balancing performance.

Objective:

The purpose of this study was to investigate the ability of the Y Balance Test (YBT) and lower limb strength to discriminate between females in 2 age groups, the relationship between YBT distance and the Berg Balance Scale (BBS), and the degree to which performance on YBT distance is related to lower limb strength in middle-aged and older females.

Method:

The 40 healthy, independently active females were divided into 2 groups: older and middle-aged. The participants underwent measurements of YBT distance using the YBT, maximal muscular strength of the lower limbs using a handheld dynamometer, and the BBS.

Results:

The YBT distance in 3 directions and lower limb muscle strength for both lower limbs were significantly lower in the older adults than in the middle-aged group. A moderate correlation but insignificant correlation was found between the YBT composite distance and the BBS score. In the older females, YBT distance was significantly positively correlated with strength of the knee flexor and hip abductor. In the middle-aged group, YBT distance was significantly positively correlated with strength of the knee flexor and hip extensor.

Conclusions:

Performance on the YBT was influenced by the strength of lower limb. We suggested that YBT can be used to alternative as a measurement of dynamic balance. Proper training programs for older people could include not only strengthening exercises but also YBT performance to improve balance.

Balance Training with Wii Fit Plus for Community-Dwelling Persons 60 Years and Older

OBJECTIVE

This study sought to determine the effect of 6 weeks of training, using activities from the Nintendo(®) (Kyoto, Japan) "Wii™ Fit Plus" disc, on balance in community-dwelling Jamaicans 60 years and older.

MATERIALS AND METHODS

A single group pretest/posttest design was used. Thirty-three subjects enrolled and 28 completed the study. Participants completed 30-minute training sessions on the Nintendo "Wii Fit" twice per week for 6 weeks. Activities used included "Obstacle Course," "Penguin Slide," "Soccer Heading," "River Bubble," "Snow Board," "Tilt Table," "Skate Board," and "Yoga Single Tree Pose." Balance was assessed with the Berg Balance Scale, the Multi Directional Reach Test, the Star Excursion Balance Test and the Modified Clinical Test for Sensory Integration in Balance.

RESULTS

There was significant improvement in the mean Berg Balance Scale score (P=0.004), Star Excursion Balance Test score (SEBT) (P<0.001 both legs), and Multi Directional Reach Test score (P=0.002). There was no significant change on the Modified Clinical Test for Sensory Integration in Balance.

CONCLUSIONS

Balance games on the Nintendo "Wii Fit Plus" disc can be used as a tool for balance training in community-dwelling persons 60 years of age and older.

Variables explaining health-related quality of life in community-dwelling older adults

BACKGROUND AND PURPOSE

Although health-related quality of life (HRQL) has been linked to numerous factors in older adults, limited or conflicting studies have investigated variables explaining HRQL in healthy, community-dwelling older adults. The purpose of this study was to determine whether physical activity, gait speed, balance, strength, endurance, and flexibility were associated with HRQL in healthy, community-dwelling older adults.

METHODS

Participants of this cross-sectional, correlational research design study included residents of a senior living community, aged 60 years and older who were independent in at least unlimited household ambulation. These residents participated in tests of physical activity, gait speed, balance, strength, endurance, flexibility, and HRQL (Medical Outcomes Study Short-Form Health Survey, SF-36). The physical (PCS) and mental (MCS) component summary scores of the SF-36 were calculated.

RESULTS

Data were collected on 84 participants (mean [SD] age = 78.6 (5.9) years, 54.8% women). Significant correlations were found between the PCS and fast gait speed (FGS) (r = 0.43; p < .001), the Fullerton Advanced Balance Scale (r = 0.44; p < .001), 8-ft up-and-go (r = -0.34; p = .002), and chair stand (r = 0.37; P = .001). Only body mass index (BMI) (r = 0.30; p = .007) was significantly correlated with MCS. Forward stepwise linear regression analyses were conducted, controlling for age, sex, and BMI, to identify factors associated with the PCS and MCS. In the model using PCS as the dependent variable, FGS accounted for 26% of the variance (R2 change) in PCS over and above age, sex, and BMI (R2 change = 0.03); for the full model, F = 5.37, p = .001. In the regression analysis using MCS as the dependent variable, only the 8-ft up-and-go was retained (R2 change = 0.06) over and above age, sex, and BMI (R2 change = 0.16); for the full model, F = 3.71, p = .01.

DISCUSSION

Fast gait speed, balance, and lower body strength were associated with the PCS of the SF-36; however, FGS was the only variable that uniquely contributed to the variance in the PCS. Body mass index was associated with the MCS; however, only balance uniquely contributed to the variance in the MCS. Physical activity was not associated with the PCS or MCS.

CONCLUSIONS

The results of this study support the assessment of FGS in community-dwelling older adults to gain insight into physical health status. Interventions directed toward FGS, balance, and BMI may contribute to optimum HRQL in this population.

Performance of the timed "up & go" test in spinal muscular atrophy

INTRODUCTION

The timed "up & go" (TUG) test is a quick measure of balance and mobility. TUG scores correlate with clinical, functional, and strength assessment and decline linearly over time. Reliability and validity have not been tested in spinal muscular atrophy (SMA).

METHODS

Fifteen ambulatory SMA participants performed TUG testing and strength, functional, and clinical assessments. Intraclass correlation coefficients quantified test-retest reliability. Convergent validity was determined using Pearson correlation coefficients.

RESULTS

Test-retest reliability was excellent for all participants. TUG was associated significantly with total leg and knee flexor strength, as well as the Hammersmith Functional Motor Scale Expanded, the 10-meter walk/run, and 6-minute walk tests. TUG findings were not associated with knee extensor strength, pulmonary function, or fatigue.

CONCLUSIONS

In SMA, the TUG test is easily administered, reliable, and correlates with established outcome measures. TUG testing is a potentially useful outcome measure for clinical trials and a measure of disability in ambulatory patients with SMA.

Ankle-brachial pressure index and mini nutritional assessment in community-dwelling elderly people

BACKGROUND

A low ankle-brachial pressure index (an ABPI value <0.90) is considered predictive of cardiovascular disease, and is widely thought to increase morbidity and mortality in the elderly. However, good nutrition is beneficial both for the health and the ability to resist and recover from the disease.

OBJECTIVE

The aim of the present study was to evaluate the relationship between the ankle-brachial pressure index and the nutritional status of the elderly in a city of Kochi prefecture, Japan.

METHODS

This was a cross-sectional study in which a total of 100 elderly people, both males and females, were screened for ankle-brachial pressure index (ABPI), nutritional status (through the use of the short form of the mini nutritional assessment), activities of daily living, lifestyle, gait speed (10MWT), postural stability (OLST), and functional mobility (TUG).

RESULTS

About 67% of the participants were found to have a normal nutritional status, 27% were at risk of malnutrition, and six percent were classified as malnourished. The mean ABPI of the participants was 1.08±0.10, and three participants had an ABPI lower than 0.90. The ABPI was statistically higher in well nourished participants compared with those at risk of malnutrition or the malnourished. The mean ABPI was significantly higher in non-smokers compared with former smokers. The ABPI was found to correlate negatively with gait speed and with TUG score.

CONCLUSION

Well-nourished elderly had a higher normal ankle-brachial pressure index as compared with the malnourished elderly. This study provides supportive evidence for the necessity of adequate nutrition for elderly people.

Describing Force Patterns: A Method for Classifying Sit-To-Stand Movement in Elderly People

The main contribution of this study is that it examined the sit-to-stand movements of elderly people and then established an assessment method to supplement the existing Berg Balance Scale for the risk of falling in elderly individuals. 36 elderly adults ( M age = 69.9 yr., SD = 4.0) volunteered to participate in this study. Three key points of the sit-to-stand movement were confirmed as aspects of the ground reaction force: the onset, maximum ground reaction force, and seat-off. Based on the characteristics indicated by the force data, the sit-to-stand movement sequences of those who were evaluated at low fall risk with a Berg Balance Scale score between 41 and 55 were classified into three patterns: typical-modal, multimodal, and incompetent-modal patterns. With this increased accuracy, medical practitioners can determine more clearly those participants who require further immediate medical consultation and those that are not at risk of falling.

Midlife physical activity preserves lower extremity function in older adults: age gene/environment susceptibility-Reykjavik study

OBJECTIVES

To examine the long-term association between midlife physical activity (PA) and lower extremity function (LEF) in late life.

DESIGN

Longitudinal study with an average of 25 years of follow-up.

SETTING

Community-dwelling old population in Reykjavik, Iceland.

PARTICIPANTS

Four thousand seven hundred fifty-three community-dwelling men and women (mean age 76 ± 6) in Reykjavik, Iceland.

MEASUREMENTS

On the basis of weekly hours of regular PA reported at the midlife examination, participants were classified as active or inactive. Measures of LEF in late life were gait speed on a 6-m walk, Timed Up and Go (TUG), and knee extension (KE) strength tests. Linear regression analysis was used to examine the association.

RESULTS

Participants who were active in midlife had significantly better LEF (faster gait speed, β = 0.50, P ≤ .001; faster TUG time, β = -0.53 P ≤ .001; stronger KE strength, β = 1.3, P ≤ .001) in late life than those who were not active in midlife after adjusting for sociodemographic and cardiovascular risk factors. After adjustment for cognitive function in late life (speed of processing, memory, and executive function), participants who were active in midlife had significantly faster gait speed (β = 0.04, P ≤ .001), faster TUG time (β = -0.34, P ≤ .001), and greater KE strength (β = 0.87, P ≤ .001) in old age than those who were not active in midlife.

CONCLUSION

Regular PA in midlife is associated with better performance of LEF in later life, even after controlling for late-life cognitive function.

A Low-Cost Point-of-Care Testing System for Psychomotor Symptoms of Depression Affecting Standing Balance: A Preliminary Study in India

The World Health Organization estimated that major depression is the fourth most significant cause of disability worldwide for people aged 65 and older, where depressed older adults reported decreased independence, poor health, poor quality of life, functional decline, disability, and increased chronic medical problems. Therefore, the objectives of this study were (1) to develop a low-cost point-of-care testing system for psychomotor symptoms of depression and (2) to evaluate the system in community dwelling elderly in India. The preliminary results from the cross-sectional study showed a significant negative linear correlation between balance and depression. Here, monitoring quantitative electroencephalography along with the center of pressure for cued response time during functional reach tasks may provide insights into the psychomotor symptoms of depression where average slope of the Theta-Alpha power ratio versus average slope of baseline-normalized response time may be a candidate biomarker, which remains to be evaluated in our future clinical studies. Once validated, the biomarker can be used for monitoring the outcome of a comprehensive therapy program in conjunction with pharmacological interventions. Furthermore, the frequency of falls can be monitored with a mobile phone-based application where the propensity of falls during the periods of psychomotor symptoms of depression can be investigated further.

The relationships among gait and mobility under single and dual task conditions in community-dwelling older adults

AIMS

The purpose of this study was to examine relationships among gait and mobility under single and dual task conditions in older adults.

METHODS

Community-dwelling older adults (n=41, mean age=75) completed mobility and gait tasks. Mobility was assessed with the Timed-Up-and-Go (TUG). Select gait parameters were examined while individuals walked at their preferred speed across the GAITRite electronic walkway. Two age groups were studied (younger age group=65-75; older age group=76+). Multiple linear regression analyses were used to examine the relationship between gait and mobility under single vs dual conditions.

RESULTS

Older adults required more time to complete the TUG when concurrently performing a second cognitive task (10.84 sec vs 15.77 sec). In addition, one or more gait characteristic such as stride length, cadence and stance explained (a) a high percentage of variance in mobility performance under single task conditions (TUG 74%) and (b) a smaller portion of variance in mobility performance under dual task conditions (TUGc 25%). No salient age group differences were observed in TUG performance, but gait characteristics accounted for a larger portion of variance in TUGc performance (46%) for the older age group (mean age=81) than for the younger age group (mean age=69; TUGc 18%).

The maximal double step length test can evaluate more adequately the decrease of physical function with age, than the maximal single step length test

The maximal double step length (MDSL) test is a modified version of the maximal step length (MSL) test used to evaluate the dynamic balance related to falls in the elderly. Although this test can evaluate their physical function using movements similar to daily activities as compared to MSL, it has not been clarified whether it can adequately evaluate the activities of daily living (ADL) abilities of the elderly, as they decrease with age. This study aimed to examine the relationship between both MSL and MDSL on age and ADL in elderly subjects. Fifty-seven elderly females who live independently (age 74.8±5.6 years) were recruited. MSL and MDSL were conducted twice after completing an ADL questionnaire. Intra-class correlation coefficients (ICCs) of both tests were high (for MSL: ICC=0.95, for MDSL: ICC=0.81-0.82). Age and ADL significantly correlated to MDSL (age: r=-0.32-0.41, ADL: r=0.28-0.48), but not to MSL (age: r=-0.19, ADL: r=0.15). MDSL has high reliability as it relates to age and ADL. It may be more useful to evaluate ADL required for independent living and prevent falls in the elderly better than MSL.

Does chair type influence outcome in the timed "Up and Go" test in older persons?

OBJECTIVE

To test the effects of the use of a collapsible, portable chair (chair B), as opposed to a 'standard' chair (chair A), on the outcome of the timed "Up and Go" (TUG) test.

DESIGN

Cross-sectional.

SETTING

Multipurpose senior centres.

PARTICIPANTS

Mobile older persons (N=118, mean age 77 years (range 62-99 years)).

OUTCOME MEASURES

Time to complete the timed "Up and Go" test using chair A and chair B, and inter-rater agreement in the time scores.

RESULTS

Time taken to complete the TUG test did not differ by chair type [median (interquartile range, IQR) = 12.3 (9.53-15.9) and 12.6 (9.7-16.6)] seconds for Chair A and B respectively, p-value=0.87. In multiple regression analyses, factors that impacted on time difference in test performance for the two chairs were use of a walking aid during the test [Odds ratio (OR) = 3.7 95%CI 1.1-11.9, p=0.031], observed difficulty with mobility (OR= 27.7 95%CI 2.6-290, p=0.006), and a history of arthritis in the knees (OR= 2.9 95%CI 1.0-8.7, P=0.05). In an inter-rater agreement analysis, no significant difference was found between time scores recorded by the two raters; median (IQR) = 12.4 (10.9-15.9) and 12.3 (7.2-59.1) seconds for the occupation therapist and for the research assistant, respectively (Wilcoxon matched pairs test, p=0.124, Spearman correlation coefficient = 0.99, p < 0.001).

CONCLUSION

The use of a portable canvas chair with standardised specifications offers an acceptable alternative to the use of a 'standard' chair in assessments of fall risk using the TUG test in field settings where field workers are reliant on public transport.

The relationship between obesity, physical activity, and physical function in older adults

OBJECTIVE

This study investigated the relationship between overweight and obesity, age, and gender with physical activity and physical function in community-dwelling older men and women.

METHOD

Multivariate analysis of covariance was used to analyze differences between normal weight, overweight, and obese adults (n = 821) above the age of 60 years.

RESULTS

Obesity but not overweight was associated with lower levels of physical activity and physical function. Within BMI groups, individuals who were physically active were less likely to have abnormal physical function scores compared to those who were sedentary. Compared to men, obese women had lower physical function scores, placing them at higher risk for future disability. Aging was associated with lower levels of physical activity and physical function.

DISCUSSION

The study illustrates the importance of avoiding obesity and participating in regular physical activity to prevent or slow down the loss of functioning in older age.

Normative values for three clinical measures of motor performance used in the neurological assessment of sports concussion

Postural control and motor coordination are essential components of normal athletic activity. Tasks involving balance and coordination are used to determine neurological function in sports-related concussion. Determining normative values for these tasks is therefore essential to provide sports medicine professionals with a frame of reference with which to interpret clinical measures obtained from players suspected of sustaining a concussion. One hundred and seventytwo healthy subjects (16-37 yrs) performed three timed tests: Tandem Gait (TG); Finger-to-Nose (FTN); Single-Leg-Stance (SLS) on firm and foam surfaces. Unadjusted geometric means (+/-SD) for each measure were averaged across three trials. Time to complete TG was 11.2+/-1.2s. FTN for the dominant and non-dominant arm were 2.9+/-1.1s and 3.0+/-1.2s, respectively. SLS values for dominant and non-dominant leg were 20.4+/-3.0s (firm), 3.4+/-1.6s (foam), and 21.0+/-2.9s (firm), 3.3+/-1.6s (foam), respectively. For TG, there was an order effect (P<.001) but no age, sex or BMI effects. FTN demonstrated a dominant arm preference (P<.001), sex (P=.006), BMI (P=.043) and order effects (P<.001). SLS demonstrated an order effect on the firm surface (P=.009) and an order (P<.001) and BMI (P=.001) effect on foam. Intra-rater reliability, as measured by ICC (3,3), demonstrated that TG and FTN had excellent reliability compared to SLS. FTN and TG should continue to be used in test batteries to determine neurological function in sports-related concussion.

Tae Kwon Do: an effective exercise for improving balance and walking ability in older adults

BACKGROUND

Age-related declines in balance and walking ability are major risk factors for falls. Older adults reduce the dynamic components of walking in an effort to achieve a more stable walking pattern. Tae Kwon Do is an exercise that trains dynamic components of balance and walking that diminish with age.

METHODS

Twenty participants from a Tae Kwon Do exercise class (average age 72.7 years) and 20 nonexercising controls (average age 73.8 years) participated. Balance and walking ability for all participants were pretested and posttested using the following measures: single-leg stance (SLS), Multidirectional Reach Test (MDRT), Timed Up-and-Go (TUG), walking velocity, cadence, gait stability ratio (GSR), and sit-and-reach (S&R). Analysis of variance for a mixed design was used to assess differences at the 0.05 level of significance.

RESULTS

For nonexercising controls, no differences were found between pretest and posttest measures. Tae Kwon Do participants showed significant improvements on the MDRT when reaching backward, right, and left. TUG, walking velocity, GSR, and S&R also showed significant improvement in this exercising group.

CONCLUSIONS

Tae Kwon Do exercise was effective for improving balance and walking ability in community-dwelling older adults. These improvements were attributed to Tae Kwon Do movements that emphasize dynamic movement components typically deficient in the older adult walking pattern. Improving balance and walking ability through Tae Kwon Do exercise may serve to restore function that has declined with age and preserve mobility for older adults.

Do Objective Measurements of Physical Function in Ambulatory Nursing Home Women Improve Assessment of Functional Status?

OBJECTIVE

To compare the functional status of ambulatory women in four academic nursing homes using standardized rating scales and physical performance measures used in community settings.

DESIGN

Observational cohort.

PARTICIPANTS

Women older than 65 years, ambulatory with or without an assistive device.

INTERVENTIONS

Direct comparison of the Functional Independence Measure and the Performance Self Maintenance Score with objective measure of the Get-up-and-go test, a six minute walk, and a six meter walk.

RESULTS

Two variables, the gait speed and creatinine clearance, correctly classified 80% of subjects with higher functional status defined by subjective rating scales.

CONCLUSION

Although gait speed calculated by a six meter walk is easily performed and highly correlated with subjectively assessed functional status, the majority of these ambulatory women nursing home residents exceeded the population means for each of the performance-based physical function measures.

Long-term locomotor training for gait and balance in a patient with mixed progressive supranuclear palsy and corticobasal degeneration

BACKGROUND AND PURPOSE

Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are slowly progressive tauopathies characterized by impaired balance, disturbances in gait, and frequent falls, among other features. Wheelchair dependence is an inevitable outcome in people with these disorders. Insufficient evidence exists regarding the effectiveness of exercise in the management of people with these disorders. This case report describes a program of exercise and long-term locomotor training, using a treadmill (both with and without body-weight support), to reduce falls and improve the balance and walking ability of a patient with mixed PSP and CBD features.

CASE DESCRIPTION

Six years after diagnosis with mixed PSP and CBD features, the client, a 72-year-old dentist, was seen for physical therapy for asymmetric limb apraxia, markedly impaired balance, and frequent falls during transitional movements.

INTERVENTION

Over a 2.5-year period, intervention included routine participation in an exercise group for people with Parkinson disease (mat exercise and treadmill training) and intermittent participation in individual locomotor training on a treadmill. The exercise group met for 1 hour, twice weekly. The individual treadmill sessions lasted 1 hour, once weekly, for two 14-week periods during the follow-up period.

OUTCOMES

Over the 2.5-year period, fall frequency decreased, and tests of functional balance showed improved limits of stability (functional reach tests) and maintained balance function (Berg Balance Scale). Tests of walking performance showed only slight declines. A 4-wheeled walker was introduced and accepted by the client early in the intervention period. The client, with supervision, remained ambulatory with this wheeled walker in the community.

DISCUSSION

In this case report of a person with mixed PSP and CBD features, a physical therapy intervention, which included locomotor training using a treadmill and a long-term exercise program of stretching and strengthening, appears to have improved some dimensions of balance, slowed the rate of gait decline, prevented progression to wheelchair dependence, and decreased falls. Contrary to the expected decline in function, this client maintained independent mobility over a 2.5-year period. An ongoing, intensive program of exercise and locomotor training may help people with PSP and CBD maintain upright balance, decrease falls, and decrease the rate of decline of ambulation.

Validity of functional stability limits as a measure of balance in adults aged 23-73 years

Functional stability limits (FSLs) are the percentage of the base of support that individuals are willing to extend their centre of pressure. The objective of this study was to provide construct validation of FSLs as a measure of balance by comparing FSLs across ages and with clinical balance measures. A total of 52 participants volunteered. FSLs significantly decreased with age (p < 0.004). Correlations between FSLs and age (-0.56 < R < -0.73), multi-directional reach test (0.35 < R < 0.75) and anteroposterior and mediolateral centre of pressure excursions during static stance (-0.29 < R < -0.72) were generally moderate to good. Cronbach's alpha (0.75) indicated that these measures were internally consistent, i.e. measuring similar aspects of the balance construct. FSLs appear to be valid indicators of balance ability. They may be used in posture prediction models to determine when a step is required when reaching or lifting objects and in biomechanical models as a means of incorporating stability constraints.