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Elshorbagy R, Alkhaldi H, Alshammari N, El Semary M. Influence of Sex on Cognitive and Motor Dual-Task Performance Among Young Adults: A Cross-Sectional Study. Ann Rehabil Med 2024; 48:163-170. [PMID: 38575372 PMCID: PMC11058369 DOI: 10.5535/arm.23150] [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: 10/13/2023] [Revised: 02/17/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE To investigate the sex-related differences in single-task performance through motor torque, cognitive tasks and walking speed, and the combined dual-task costs (DTCs) considering both motor and cognitive performance in young adults. METHODS Sixty-seven non-athletic subjects 37 females and 30 males were enrolled. The study measured their knee extension muscle torque using an isokinetic strength dynamometer and their walking speed using the one step app. these assessments were performed both with and without a cognitive task, and the DTCs were calculated. RESULTS The females exhibited significantly larger motor performance dual task effect through (torque-DTC, speed-DTC) compared with males while exhibiting smaller cognitive dual task effect with muscle torque and speed. CONCLUSION Deterioration in motor performance during muscle force production and speed during dual tasks was large in females compared to males, whereas males experience a decline in cognitive ability when performing dual tasks compared with females.
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Affiliation(s)
- Radwa Elshorbagy
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
- Department of Physical Therapy for Musculoskeletal Disorders and Their Surgeries, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hanin Alkhaldi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Njoud Alshammari
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Moataz El Semary
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakaka, Saudi Arabia
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Cho H, Arnold AJ, Cui C, Yang Z, Becker T, Kulkarni A, Naik A, Rietdyk S. Risky behavior during stair descent for young adults: Differences in men versus women. PLoS One 2023; 18:e0288438. [PMID: 37494307 PMCID: PMC10370699 DOI: 10.1371/journal.pone.0288438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/15/2023] [Indexed: 07/28/2023] Open
Abstract
Injuries commonly occur on stairs, with high injury rates in young adults, especially young women. High injury rates could result from physiological and/or behavioral differences; this study focuses on behaviors. The purposes of this observational study were (1) to quantify young adult behaviors during stair descent and (2) to identify differences in stair descent behavior for young adult men versus women. Young adult pedestrians (N = 2,400, 1,470 men and 930 women) were videotaped during descent of two indoor campus staircases, a short staircase (2 steps) and a long staircase (17 steps). Behaviors during stair descent were coded by experimenters. Risky behaviors observed on the short staircase included: No one used the handrail, 16.1% used an electronic device, and 16.4% had in-person conversations. On the long staircase: 64.8% of pedestrians did not use the handrail, 11.9% used an electronic device, and 14.5% had in-person conversations. Risky behaviors observed more in women included: less likely to use the handrail (long staircase), more likely to carry an item in their hands (both staircases), more likely to engage in conversation (both staircases), and more likely to wear sandals or heels (both staircases) (p≤0.05). Protective behaviors observed more in women included: less likely to skip steps (both staircases), and more likely to look at treads during transition steps (long staircase) (p≤0.05). The number of co-occurring risky behaviors was higher in women: 1.9 vs 2.3, for men vs women, respectively (p<0.001). Five pedestrians lost balance but did not fall; four of these pedestrians lost balance on the top step and all five had their gaze diverted from the steps at the time balance was lost. The observed behaviors may be related to the high injury rate of stair-related falls in young adults, and young women specifically.
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Affiliation(s)
- HyeYoung Cho
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Amanda J. Arnold
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Chuyi Cui
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Zihan Yang
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Tim Becker
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Ashwini Kulkarni
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Anvesh Naik
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
| | - Shirley Rietdyk
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States of America
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Shumski EJ, Lempke LB, Johnson RS, Oh J, Schmidt JD, Lynall RC. Jump Height and Hip Power Decrease During Cognitive Loading Regardless of Sex: Implications for Sport Performance Metrics. J Strength Cond Res 2023; 37:793-798. [PMID: 36165881 DOI: 10.1519/jsc.0000000000004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Shumski, EJ, Lempke, LB, Johnson, RS, Oh, J, Schmidt, JD, and Lynall, RC. Jump height and hip power decrease during cognitive loading regardless of sex: implications for sport performance metrics. J Strength Cond Res 37(4): 793-798, 2023-Sex and cognitive loading separately influence jumping performance. However, it is unknown how cognitive loading influences jump performance and how sex and cognitive loading interact. The purpose of our study was to determine if an interaction existed between sex and cognitive loading for the dependent variables jump height, ground contact time, reactive strength index, vertical stiffness, impulse, and lower extremity joint power during a double limb drop vertical jump. Twenty-one male (23.2 ± 2.5 years, 180.8 ± 8.4 cm, 80.4 ± 10.2 kg) and 20 female (21.7 ± 1.0 years, 163.7 ± 8.2 cm, 61.2 ± 9.4 kg) physically active individuals participated. Subjects jumped from a 30 cm box placed 50% of their height away from 2 force plates under single-task and dual-task (serial 6s or 7s) conditions. Separate 2 × 2 analyses of variance were used for all dependent variables (α = 0.05) with Bonferroni post hoc mean differences and 95% confidence intervals (CIs). There were no significant interactions for any outcomes ( p ≥ 0.190). Condition main effects demonstrated subjects jumped significantly higher (1.84 cm, 95% CI = 0.68-3.01, d = 0.26, p = 0.003) and with greater hip power (0.29 Watts·BW -1 ·HT -1 , 95% CI = 0.04-0.54, d = 0.21, p = 0.025) during single task compared with dual task. Sex main effects revealed males jumped higher (9.88 cm, 95% CI = 7.00-12.77, d = 2.17, p < 0.001), with greater reactive strength index (0.29, 95% CI = 0.17-0.41, d = 1.52, p < 0.001), greater ankle power (3.70 Watts·BW -1 ·HT -1 , 95% CI = 2.26-5.13, d = 1.64, p < 0.001), and greater knee power (5.00 Watts·BW -1 ·HT -1 , 95% CI = 3.25-6.75, d = 1.82, p < 0.001) compared with females. Jump performance is influenced by sex and dual-task conditions but not their interaction. To optimize jumping performance, testing should be completed without distractions (single task) to decrease cognitive loading.
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Affiliation(s)
- Eric J Shumski
- Department of Kinesiology, UGA Concussion Research Laboratory and Biomechanics Laboratory, University of Georgia, Athens, Georgia
| | - Landon B Lempke
- Department of Kinesiology, UGA Concussion Research Laboratory and Biomechanics Laboratory, University of Georgia, Athens, Georgia
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts
- Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; and
| | - Rachel S Johnson
- Department of Kinesiology, UGA Concussion Research Laboratory and Biomechanics Laboratory, University of Georgia, Athens, Georgia
| | - Jeonghoon Oh
- Department of Kinesiology, UGA Concussion Research Laboratory and Biomechanics Laboratory, University of Georgia, Athens, Georgia
- Department of Neurosurgery, Center of Neuroregeneration, Houston Methodist Research Institute, Houston, Texas
| | - Julianne D Schmidt
- Department of Kinesiology, UGA Concussion Research Laboratory and Biomechanics Laboratory, University of Georgia, Athens, Georgia
| | - Robert C Lynall
- Department of Kinesiology, UGA Concussion Research Laboratory and Biomechanics Laboratory, University of Georgia, Athens, Georgia
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Almajid R, Appiah-Kubi KO, Cipriani D, Goel R. Dual-tasking interference is exacerbated outdoors: A pilot study. Front Sports Act Living 2023; 5:1077362. [PMID: 36891128 PMCID: PMC9986320 DOI: 10.3389/fspor.2023.1077362] [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: 10/24/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Walking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments. Methods Twenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments. Results While there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008). Discussion Dual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, Stockton University, Galloway, United States
- Department of Physical Therapy, West Coast University, Los Angeles, CA, United States
| | | | - Daniel Cipriani
- Department of Physical Therapy, West Coast University, Los Angeles, CA, United States
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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Effects of gender on dual-tasking and prioritization in older adults. Gait Posture 2022; 97:104-108. [PMID: 35917700 DOI: 10.1016/j.gaitpost.2022.07.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/07/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The ability to produce effective posture and balance while distracted (dual-tasking; DT), is critical for mobility. In particular, individuals implicit prioritization across posture and secondary, distracting stimuli may impact fall risk. However, the impact of gender on DT and prioritization during gait is poorly understood. RESEARCH QUESTION Does gender impact DT effects or prioritization while DT walking? METHODS One hundred older adults participated. The timed up and go (TUG) was completed with and without a secondary cognitive task (counting backwards by 3's). Gait (time to complete the TUG), and cognitive (rate of correct numbers listed) performance was recorded during both single tasks and while dual-tasking. DT effects were calculated for cognitive and gait performance. Prioritization was calculated as the difference between cognitive and gait DT effects. The effect of gender on DT and prioritization was assessed, controlling for age and cognitive ability. RESULTS Gender by condition (single vs. dual-task) interaction effects were observed (Gait: F1,96 =8.7; p = 0.004; Cognition: F1,96 =5.2; p = 0.024) such that, compared to male participants, females exhibited smaller cognitive DT effects, and larger gait DT effects. Further, females exhibited significantly larger prioritization scores (F1,95 =10.0, p = 0.002), indicating a cognitive prioritization compared to males. SIGNIFICANCE Given the link between posture-second strategies and falls, the current findings may provide some insight into previous results suggesting an increased fall-risk in older-adult women. However, this study did not investigate falls. Therefore, additional work is necessary to confirm current findings and further investigate the relationship between gender, prioritization, and falls; and its possible clinical relevance.
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Roostaei M, Raji P, Kalantari KK, Faghihzadeh E, Fragala-Pinkham M. Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. Dev Neurorehabil 2022; 25:281-288. [PMID: 34971522 DOI: 10.1080/17518423.2021.2020351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. MATERIALS AND METHODS Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I-II) were evaluated with the Timed Up and Go (TUG) and Biodex Balance System during three upper extremity (UE) conditions: 1) Free UEs (no constraints), 2) Simple UE constraint (unaffected/dominant UE constrained with a sling), and 3) Difficult UE constraint (Simple constraint plus the other UE holding cup of water). RESULTS The UE condition had significant effects on Overall Stability Index (OSI) (F(2,44) = 24.899, p < .001), Medial-Lateral Stability Index (MLSI) (F(2,44) = 4.380, p = .018), Anterior-Posterior Stability Index (F(2,44) = 6.187, p = .004), and TUG scores (F(2,44) = 113.372, p < .001). Group was significant for OSI (F(1,22) = 7.906, p = .010), MLSI (F(1,22) = 13.113, p = .002), and TUG (F(1,22) = 36.282, p < .001). CONCLUSIONS The upper extremity appears to have a role in maintaining functional balance and postural stability in children with hemiplegic cerebral palsy and should be considered during intervention programs.
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Affiliation(s)
- Meysam Roostaei
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Faghihzadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maria Fragala-Pinkham
- Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
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Almajid R, Goel R. Assessment of dual-tasking during a dynamic balance task using a smartphone app: a pilot study. J Phys Ther Sci 2022; 34:115-121. [PMID: 35221514 PMCID: PMC8860690 DOI: 10.1589/jpts.34.115] [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: 09/30/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
[Purpose] To assess if the instrumented Timed Up and Go (iTUG) task score calculated
with an iPhone application can detect gait changes under dual-tasking conditions.
[Participants and Methods] Twenty participants (age 38.30 ± 12.54, 12 females) were asked
to complete the TUG as a single task and under two dual-tasking conditions: 1) verbal
fluency and 2) mental calculation. We used a smartphone, stopwatch, digital camera, and
wearable sensor to calculate the dependent variables which included time, step count, gait
speed, and iTUG score and, the dual-tasking cost (DTC) of those variables. We used
Friedman analyses of variance and Wilcoxon tests for statistical analyses. [Results] the
iTUG score, step count, gait speed, and the time measured by the stopwatch and wearable
sensor differed significantly for all tasks, but the smartphone time did not. [Conclusion]
We conclude that the iTUG score could be used as a sensitive measure for identifying gait
changes under dual-tasking conditions. With the growing demands of telehealth, using
technology as an objective tool for movement analysis is needed for clinicians and payers.
Our findings demonstrate the potential value of the iTUG score to assess and track
patient’s progress.
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Affiliation(s)
- Rania Almajid
- Physical Therapy Program, Stockton University: 101 Vera King Farris Drive, Galloway, New Jersey 08205, USA
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, USA
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Keshner EA, Lamontagne A. The Untapped Potential of Virtual Reality in Rehabilitation of Balance and Gait in Neurological Disorders. FRONTIERS IN VIRTUAL REALITY 2021; 2:641650. [PMID: 33860281 PMCID: PMC8046008 DOI: 10.3389/frvir.2021.641650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Dynamic systems theory transformed our understanding of motor control by recognizing the continual interaction between the organism and the environment. Movement could no longer be visualized simply as a response to a pattern of stimuli or as a demonstration of prior intent; movement is context dependent and is continuously reshaped by the ongoing dynamics of the world around us. Virtual reality is one methodological variable that allows us to control and manipulate that environmental context. A large body of literature exists to support the impact of visual flow, visual conditions, and visual perception on the planning and execution of movement. In rehabilitative practice, however, this technology has been employed mostly as a tool for motivation and enjoyment of physical exercise. The opportunity to modulate motor behavior through the parameters of the virtual world is often ignored in practice. In this article we present the results of experiments from our laboratories and from others demonstrating that presenting particular characteristics of the virtual world through different sensory modalities will modify balance and locomotor behavior. We will discuss how movement in the virtual world opens a window into the motor planning processes and informs us about the relative weighting of visual and somatosensory signals. Finally, we discuss how these findings should influence future treatment design.
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Affiliation(s)
- Emily A. Keshner
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States
- Correspondence: Emily A. Keshner,
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Virtual Reality and Mobility Laboratory, CISSS Laval—Jewish Rehabilitation Hospital Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, QC, Canada
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Muhaidat J, Al-Yahya E, Mohammad MT, Qutishat D, Okasheh R, Al-Khlaifat L, Lawrie S, Esser P, Dawes H. Dual-tasking in older women: physical activity or else? J Women Aging 2020; 34:101-111. [PMID: 32926645 DOI: 10.1080/08952841.2020.1819177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The interplay between gender, Physical Activity (PA), and Dual Tasking (DT) in older adults is unclear. This study aimed to address DT based on gender and PA level. One-hundred and twenty older adults (81 women and 39 men) participated. Timed up and go test and spatiotemporal gait measures were collected in single and DT conditions. Participants were grouped according to gender and PA level. Physical activity did not explain gender differences, women were slower and had shorter stride lengths when DT regardless of PA level. Findings indicate the necessity for tailored PA and functional interventions to improve women's performance.
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Affiliation(s)
- Jennifer Muhaidat
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Emad Al-Yahya
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan.,Centre for Movement, Occupational, and Rehabilitation Sciences (MORES), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Maha T Mohammad
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Dania Qutishat
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Rasha Okasheh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Lara Al-Khlaifat
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Sophie Lawrie
- Centre for Movement, Occupational, and Rehabilitation Sciences (MORES), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Patrick Esser
- Centre for Movement, Occupational, and Rehabilitation Sciences (MORES), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Dawes
- Centre for Movement, Occupational, and Rehabilitation Sciences (MORES), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Department of Clinical Neurology, University of Oxford, Oxford, UK
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Almajid R, Goel R, Tucker C, Keshner E. Balance confidence and turning behavior as a measure of fall risk. Gait Posture 2020; 80:1-6. [PMID: 32454377 DOI: 10.1016/j.gaitpost.2020.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Diminished balance confidence increases the risk of a fall and falls that occur when turning during walking are associated with an eightfold increase in hip fractures compared to when walking in a straight trajectory. Although an effect of aging on turning is revealed, the role of gender during turning is not yet clear. RESEARCH QUESTION How can balance confidence impact turning behavior in younger, middle-aged, and older men and women? METHODS This cross-sectional study included 22 young adults (11 women), 13 middle-aged adults (9 women), and 13 older adults (6 women). Participants ranked their balance confidence using the activities-specific balance confidence (ABC) scale and completed two different turns: Turn1 (around the cone) and Turn2 (turn to sit). Measures obtained for each turn included: turning time, step count, and peak trunk velocities (PTV) in pitch, yaw, and roll. RESULTS In Turn1, older adults exhibited an increase in turning time and step count relative to younger adults (both p < 0.03). In Turn2, older adults showed an increase in turning time and roll PTV compared to the middle-aged group (both p < 0.02). Lower scores in ABC were significantly correlated with an increase in Turn1 time (p < 0.001) and step count (p = 0.04) in middle-aged and older adults, respectively. Bivariate correlations revealed that women with lower scores on the ABC took more time to complete both turns (both p = 0.01). SIGNIFICANCE Older adults demonstrated longer turning time, more steps, and higher roll PTV while turning that were associated with decreased balance confidence scores. The association between decreased balance confidence and turning kinematics implies a relationship between turning and increased fall risk. These results suggest that testing for fall risk requires tests of activities that are performed outside traditional clinical settings and gait laboratories.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, West Coast University, 590 N Vermont Ave, Los Angeles, CA 90004, USA; Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA 19122 USA.
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Carole Tucker
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA 19122 USA
| | - Emily Keshner
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA 19122 USA
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