1
|
Jia S, Si Y, Guo C, Wang P, Li S, Wang J, Wang X. The prediction model of fall risk for the elderly based on gait analysis. BMC Public Health 2024; 24:2206. [PMID: 39138430 PMCID: PMC11323353 DOI: 10.1186/s12889-024-19760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 08/12/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Early screening and identification are crucial for fall prevention, and developing a new method to predict fall risk in the elderly can address the current lack of objectivity in assessment tools. METHODS A total of 132 elderly individuals over 80 years old residing in some nursing homes in Shanghai were selected using a convenient sampling method. Fall history information was collected, and gait data during a 10-meter walk were recorded. Logistic regression was employed to establish the prediction model, and a nomogram was used to assess the importance of the indicators. The Bootstrap method was utilized for internal validation of the model, while the verification set was used for external validation. The predictive performance of the model was evaluated using the area under the ROC curve, calibration curve, and decision curve analysis (DCA) to assess clinical benefits. RESULTS The incidence of falls in the sample population was 36.4%. The Tinetti Gait and Balance Test (TGBT) score (OR = 0.832, 95% CI: 0.734,0.944), stride length (OR = 0.007, 95% CI: 0.000,0.104), difference in standing time (OR = 0.001, 95% CI: 0.000,0.742), and mean stride time (OR = 0.992, 95% CI:0.984,1.000) were identified as significant factors. The area under the ROC curve was 0.878 (95% CI: 0.805, 0.952), with a sensitivity of 0.935 and specificity of 0.726. The Brier score was 0.135, and the Hosmer-Lemeshow test (χ2 = 10.650, P = 0.222) indicated a good fit and calibration of the model. CONCLUSION The TGBT score, stride length, difference in standing time, and stride time are all protective factors associated with fall risk among the elderly. The developed risk prediction model demonstrates good discrimination and calibration, providing valuable insights for early screening and intervention in fall risk among older adults.
Collapse
Affiliation(s)
- Shuqi Jia
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Yanran Si
- Physical Education and Sport Department, Shanghai International Studies University, Shanghai, China
| | - Chengcheng Guo
- School of Public Administration, Hohai University, Nanjing, China
| | - Peng Wang
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Shufan Li
- School of Physical Education, Shanghai University of Sport, Shanghai, China
| | - Jing Wang
- School of Physical Education and Health, Shanghai Lixin University of Accounting and Finance, Shanghai, China
| | - Xing Wang
- School of Physical Education, Shanghai University of Sport, Shanghai, China.
| |
Collapse
|
2
|
Kosana P, Wu K, Tassiopoulos K, Letendre S, Ma Q, Paul R, Ellis R, Erlandson KM, Farhadian SF. Polypharmacy Is Associated With Slow Gait Speed and Recurrent Falls in Older People With HIV. Clin Infect Dis 2024; 78:1608-1616. [PMID: 38147306 PMCID: PMC11175684 DOI: 10.1093/cid/ciad782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Older people with human immunodeficiency virus (HIV, PWH) are prone to using multiple medications due to higher rates of medical comorbidities and the use of antiretroviral therapy (ART). We assessed the prevalence and clinical impact of polypharmacy among PWH. METHODS We leveraged clinical data from the AIDS Clinical Trials Group A5322 study "Long-Term Follow-up of Older HIV-infected Adults: Addressing Issues of Aging, HIV Infection and Inflammation" (HAILO). We included PWH aged ≥40 years with plasma HIV RNA levels <200 copies/µL. We assessed the relationship between polypharmacy (defined as the use of 5 or more prescription medications, excluding ART) and hyperpolypharmacy (defined as the use of 10 or more prescription medications, excluding ART) with slow gait speed (less than 1 meter/second) and falls, including recurrent falls. RESULTS Excluding ART, 24% of study participants had polypharmacy and 4% had hyperpolypharmacy. Polypharmacy was more common in women (30%) than men (23%). Participants with polypharmacy had a higher risk of slow gait speed (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.27-2.50) and increased risk of recurrent falls (OR = 2.12; 95% CI = 1.06-4.23). The risk for recurrent falls was further increased in those with hyperpolypharmacy compared with those without polypharmacy (OR = 3.46; 95% CI = 1.32-9.12). CONCLUSIONS In this large, mixed-sex cohort of PWH aged ≥40 years, polypharmacy was associated with slow gait speed and recurrent falls, even after accounting for medical comorbidities, alcohol use, substance use, and other factors. These results highlight the need for increased focus on identifying and managing polypharmacy and hyperpolypharmacy in PWH.
Collapse
Affiliation(s)
- Priya Kosana
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Kunling Wu
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Scott Letendre
- Department of Medicine, University of California San Diego, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Qing Ma
- School of Pharmacy and Pharmaceutical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri–St.Louis, St. Louis, Missouri, USA
| | - Ronald Ellis
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shelli F Farhadian
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
3
|
Kim B, Youm C, Park H, Choi H, Shin S. Machine learning approach to classifying declines of physical function and muscle strength associated with cognitive function in older women: gait characteristics based on three speeds. Front Public Health 2024; 12:1376736. [PMID: 38983250 PMCID: PMC11232496 DOI: 10.3389/fpubh.2024.1376736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 07/11/2024] Open
Abstract
Background The aging process is associated with a cognitive and physical declines that affects neuromotor control, memory, executive functions, and motor abilities. Previous studies have made efforts to find biomarkers, utilizing complex factors such as gait as indicators of cognitive and physical health in older adults. However, while gait involves various complex factors, such as attention and the integration of sensory input, cognitive-related motor planning and execution, and the musculoskeletal system, research on biomarkers that simultaneously considers multiple factors is scarce. This study aimed to extract gait features through stepwise regression, based on three speeds, and evaluate the accuracy of machine-learning (ML) models based on the selected features to solve classification problems caused by declines in cognitive function (Cog) and physical function (PF), and in Cog and muscle strength (MS). Methods Cognitive assessments, five times sit-to-stand, and handgrip strength were performed to evaluate the Cog, PF, and MS of 198 women aged 65 years or older. For gait assessment, all participants walked along a 19-meter straight path at three speeds [preferred walking speed (PWS), slower walking speed (SWS), and faster walking speed (FWS)]. The extracted gait features based on the three speeds were selected using stepwise regression. Results The ML model accuracies were revealed as follows: 91.2% for the random forest model when using all gait features and 91.9% when using the three features (walking speed and coefficient of variation of the left double support phase at FWS and the right double support phase at SWS) selected for the Cog+PF+ and Cog-PF- classification. In addition, support vector machine showed a Cog+MS+ and Cog-MS- classification problem with 93.6% accuracy when using all gait features and two selected features (left step time at PWS and gait asymmetry at SWS). Conclusion Our study provides insights into the gait characteristics of older women with decreased Cog, PF, and MS, based on the three walking speeds and ML analysis using selected gait features, and may help improve objective classification and evaluation according to declines in Cog, PF, and MS among older women.
Collapse
Affiliation(s)
- Bohyun Kim
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Changhong Youm
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Hwayoung Park
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Hyejin Choi
- Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
- Biomechanics Laboratory, Dong-A University, Busan, Republic of Korea
| | - Sungtae Shin
- Department of Mechanical Engineering, College of Engineering, Dong-A University, Busan, Republic of Korea
| |
Collapse
|
4
|
Hars M, Fernandez N, Herrmann F, Rizzoli R, Ferrari S, Graf C, Vuilleumier P, Trombetti A. Effects of Dalcroze Eurhythmics Exercise Versus Multicomponent Exercise on Physical and Cognitive Function, and Falls in Older Adults: The EPHYCOS Randomized Controlled Trial. Adv Biol (Weinh) 2024:e2400089. [PMID: 38700122 DOI: 10.1002/adbi.202400089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/18/2024] [Indexed: 05/05/2024]
Abstract
Currently, robust evidence is lacking to support one exercise type over another in the prevention of physical and cognitive decline and falls among older adults, primarily because of the lack of comparative trials of proven interventions. Therefore, a 12-month randomized, single-blind, comparative effectiveness trial is conducted, in which 142 older adults at high risk for falls are randomized (1:1) to receive an evidence-based Dalcroze Eurhythmics (DE) exercise program (once weekly, group-based) or an evidence-based multicomponent (MULTI) exercise program incorporating balance, functional, and strength training activities (twice weekly, group- and home-based), for 12 months. The primary outcome is gait variability under dual-task at 12 months. At 12 months, the DE group has significant improvements compared with MULTI group on gait under both dual-task (adjusted β for stride variability: -2.3, 95%CI, -3.1 to -1.4; p < 0.001) and single-task, and on a variety of secondary physical and cognitive/executive function outcomes. The adjusted hazard ratio for falls is 0.58 (95%CI, 0.37 to 0.93) for the DE group compared with MULTI group. In conclusion, DE exercise is more effective than MULTI exercise in improving physical and cognitive function and reducing falls in older adults. The mechanisms underlying DE exercise-induced benefits remain to be fully elucidated.
Collapse
Affiliation(s)
- Mélany Hars
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, 1205, Switzerland
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, 1226, Switzerland
| | - Natalia Fernandez
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, Faculty of Medicine, University of Geneva, Geneva, 1205, Switzerland
| | - François Herrmann
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, 1226, Switzerland
| | - René Rizzoli
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, 1205, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, 1205, Switzerland
| | - Christophe Graf
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, 1226, Switzerland
| | - Patrik Vuilleumier
- Laboratory for Behavioral Neurology and Imaging of Cognition, Department of Neuroscience, Faculty of Medicine, University of Geneva, Geneva, 1205, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, 1205, Switzerland
- Division of Geriatrics and Rehabilitation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, 1226, Switzerland
| |
Collapse
|
5
|
Kim YK, Gwerder M, Taylor WR, Baur H, Singh NB. Adaptive gait responses to varying weight-bearing conditions: Inferences from gait dynamics and H-reflex magnitude. Exp Physiol 2024; 109:754-765. [PMID: 38488681 PMCID: PMC11061628 DOI: 10.1113/ep091492] [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: 09/07/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024]
Abstract
This study investigates the effects of varying loading conditions on excitability in neural pathways and gait dynamics. We focussed on evaluating the magnitude of the Hoffman reflex (H-reflex), a neurophysiological measure representing the capability to activate motor neurons and the timing and placement of the foot during walking. We hypothesized that weight manipulation would alter H-reflex magnitude, footfall and lower body kinematics. Twenty healthy participants were recruited and subjected to various weight-loading conditions. The H-reflex, evoked by stimulating the tibial nerve, was assessed from the dominant leg during walking. Gait was evaluated under five conditions: body weight, 20% and 40% additional body weight, and 20% and 40% reduced body weight (via a harness). Participants walked barefoot on a treadmill under each condition, and the timing of electrical stimulation was set during the stance phase shortly after the heel strike. Results show that different weight-loading conditions significantly impact the timing and placement of the foot and gait stability. Weight reduction led to a 25% decrease in double limb support time and an 11% narrowing of step width, while weight addition resulted in an increase of 9% in step width compared to body weight condition. Furthermore, swing time variability was higher for both the extreme weight conditions, while the H-reflex reduced to about 45% between the extreme conditions. Finally, the H-reflex showed significant main effects on variability of both stance and swing phases, indicating that muscle-motor excitability might serve as feedback for enhanced regulation of gait dynamics under challenging conditions.
Collapse
Affiliation(s)
- Yong Kuk Kim
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Michelle Gwerder
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - William R. Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
| | - Heiner Baur
- School of Health Professions, PhysiotherapyUniversity of Applied SciencesBernSwitzerland
| | - Navrag B. Singh
- Laboratory for Movement Biomechanics, Institute for Biomechanics, Department of Health Sciences and TechnologyETH ZurichZurichSwitzerland
- Singapore‐ETH Centre, Future Health Technologies ProgramSingaporeSingapore
| |
Collapse
|
6
|
Scarmagnan GS, Lino TB, Pimentel DE, Silva AVB, da Silva Ramos IM, Christofoletti G. Benefits of a Dual-Task Training on Motor and Cognitive Functions in Community-Dwelling Older Adults: A Controlled Clinical Trial. Am J Phys Med Rehabil 2024; 103:377-383. [PMID: 37903601 DOI: 10.1097/phm.0000000000002352] [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: 11/01/2023]
Abstract
OBJECTIVE The aim of the study is to verify the effects of a 3-mo dual-task training on motor and cognitive functions in community-dwelling older adults. DESIGN In this prospective, single-blinded, controlled clinical trial, a total of 40 participants were allocated to either the experimental or the control (no-exercise) group. The intervention program consisted of a combination of motor and cognitive exercises conducted twice a week on nonconsecutive days. The main outcome measures were postural stability, mobility, fear of falling, and cognitive functions. Multiple analyses of variance were used to assess the impact of the dual-task training. Effect sizes (η 2 p) were reported. Significance was set at 5%. RESULTS Compared with the control group, participants who underwent the dual-task training showed positive outcomes in terms of postural stability (η 2 p = 0.298, P = 0.020), mobility (η 2 p = 0.285, P = 0.003), and cognitive functions (η 2 p = 0.536, P = 0.001). No significant differences were observed between the groups in terms of the fear of falling ( P = 0.566). CONCLUSIONS Three-month dual-task training was beneficial for postural control, mobility, and cognitive functions in community-dwelling older adults. Based on the present findings, healthcare professionals should consider incorporating dual-task training into clinical practice.
Collapse
Affiliation(s)
- Gabriella Simões Scarmagnan
- From the Faculty of Medicine, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil (GSS, TBL, GC); and Institute of Health, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil (DEP, AVBS, IMSR, GC)
| | | | | | | | | | | |
Collapse
|
7
|
Buekers J, Delgado-Ortiz L, Megaritis D, Polhemus A, Breuls S, Buttery SC, Chynkiamis N, Demeyer H, Gimeno-Santos E, Hume E, Koch S, Williams P, Wuyts M, Hopkinson NS, Vogiatzis I, Troosters T, Frei A, Garcia-Aymerich J. Gait differences between COPD and healthy controls: systematic review and meta-analysis. Eur Respir Rev 2024; 33:230253. [PMID: 38657998 PMCID: PMC11040389 DOI: 10.1183/16000617.0253-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls. METHODS We searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias. RESULTS Searches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) -19 cm·s-1, 95% CI -28 to -11 cm·s-1) and at a fast speed (MD -30 cm·s-1, 95% CI -47 to -13 cm·s-1). Alterations in other gait characteristics were not statistically significant. CONCLUSION Low-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive. Gait impairment appears to be an important but understudied area in COPD.
Collapse
Affiliation(s)
- Joren Buekers
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Ashley Polhemus
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Sofie Breuls
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara C Buttery
- National Lung and Heart Institute, Imperial College London, London, UK
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Heleen Demeyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Hospital Clinic of Barcelona - August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Parris Williams
- National Lung and Heart Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, London, UK
| | - Marieke Wuyts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Thierry Troosters
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
8
|
Liu WY, Spruit MA, Delbressine JM, Willems PJ, Yentes JM, Bruijn SM, Franssen FME, Wouters EFM, Meijer K. Alterations in stride-to-stride fluctuations in patients with chronic obstructive pulmonary disease during a self-paced treadmill 6-minute walk test. PLoS One 2024; 19:e0300592. [PMID: 38489297 PMCID: PMC10942081 DOI: 10.1371/journal.pone.0300592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/29/2024] [Indexed: 03/17/2024] Open
Abstract
Evaluating variability and stability using measures for nonlinear dynamics may provide additional insight into the structure of the locomotor system, reflecting the neuromuscular system's organization of gait. This is in particular of interest when this system is affected by a respiratory disease and it's extrapulmonary manifestations. This study assessed stride-to-stride fluctuations and gait stability in patients with chronic obstructive pulmonary disease (COPD) during a self-paced, treadmill 6-minute walk test (6MWT) and its association with clinical outcomes. In this cross-sectional study, eighty patients with COPD (age 62±7y; forced expiratory volume in first second 56±19%predicted) and 39 healthy older adults (62±7y) were analyzed. Gait parameters including stride-to-stride fluctuations (coefficient of variation (CoV), predictability (sample entropy) and stability (Local Divergence Exponent (LDE)) were calculated over spatiotemporal parameters and center of mass velocity. Independent t-test, Mann-Whitney U test and ANCOVA analyses were conducted. Correlations were calculated between gait parameters, functional mobility using Timed Up and Go Test, and quadriceps muscle strength using dynamometry. Patients walked slower than healthy older adults. After correction for Speed, patients demonstrated increased CoV in stride length (F(1,116) = 5.658, p = 0.019), and increased stride length predictability (F(1,116) = 3.959, p = 0.049). Moderate correlations were found between mediolateral center of mass velocity LDE and normalized maximum peak torque (ρ = -0.549). This study showed that patients with COPD demonstrate alterations in stride length fluctuations even when adjusted for walking speed, highlighting the potential of nonlinear measures to detect alterations in gait function in patients with COPD. Association with clinical outcomes were moderate to weak, indicating that these clinical test are less discriminative for gait alterations.
Collapse
Affiliation(s)
- Wai-Yan Liu
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Horn, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Paul J. Willems
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jennifer M. Yentes
- Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Emiel F. M. Wouters
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
9
|
Lewis MM, Waltz C, Scelina L, Scelina K, Owen KM, Hastilow K, Zimmerman EM, Rosenfeldt AB, Miller Koop M, Alberts JL. Gait patterns during overground and virtual omnidirectional treadmill walking. J Neuroeng Rehabil 2024; 21:29. [PMID: 38388883 PMCID: PMC10885397 DOI: 10.1186/s12984-023-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/20/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Omnidirectional treadmills (ODTs) offer a promising solution to the virtual reality (VR) locomotion problem, which describes the mismatch between visual and somatosensory information and contributes to VR sickness. However, little is known about how walking on ODTs impacts the biomechanics of gait. This project aimed to compare overground and ODT walking and turning in healthy young adults. METHODS Fifteen young adults completed forward walk, 180° turn, and 360° turn tasks under three conditions: (1) overground, (2) on the Infinadeck ODT in a virtual environment without a handrail, and (3) on the ODT with a handrail. Kinematic data for all walking trials were gathered using 3D optical motion capture. RESULTS Overall, gait speed was slower during ODT walking than overground. When controlling for gait speed, ODT walking resulted in shorter steps and greater variability in step length. There were no significant differences in other spatiotemporal metrics between ODT and overground walking. Turning on the ODT required more steps and slower rotational speeds than overground turns. The addition of the stability handrail to the ODT resulted in decreased gait variability relative to the ODT gait without the handrail. CONCLUSION Walking on an ODT resembles natural gait patterns apart from slower gait speed and shorter step length. Slower walking and shorter step length are likely due to the novelty of physically navigating a virtual environment which may result in a more conservative approach to gait. Future work will evaluate how older adults and those with neurological disease respond to ODT walking.
Collapse
Affiliation(s)
- Morgan McGrath Lewis
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Colin Waltz
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Logan Scelina
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Kathryn Scelina
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Kelsey M Owen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Karissa Hastilow
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Eric M Zimmerman
- Neurological Institute, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
- Neurological Institute, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
10
|
Aleixo P, Abrantes J. Proprioceptive and Strength Exercise Guidelines to Prevent Falls in the Elderly Related to Biomechanical Movement Characteristics. Healthcare (Basel) 2024; 12:186. [PMID: 38255074 PMCID: PMC10815388 DOI: 10.3390/healthcare12020186] [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: 11/29/2023] [Revised: 12/14/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Falls are a major concern in the elderly and walking is an important daily activity in which falls occur, with tripping and slipping being the most frequent causes. Gait biomechanical parameters have been related to the occurrence of falls in the elderly. Moreover, there is evidence that falls can be prevented through exercise programs, which have been shown to be also effective in improving gait biomechanical parameters. However, a question remains: "What types of exercises must be included in exercise programs to prevent falls?". The purpose of this manuscript was to present guidelines for a fall prevention exercise program for the elderly, which was created with the aim of improving the gait biomechanical parameters related to falls. The critical review performed during the preparation of this manuscript collected important evidence and knowledge in order to create a structural basis for the development of a fall prevention exercise program. This type of program should last 6 or more weeks and be prescribed based on four movement pillars (locomotion, level changes, pulling and pushing, and rotations); however, the locomotion pillar must be the focus of the program. Proprioceptive and functional strength exercises should be included in this program. Based on the theoretical rationale, a proposal for a fall prevention exercise program is presented.
Collapse
Affiliation(s)
- Pedro Aleixo
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Universidade Lusófona, 1749-024 Lisbon, Portugal
| | - João Abrantes
- Centre for Research in Applied Communication, Culture, and New Technologies (CICANT), Universidade Lusófona, 1749-024 Lisbon, Portugal;
| |
Collapse
|
11
|
Sturnieks DL, Hicks C, Smith N, Ratanapongleka M, Menant J, Turner J, Lo J, Chaplin C, Garcia J, Valenzuela MJ, Delbaere K, Herbert RD, Sherrington C, Toson B, Lord SR. Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial. Nat Med 2024; 30:98-105. [PMID: 38228913 DOI: 10.1038/s41591-023-02739-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024]
Abstract
Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months-the primary outcome of the trial-was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56-0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65-1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493 .
Collapse
Affiliation(s)
- Daina L Sturnieks
- Neuroscience Research Australia, Randwick, New South Wales, Australia.
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia.
| | - Cameron Hicks
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natassia Smith
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica Turner
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Jaime Garcia
- UTS Games Studio, Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Valenzuela
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Skin2Neuron Pty Ltd, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Sydney School of Public Health, Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
Wang M, Wu F, Callisaya ML, Jones G, Winzenberg TM. Longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle-aged women. Eur J Sport Sci 2023; 23:2240-2250. [PMID: 37272369 DOI: 10.1080/17461391.2023.2222096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We examined the longitudinal associations of accelerometer-measured physical activity and sedentary time with leg muscle strength (LMS), balance, and falls in middle-aged women. This was a 5-year cohort study among 308 women aged 36-56 years. We used linear mixed-effects models to examine associations of baseline and change in accelerometer-measured sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) with baseline and 5-year change in LMS and balance (timed up and go test [TUG], functional reach test [FRT], lateral reach test [LRT], and step test [ST]), and negative binomial/Poisson and log-binomial regression as appropriate to assess associations with falls after 5-year follow-up. Greater baseline MVPA was associated with better baseline LMS (β = 4.65 kg/SD, 95% CI: 1.37, 7.93) and TUG (β = -0.09 s/SD, 95% CI: -0.18, -0.01) but not with change in them over 5 years. Baseline MVPA was not associated with FRT at baseline but associated with a greater decrease in FRT (β = -0.87 cm/SD, 95% CI: -1.57, -0.17). Increased MVPA over 5 years was associated with less deterioration in FRT (β = 0.88 cm/SD, 95% CI: 0.14, 1.61). Increased sedentary time over 5 years was associated with a larger decrease in FRT (β = -0.82 cm/SD, 95% CI: -1.58, -0.07). Higher baseline LPA was associated with higher falls risk (IRR = 1.27, 95% CI: 1.02, 1.57). Higher baseline MVPA may benefit LMS and balance, while increasing MVPA in the medium term has little effect on change in these outcomes in mid-life. Detrimental association of LPA with falls may be due to greater exposures to environmental hazards.HighlightsOur study for the first time examined the longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle-aged women.Higher baseline moderate-to-vigorous physical activity (MVPA) may be beneficial for muscle strength and balance at baseline but increasing MVPA in the medium term has little effect on change in LMS or balance outcomes in middle-aged women.Higher baseline light physical activity (LPA) was associated with an increased risk of falls.The detrimental association of LPA with falls may be due to a greater exposure to environmental hazards in midlife, which needs to be clarified in future research.
Collapse
Affiliation(s)
- Mengmeng Wang
- School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tania M Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
14
|
Buekers J, Megaritis D, Koch S, Alcock L, Ammour N, Becker C, Bertuletti S, Bonci T, Brown P, Buckley E, Buttery SC, Caulfied B, Cereatti A, Chynkiamis N, Demeyer H, Echevarria C, Frei A, Hansen C, Hausdorff JM, Hopkinson NS, Hume E, Kuederle A, Maetzler W, Mazzà C, Micó-Amigo EM, Mueller A, Palmerini L, Salis F, Scott K, Troosters T, Vereijken B, Watz H, Rochester L, Del Din S, Vogiatzis I, Garcia-Aymerich J. Laboratory and free-living gait performance in adults with COPD and healthy controls. ERJ Open Res 2023; 9:00159-2023. [PMID: 37753279 PMCID: PMC10518872 DOI: 10.1183/23120541.00159-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 09/28/2023] Open
Abstract
Background Gait characteristics are important risk factors for falls, hospitalisations and mortality in older adults, but the impact of COPD on gait performance remains unclear. We aimed to identify differences in gait characteristics between adults with COPD and healthy age-matched controls during 1) laboratory tests that included complex movements and obstacles, 2) simulated daily-life activities (supervised) and 3) free-living daily-life activities (unsupervised). Methods This case-control study used a multi-sensor wearable system (INDIP) to obtain seven gait characteristics for each walking bout performed by adults with mild-to-severe COPD (n=17; forced expiratory volume in 1 s 57±19% predicted) and controls (n=20) during laboratory tests, and during simulated and free-living daily-life activities. Gait characteristics were compared between adults with COPD and healthy controls for all walking bouts combined, and for shorter (≤30 s) and longer (>30 s) walking bouts separately. Results Slower walking speed (-11 cm·s-1, 95% CI: -20 to -3) and lower cadence (-6.6 steps·min-1, 95% CI: -12.3 to -0.9) were recorded in adults with COPD compared to healthy controls during longer (>30 s) free-living walking bouts, but not during shorter (≤30 s) walking bouts in either laboratory or free-living settings. Double support duration and gait variability measures were generally comparable between the two groups. Conclusion Gait impairment of adults with mild-to-severe COPD mainly manifests during relatively long walking bouts (>30 s) in free-living conditions. Future research should determine the underlying mechanism(s) of this impairment to facilitate the development of interventions that can improve free-living gait performance in adults with COPD.
Collapse
Affiliation(s)
- Joren Buekers
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Dimitrios Megaritis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Sarah Koch
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Lisa Alcock
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nadir Ammour
- Clinical Science and Operations, GlobalDevelopment, Sanofi R&D, Chilly-Mazarin, France
| | - Clemens Becker
- Robert Bosch Gesellschaft für Medizinische Forschung, Stuttgart, Germany
| | - Stefano Bertuletti
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tecla Bonci
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Philip Brown
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ellen Buckley
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Sara C. Buttery
- National Lung and Heart Institute, Imperial College, London, UK
| | - Brian Caulfied
- Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Andrea Cereatti
- Polytechnic University of Torino, Department of Electronics and Telecommunications, Turin, Italy
| | - Nikolaos Chynkiamis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences and Pulmonary Rehabilitation, Respiratory Division, University Hospital Gasthuisberg, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Carlos Echevarria
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Clint Hansen
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Department of Physical Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Emily Hume
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Arne Kuederle
- Machine Learning and Data Analytics Lab, Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Walter Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
| | - Claudia Mazzà
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Encarna M. Micó-Amigo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arne Mueller
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Luca Palmerini
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | - Francesca Salis
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Kirsty Scott
- Department of Mechanical Engineering and INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences and Pulmonary Rehabilitation, Respiratory Division, University Hospital Gasthuisberg, Leuven, Belgium
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Lynn Rochester
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Silvia Del Din
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle upon Tyne, UK
- Thorax Research Foundation and First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria General Chest Hospital, Athens, Greece
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| |
Collapse
|
15
|
Alcock L, Vitório R, Stuart S, Rochester L, Pantall A. Faster Walking Speeds Require Greater Activity from the Primary Motor Cortex in Older Adults Compared to Younger Adults. SENSORS (BASEL, SWITZERLAND) 2023; 23:6921. [PMID: 37571703 PMCID: PMC10422240 DOI: 10.3390/s23156921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
Gait speed declines with age and slower walking speeds are associated with poor health outcomes. Understanding why we do not walk faster as we age, despite being able to, has implications for rehabilitation. Changes in regional oxygenated haemoglobin (HbO2) across the frontal lobe were monitored using functional near infrared spectroscopy in 17 young and 18 older adults while they walked on a treadmill for 5 min, alternating between 30 s of walking at a preferred and fast (120% preferred) speed. Gait was quantified using a triaxial accelerometer (lower back). Differences between task (preferred/fast) and group (young/old) and associations between regional HbO2 and gait were evaluated. Paired tests indicated increased HbO2 in the supplementary motor area (right) and primary motor cortex (left and right) in older adults when walking fast (p < 0.006). HbO2 did not significantly change in the young when walking fast, despite both groups modulating gait. When evaluating the effect of age (linear mixed effects model), greater increases in HbO2 were observed for older adults when walking fast (prefrontal cortex, premotor cortex, supplementary motor area and primary motor cortex) compared to young adults. In older adults, increased step length and reduced step length variability were associated with larger increases in HbO2 across multiple regions when walking fast. Walking fast required increased activation of motor regions in older adults, which may serve as a therapeutic target for rehabilitation. Widespread increases in HbO2 across the frontal cortex highlight that walking fast represents a resource-intensive task as we age.
Collapse
Affiliation(s)
- Lisa Alcock
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (L.A.); (L.R.)
- National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Rodrigo Vitório
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (R.V.); (S.S.)
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; (R.V.); (S.S.)
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (L.A.); (L.R.)
- National Institute for Health and Care Research (NIHR), Newcastle Biomedical Research Centre (BRC), Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Annette Pantall
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| |
Collapse
|
16
|
Urbanek JK, Roth DL, Karas M, Wanigatunga A, Mitchell C, Juraschek S, Cai Y, Appel L, Schrack J. Free-Living Gait Cadence Measured by Wearable Accelerometer: A Promising Alternative to Traditional Measures of Mobility for Assessing Fall Risk. J Gerontol A Biol Sci Med Sci 2023; 78:802-810. [PMID: 35029661 PMCID: PMC10172982 DOI: 10.1093/gerona/glac013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Wearable devices have become widespread in research applications, yet evidence on whether they are superior to structured clinic-based assessments is sparse. In this manuscript, we compare traditional, laboratory-based metrics of mobility with a novel accelerometry-based measure of free-living gait cadence for predicting fall rates. METHODS Using negative binomial regression, we compared traditional in-clinic measures of mobility (6-minute gait cadence, speed, and distance, and 4-m gait speed) with free-living gait cadence from wearable accelerometers in predicting fall rates. Accelerometry data were collected with wrist-worn Actigraphs (GT9X) over 7 days in 432 community-dwelling older adults (aged 77.29 ± 5.46 years, 59.1% men, 80.2% White) participating in the Study to Understand Fall Reduction and Vitamin D in You. Falls were ascertained using monthly calendars, quarterly contacts, and ad hoc telephone reports. Accelerometry-based free-living gait cadence was estimated with the Adaptive Empirical Pattern Transformation algorithm. RESULTS Across all participants, free-living cadence was significantly related to fall rates; every 10 steps per minute higher cadence was associated with a 13.2% lower fall rate (p = .036). Clinic-based measures of mobility were not related to falls (p > .05). Among higher-functioning participants (cadence ≥100 steps/minute), every 10 steps per minute higher free-living cadence was associated with a 27.7% lower fall rate (p = .01). In participants with slow baseline gait (gait speed <0.8 m/s), all metrics were significantly associated with fall rates. CONCLUSION Data collected from biosensors in the free-living environment may provide a more sensitive indicator of fall risk than in-clinic tests, especially among higher-functioning older adults who may be more responsive to intervention. CLINICAL TRIAL REGISTRATION NCT02166333.
Collapse
Affiliation(s)
- Jacek K Urbanek
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center on Aging and Health, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marta Karas
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amal A Wanigatunga
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christine M Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P Juraschek
- Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yurun Cai
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Center on Aging and Health, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
17
|
Walsh GS, Snowball J. Cognitive and visual task effects on gaze behaviour and gait of younger and older adults. Exp Brain Res 2023; 241:1623-1631. [PMID: 37148282 DOI: 10.1007/s00221-023-06627-4] [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: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
Cognitive dual tasks alter gait of younger and older adults and recent research has demonstrated that they also influence gaze behaviour and standing postural control. These findings suggest that age-related changes in cognitive and gaze function might increase fall risk in older adults. The purpose of this study was to determine the effect cognitive and visual dual tasks on the gait and gaze behaviour of younger and older adults. Ten older and ten younger adults walked for 3 min on a treadmill at preferred walking speed under three conditions, single task, cognitive and visual dual task conditions. Gait dynamics were measured using accelerometry and gaze behaviour was measured using wearable eye-trackers. Stride time variability and centre of mass (COM) motion complexity increased in dual-task conditions in older adults but had no difference for younger adults. Dual tasks had limited effect on gaze behaviour; however, visual input duration was greater, and visual input frequency and saccade frequency were lower in older than younger adults. The gaze adaptations in older adults may be the result of slower visual processing or represent a compensatory strategy to suppress postural movement. The increase in gait COM motion complexity in older adults suggests the dual tasks led to more automatic gait control resulting from both cognitive and visual tasks.
Collapse
Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, OX3 0BP, UK.
| | - James Snowball
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, OX3 0BP, UK
| |
Collapse
|
18
|
Hsieh KL, Speiser JL, Neiberg RH, Marsh AP, Tooze JA, Houston DK. Factors associated with falls in older adults: A secondary analysis of a 12-month randomized controlled trial. Arch Gerontol Geriatr 2023; 108:104940. [PMID: 36709562 PMCID: PMC10068618 DOI: 10.1016/j.archger.2023.104940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE While identifying older adults at risk for falls is important, fall prediction models have had limited success, in part because of a poor understanding of which physical function measures to include. The purpose of this secondary analysis was to determine physical function measures that are associated with future falls in older adults. METHODS In a 12-month trial comparing Vitamin D3 supplementation versus placebo on neuromuscular function, 124 older adults completed physical function measures at baseline, including the Short Physical Performance Battery (SPPB), Timed Up and Go, tests of leg strength and power, standing balance on a force plate with firm and foam surfaces, and walking over an instrumented walkway. Falls were recorded with monthly diaries over 12 months and categorized as no falls vs. one or more falls. Univariate and multivariable logistic regression adjusting for demographics, treatment assignment, depression, and prescription medications were conducted to examine the association between each physical function measure and future falls. Models were additionally adjusted for fall history. RESULTS 61 participants sustained one or more falls. In univariate analysis, white race, depression, fall history, SPPB, and postural stability on foam were significantly associated with future falls. In multivariable analysis, fall history (OR (95% CI): 3.20 (1.42-7.43)), SPPB (0.80 (0.62-1.01)), and postural stability on foam (3.01 (1.18, 8.45)) were each significantly associated with future falls. After adjusting for fall history, only postural stability on foam was significantly associated with falls. CONCLUSIONS When developing fall prediction models, fall history, the SPPB, and postural stability when standing on foam should be considered.
Collapse
Affiliation(s)
- Katherine L Hsieh
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine; Department of Physical Therapy, Georgia State University.
| | - Jaime L Speiser
- Department of Biostatistics and Data Science, Division of Public Health Services, Wake Forest University School of Medicine
| | - Rebecca H Neiberg
- Department of Biostatistics and Data Science, Division of Public Health Services, Wake Forest University School of Medicine
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Division of Public Health Services, Wake Forest University School of Medicine
| | - Denise K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
| |
Collapse
|
19
|
Greenfield J, Delcroix V, Ettaki W, Derollepot R, Paire-Ficout L, Ranchet M. Left and Right Cortical Activity Arising from Preferred Walking Speed in Older Adults. SENSORS (BASEL, SWITZERLAND) 2023; 23:3986. [PMID: 37112327 PMCID: PMC10141493 DOI: 10.3390/s23083986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
Cortical activity and walking speed are known to decline with age and can lead to an increased risk of falls in the elderly. Despite age being a known contributor to this decline, individuals age at different rates. This study aimed to analyse left and right cortical activity changes in elderly adults regarding their walking speed. Cortical activation and gait data were obtained from 50 healthy older individuals. Participants were then grouped into a cluster based on their preferred walking speed (slow or fast). Analyses on the differences of cortical activation and gait parameters between groups were carried out. Within-subject analyses on left and right-hemispheric activation were also performed. Results showed that individuals with a slower preferred walking speed required a higher increase in cortical activity. Individuals in the fast cluster presented greater changes in cortical activation in the right hemisphere. This work demonstrates that categorizing older adults by age is not necessarily the most relevant method, and that cortical activity can be a good indicator of performance with respect to walking speed (linked to fall risk and frailty in the elderly). Future work may wish to explore how physical activity training influences cortical activation over time in the elderly.
Collapse
Affiliation(s)
- Julia Greenfield
- Laboratory of Industrial and Human Automation Control, Mechanical Engineering and Computer Science, UMR 8201—LAMIH, University Polytechnic Hauts-de-France, F-59313 Valenciennes, France
| | - Véronique Delcroix
- Laboratory of Industrial and Human Automation Control, Mechanical Engineering and Computer Science, UMR 8201—LAMIH, University Polytechnic Hauts-de-France, F-59313 Valenciennes, France
| | - Wafae Ettaki
- Laboratory of Industrial and Human Automation Control, Mechanical Engineering and Computer Science, UMR 8201—LAMIH, University Polytechnic Hauts-de-France, F-59313 Valenciennes, France
| | - Romain Derollepot
- Health, Safety and Transport Department, Laboratory Ergonomics and Cognitive Sciences Applied to Transport (TS2-LESCOT), University Gustave Eiffel, The French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), University of Lyon, F-69675 Lyon, France
| | - Laurence Paire-Ficout
- Health, Safety and Transport Department, Laboratory Ergonomics and Cognitive Sciences Applied to Transport (TS2-LESCOT), University Gustave Eiffel, The French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), University of Lyon, F-69675 Lyon, France
| | - Maud Ranchet
- Health, Safety and Transport Department, Laboratory Ergonomics and Cognitive Sciences Applied to Transport (TS2-LESCOT), University Gustave Eiffel, The French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), University of Lyon, F-69675 Lyon, France
| |
Collapse
|
20
|
Chou SJ, Tung HH, Peng LN, Chen LK. Timed Up and Go test and gastrointestinal disorders among hospitalized older adults with fall risk. Arch Gerontol Geriatr 2023; 107:104918. [PMID: 36580885 DOI: 10.1016/j.archger.2022.104918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/16/2022] [Accepted: 12/24/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE RESEARCH The study aimed to examine the correlation between underlying medical conditions and gait analysis parameters as well as determine the key determiners of fall risk. MATERIALS AND METHODS This was a cross-sectional study. A total of 120 hospitalized older adults, recruited from a medical center in northern Taiwan, completed three instruments: the Timed Up and Go (TUG) test, a demographic questionnaire, and the Morse Fall Scale. The inferential statistics were subjected to the chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and Spearman's rank correlation coefficient analysis to determine the correlations among the demographic variables, gait analysis parameters, and fall risk in elderly inpatients. Logistic regression was used to analyze the predictors of elderly inpatients' fall risk. RESULTS The results showed that longer TUG test times, slower walking speeds, or shorter stride lengths are related to higher fall risk. The new finding was that longer TUG test times and slow gait speeds were correlated with lower gastrointestinal as well as hepatobiliary and pancreatic diseases. CONCLUSIONS This study confirms that gait analysis parameters are significantly correlated with fall risk among older inpatients and that TUG is an important indicator of frailty, prefrailty, or metabolic state. Early detection of the symptoms of gastrointestinal disorders and the provision of adequate nutrition could potentially improve inpatients' gait and prevent falls.
Collapse
Affiliation(s)
- Shan-Ju Chou
- Registered Nurse, Department of Nursing, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11217 Taiwan, R.O.C..
| | - Heng-Hsin Tung
- Professor/Director, Department of Nursing, National Yang Ming Chiao Tung University,No. 155, Sec. 2, Li-Nong Street, Taipei City, 11304 Taiwan, R.O.C. Consultant, Tungs' Taichung MetroHarbor Hospital, No.699, Section 8, Taiwan Boulevard, Wuqi District,Taichung City, 43503 Taiwan. R.O.C..
| | - Li-Ning Peng
- Professor/Chief, Division of Geriatric Medicine, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, 11217 Taiwan, R.O.C..
| | - Liang-Kung Chen
- Professor/Superintendent, Taipei Municipal Gan-Dau Hospital, Taipei, R.O.C., No. 12, 225 Lane, Zhi-Sing Road, Taipei CIty, 11260 Taiwan. R.O.C. Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Li-Nong Street, Taipei City, 112304 Taiwan, R.O.C..
| |
Collapse
|
21
|
Marshall S, Gabiazon R, Persaud P, Nagamatsu LS. What do functional neuroimaging studies tell us about the association between falls and cognition in older adults? A systematic review. Ageing Res Rev 2023; 85:101859. [PMID: 36669688 DOI: 10.1016/j.arr.2023.101859] [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: 09/26/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
Impaired cognition is a known risk factor for falls in older adults. To enhance prevention strategies and treatment of falls among an aging global population, an understanding of the neural processes and networks involved is required. We present a systematic review investigating how functional neuroimaging techniques have been used to examine the association between falls and cognition in seniors. Peer-reviewed articles were identified through searching five electronic databases: 1) Medline, 2) PsycINFO, 3) CINAHL, 4) EMBASE, and 5) Pubmed. Key author, key paper, and reference searching was also conducted. Nine studies were included in this review. A questionnaire composed of seven questions was used to assess the quality of each study. EEG, fMRI, and PET were utilized across studies to examine brain function in older adults. Consistent evidence demonstrates that cognition is associated with measures of falls/falls risk, specifically visual attention and executive function. Our results show that falls/falls risk may be implicated with specific brain regions and networks. Future studies should be prospective and long-term in nature, with standardized outcome measures. Mobile neuroimaging techniques may also provide insight into brain activity as it pertains to cognition and falls in older adults in real-world settings.
Collapse
Affiliation(s)
- Samantha Marshall
- Faculty of Health Sciences, School of Kinesiology, Western University, Ontario, Canada
| | - Raphael Gabiazon
- Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Priyanka Persaud
- Faculty of Health Sciences, School of Kinesiology, Western University, Ontario, Canada
| | - Lindsay S Nagamatsu
- Faculty of Health Sciences, School of Kinesiology, Western University, Ontario, Canada.
| |
Collapse
|
22
|
Stojan R, Mack M, Bock O, Voelcker-Rehage C. Inefficient frontal and parietal brain activation during dual-task walking in a virtual environment in older adults. Neuroimage 2023; 273:120070. [PMID: 37004827 DOI: 10.1016/j.neuroimage.2023.120070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Walking while performing an additional cognitive task (dual-task walking; DT walking) is a common yet highly demanding behavior in daily life. Previous neuroimaging studies have shown that performance declines from single- (ST) to DT conditions are accompanied by increased prefrontal cortex (PFC) activity. This increment is particularly pronounced in older adults and has been explained either by compensation, dedifferentiation, or ineffective task processing in fronto-parietal circuits. However, there is only limited evidence for the hypothesized fronto-parietal activity changes measured under real life conditions such as walking. In this study, we therefore assessed brain activity in PFC and parietal lobe (PL), to investigate whether higher PFC activation during DT walking in older adults is related to compensation, dedifferentiation, or neural inefficiency. Fifty-six healthy older adults (69.11 ± 4.19 years, 30 female) completed three tasks (treadmill walking at 1 m/s, Stroop task, Serial 3's task) under ST and DT conditions (Walking + Stroop, Walking + Serial 3's), and a baseline Standing task. Behavioral outcomes were step time variability (Walking), Balance Integration Score BIS (Stroop), and number of correct calculations S3corr (Serial 3's). Brain activity was measured using functional near-infrared spectroscopy (fNIRS) over ventrolateral and dorsolateral PFC (vlPFC, dlPFC) and inferior and superior PL (iPL, sPL). Neurophysiological outcome measures were oxygenated (HbO2) and deoxygenated hemoglobin (HbR). Linear mixed models with follow-up estimated marginal means contrasts were applied to investigate region-specific upregulations of brain activation from ST to DT conditions. Furthermore, the relationships of DT-specific activations across all brain regions was analyzed as well as the relationship between changes in brain activation and changes in behavioral performance from ST to DT. Data indicated the expected upregulation from ST to DT and that DT-related upregulation was more pronounced in PFC (particularly in vlPFC) than in PL regions. Activation increases from ST to DT were positively correlated between all brain regions, and higher brain activation changes predicted higher declines in behavioral performance from ST to DT. Results were largely consistent for both DTs (Stroop and Serial 3's). These findings more likely suggest neural inefficiency and dedifferentiation in PFC and PL rather than fronto-parietal compensation during DT walking in older adults. Findings have implications for interpreting and promoting efficacy of long-term interventions to improve DT walking in older persons.
Collapse
|
23
|
Shah VV, Jagodinsky A, McNames J, Carlson-Kuhta P, Nutt JG, El-Gohary M, Sowalsky K, Harker G, Mancini M, Horak FB. Gait and turning characteristics from daily life increase ability to predict future falls in people with Parkinson's disease. Front Neurol 2023; 14:1096401. [PMID: 36937534 PMCID: PMC10015637 DOI: 10.3389/fneur.2023.1096401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/02/2023] [Indexed: 03/05/2023] Open
Abstract
Objectives To investigate if digital measures of gait (walking and turning) collected passively over a week of daily activities in people with Parkinson's disease (PD) increases the discriminative ability to predict future falls compared to fall history alone. Methods We recruited 34 individuals with PD (17 with history of falls and 17 non-fallers), age: 68 ± 6 years, MDS-UPDRS III ON: 31 ± 9. Participants were classified as fallers (at least one fall) or non-fallers based on self-reported falls in past 6 months. Eighty digital measures of gait were derived from 3 inertial sensors (Opal® V2 System) placed on the feet and lower back for a week of passive gait monitoring. Logistic regression employing a "best subsets selection strategy" was used to find combinations of measures that discriminated future fallers from non-fallers, and the Area Under Curve (AUC). Participants were followed via email every 2 weeks over the year after the study for self-reported falls. Results Twenty-five subjects reported falls in the follow-up year. Quantity of gait and turning measures (e.g., number of gait bouts and turns per hour) were similar in future fallers and non-fallers. The AUC to discriminate future fallers from non-fallers using fall history alone was 0.77 (95% CI: [0.50-1.00]). In contrast, the highest AUC for gait and turning digital measures with 4 combinations was 0.94 [0.84-1.00]. From the top 10 models (all AUCs>0.90) via the best subsets strategy, the most consistently selected measures were variability of toe-out angle of the foot (9 out of 10), pitch angle of the foot during mid-swing (8 out of 10), and peak turn velocity (7 out of 10). Conclusions These findings highlight the importance of considering precise digital measures, captured via sensors strategically placed on the feet and low back, to quantify several different aspects of gait (walking and turning) during daily life to improve the classification of future fallers in PD.
Collapse
Affiliation(s)
- Vrutangkumar V. Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - Adam Jagodinsky
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - James McNames
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - John G. Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - Kristen Sowalsky
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - Graham Harker
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| |
Collapse
|
24
|
Jayakody O, Breslin M, Ayers E, Verghese J, Barzilai N, Weiss E, Milman S, Blumen HM. Age-related changes in gait domains: Results from the LonGenity study. Gait Posture 2023; 100:8-13. [PMID: 36463714 PMCID: PMC9974801 DOI: 10.1016/j.gaitpost.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/30/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Impairment in gait domains such as pace, rhythm, and variability are associated with falls, cognitive decline, and dementia. However, the longitudinal changes in these gait domains are poorly understood. The aim of this study was to examine age-related changes in gait domains overall and in those with cognitive impairment and mobility disability. METHODS Participants were from the LonGenity study (n = 797; M Age=75.1 SD 6.5 years; 58.2% female) and were followed up to 12 years (Median=3.3; IQR: 1.1; 6.3). Gait speed and absolute values of step length, step time, cadence and, variability (standard deviation) of step length and step time during usual pace walking were assessed. Principal components analysis was used to obtain weighted combinations of three gait domains: pace (velocity, step length), variability (step length variability, step time variability) and rhythm (step time). Linear mixed effect models were used to examine age-related changes in gait domains overall, and in those with cognitive impairment and mobility disability at baseline. RESULTS Pace declined, and rhythm increased (worsened) in an accelerating non-linear fashion. Variability gradually increased with age. Those with cognitive impairment had faster rates of change in pace and rhythm. Those with mobility disability had faster increases in rhythm. CONCLUSIONS Age-related changes in gait domains are not uniform. Individuals with cognitive and mobility impairments are particularly vulnerable to accelerated change in pace and or rhythm.
Collapse
Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Erica Weiss
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
25
|
Kacmaz KS, Unver B, Karatosun V. The Reliability and Validity of the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) Test in Knee Osteoarthritis. Indian J Orthop 2023; 57:290-296. [PMID: 36777119 PMCID: PMC9880116 DOI: 10.1007/s43465-022-00802-5] [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: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Background Several neuromuscular impairments may be observed in older patients with knee osteoarthritis (OA), increasing the risk of falling, which is common during transfer activities. The Lie-to-Sit-to- Stand-to-Walk Transfer (LSSWT) test was developed to evaluate complex transfer abilities. The study aims to investigate the reliability and validity of LSSWT in patients with knee OA. Methods Twenty-nine patients with knee OA were included in this study. The LSSWT, Timed up and go test (TUG), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were administered to the patients. Patients rested for at least an hour between the trials to avoid fatigue. Results The LSSWT has excellent reliability and high validity in patients with knee OA. The relative (ICC coefficient) and absolute (SEM and SRD95) reliability values are 0.96 (95% CI: 0.91-0.98), 1.00, and 2,75, respectively. The Pearson correlation coefficient of the LSSWT with the TUG is 0.73 (p < 0.01), and the Spearmen correlation coefficient of the LSSWT with the WOMAC is 0.54 (p < 0.05). Conclusions The LSSWT is highly reliable and valid in knee OA and is recommended for routine dynamic balance establishment. Having a low minimal clinically important difference shows the LSSWT's sensitivity. The LSSWT can easily identify dynamic balance deficits in knee OA patients and help prevent fall incidents.
Collapse
Affiliation(s)
- Kevser Sevik Kacmaz
- Department of Physical Therapy and Rehabilitation, Izmir Katip Celebi University, TR-35340 Cigli Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, TR-35340 Balçova Izmir, Turkey
| | - Vasfi Karatosun
- Department of Orthopaedics and Traumatology, School of Medicine, Dokuz Eylul University, TR-35340 Balçova-Izmir, Turkey
| |
Collapse
|
26
|
Jayakody O, Blumen HM, Ayers E, Verghese J. Longitudinal Associations Between Falls and Risk of Gait Decline: Results From the Central Control of Mobility and Aging Study. Arch Phys Med Rehabil 2023; 104:245-250. [PMID: 36108766 PMCID: PMC9898168 DOI: 10.1016/j.apmr.2022.08.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/01/2022] [Accepted: 08/24/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine whether falls are associated with longitudinal changes in different gait domains and onset of clinical gait abnormalities. DESIGN Longitudinal study. SETTING General community. PARTICIPANTS Ambulatory older adults free of dementia (N=428; mean age, 77.8±6.4 years). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait was assessed with a computerized walkway. Pace, rhythm, and variability (outcome measures) were derived from individual gait measures, using principal component analysis. Clinical gait abnormalities (neurologic, nonneurologic, mixed) were visually assessed by clinicians. Linear mixed-effects models were used to examine the associations between falls (the exposure variable coded as none, single, and multiple) and changes in gait domains. Multinomial logistic regression was used to examine associations between falls and the onset of clinical gait abnormalities. Models were adjusted for sex, education, age, body mass index, number of comorbidities, gait speed at the first follow-up, and time between the last fall and the first follow-up gait assessment. RESULTS Pace declined while rhythm and variability increased at a faster rate (P<.05) among 32 participants with multiple falls in the first year of follow-up compared with 299 participants with no falls. Risk for clinical gait abnormalities between those with no falls, a single fall, or multiple falls was not different. CONCLUSIONS Multiple falls predict future gait decline in multiple domains in aging. Interventions to prevent gait decline after multiple falls should be investigated.
Collapse
Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
| |
Collapse
|
27
|
Shah VV, McNames J, Carlson‐Kuhta P, Nutt JG, El‐Gohary M, Sowalsky K, Mancini M, Horak FB. Effect of Levodopa and Environmental Setting on Gait and Turning Digital Markers Related to Falls in People with Parkinson's Disease. Mov Disord Clin Pract 2023; 10:223-230. [PMID: 36825056 PMCID: PMC9941945 DOI: 10.1002/mdc3.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
Background It is unknown whether medication status (off and on levodopa) or laboratory versus home settings plays a role in discriminating fallers and non-fallers in people with Parkinson's disease (PD). Objectives To investigate which specific digital gait and turning measures, obtained with body-worn sensors, best discriminated fallers from non-fallers with PD in the clinic and during daily life. Methods We recruited 34 subjects with PD (17 fallers and 17 non-fallers based on the past 6 month's falls). Subjects wore three inertial sensors attached to both feet and the lumbar region in the laboratory for a 3-minute walking task (both off and on levodopa) and during daily life activities for a week. We derived 24 digital (18 gait and 6 turn) measures from the 3-minute walk and from daily life. Results In clinic, none of the gait and turning measures collected during on levodopa state were significantly different between fallers and non-fallers. In contrast, digital measures collected in the off levodopa state were significantly different between groups, (average turn velocity, average number of steps to complete a turn, and variability of gait speed, P < 0.03). During daily life, the variability of average turn velocity (P = 0.023) was significantly different in fallers than non-fallers. Last, the average number of steps to complete a turn was significantly correlated with the patient-reported outcomes. Conclusions Digital measures of turning, but not gait, were different in fallers compared to non-fallers with PD, in the laboratory when off medication and during a daily life.
Collapse
Affiliation(s)
- Vrutangkumar V. Shah
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- APDM Wearable Technologies, a Clario companyPortlandOregonUSA
| | - James McNames
- APDM Wearable Technologies, a Clario companyPortlandOregonUSA
- Department of Electrical and Computer EngineeringPortland State UniversityPortlandOregonUSA
| | | | - John G. Nutt
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | | | | | - Martina Mancini
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
| | - Fay B. Horak
- Department of NeurologyOregon Health & Science UniversityPortlandOregonUSA
- APDM Wearable Technologies, a Clario companyPortlandOregonUSA
| |
Collapse
|
28
|
Harrison EC, Earhart GM. The effect of auditory cues on gait variability in people with Parkinson's disease and older adults: a systematic review. Neurodegener Dis Manag 2023; 13:113-128. [PMID: 36695189 DOI: 10.2217/nmt-2021-0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim: The goal of this study was to analyze the effects of external rhythmic auditory stimulation (RAS) on gait variability in older adults and people with Parkinson's disease (PD). Methods: Academic databases searched included PubMed, Web of Science, PEDro and Cochrane, from inception to September 2021. Eligible articles scored a minimum of 4 on the PEDro scale. Results: Twenty-three papers were included. People with PD show varied responses in gait variability to RAS during cued walking trials. Healthy older adults tended to increase variability during cued trials. Cue rates below preferred walking cadence tend to increase gait variability. Conclusion: Gait variability is closely associated with fall risk and an important consideration in development of gait rehabilitation techniques.
Collapse
Affiliation(s)
- Elinor C Harrison
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, St. Louis, MO 63110, USA.,Washington University in St. Louis, Performing Arts Department, St. Louis, MO 63105, USA
| | - Gammon M Earhart
- Washington University in St. Louis School of Medicine, Program in Physical Therapy, St. Louis, MO 63110, USA.,Washington University in St. Louis School of Medicine, Department of Neurology, St. Louis, MO 63110, USA.,Washington University in St. Louis School of Medicine, Department of Neuroscience, St. Louis, MO 63110, USA
| |
Collapse
|
29
|
Hwang HF, Suprawesta L, Chen SJ, Yu WY, Lin MR. Predictors of incident reversible and potentially reversible cognitive frailty among Taiwanese older adults. BMC Geriatr 2023; 23:24. [PMID: 36639766 PMCID: PMC9837919 DOI: 10.1186/s12877-023-03741-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Few studies emphasize on predictors of incident cognitive frailty (CF) and examine relationships between various gait characteristics and CF. Therefore, we conducted a 2-year prospective study to investigate potential predictors, including gait characteristics, of incident reversible CF (RCF) and potentially RCF (PRCF) among Taiwanese older adults. METHODS Eligible participants were individuals aged ≥ 65 years, who could ambulate independently, and did not have RCF/PRCF at the baseline. The baseline assessment collected information on physical frailty and cognitive measures, in addition to sociodemographic and lifestyle characteristics, preexisting comorbidities and medications, gait characteristics, Tinetti's balance, balance confidence as assessed by Activities-specific Balance Confidence (ABC) scale, and the depressive status as assessed by the Geriatric Depression Scale. The Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, and Digit Symbol Substitution Test were used to evaluate cognitive functions. Incident RCF and PRCF were ascertained at a 2-year follow-up assessment. RESULTS Results of the multinomial logistic regression analysis showed that incident RCF was significantly associated with older age (odds ratio [OR] = 1.05) and lower ABC scores (OR = 0.97). Furthermore, incident PRCF was significantly associated with older age (OR = 1.07), lower ABC scores (OR = 0.96), the presence of depression (OR = 3.61), lower MMSE scores (OR = 0.83), slower gait velocity (OR = 0.97), and greater double-support time variability (OR = 1.09). CONCLUSIONS Incident RCF was independently associated with older age and lower balance confidence while incident PRCF independently associated with older age, reduced global cognition, the presence of depression, slower gait velocity, and greater double-support time variability. Balance confidence was the only modifiable factor associated with both incident RCF and PRCF.
Collapse
Affiliation(s)
- Hei-Fen Hwang
- grid.412146.40000 0004 0573 0416Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC ,grid.412896.00000 0000 9337 0481Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan, ROC
| | - Lalu Suprawesta
- grid.412896.00000 0000 9337 0481Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan, ROC ,grid.513056.4Department of Sport and Health Education, Faculty of Sport Science and Public Health, Universitas Pendidikan Mandalika, Mataram, West Nusa Tenggara Indonesia
| | - Sy-Jou Chen
- grid.260565.20000 0004 0634 0356Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen-Yu Yu
- grid.412897.10000 0004 0639 0994Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Mau-Roung Lin
- grid.412146.40000 0004 0573 0416Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC ,grid.412896.00000 0000 9337 0481Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 11031 Taiwan, ROC
| |
Collapse
|
30
|
Williams D, Martin AE. Predicting fall risk using multiple mechanics-based metrics for a planar biped model. PLoS One 2023; 18:e0283466. [PMID: 36972264 PMCID: PMC10042378 DOI: 10.1371/journal.pone.0283466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
For both humans and robots, falls are undesirable, motivating the development of fall prediction models. Many mechanics-based fall risk metrics have been proposed and validated to varying degrees, including the extrapolated center of mass, the foot rotation index, Lyapunov exponents, joint and spatiotemporal variability, and mean spatiotemporal parameters. To obtain a best-case estimate of how well these metrics can predict fall risk both individually and in combination, this work used a planar six-link hip-knee-ankle biped model with curved feet walking at speeds ranging from 0.8 m/s to 1.2 m/s. The true number of steps to fall was determined using the mean first passage times from a Markov chain describing the gaits. In addition, each metric was estimated using the Markov chain of the gait. Because calculating the fall risk metrics from the Markov chain had not been done before, the results were validated using brute force simulations. Except for the short-term Lyapunov exponents, the Markov chains could accurately calculate the metrics. Using the Markov chain data, quadratic fall prediction models were created and evaluated. The models were further evaluated using differing length brute force simulations. None of the 49 tested fall risk metrics could accurately predict the number of steps to fall by themselves. However, when all the fall risk metrics except the Lyapunov exponents were combined into a single model, the accuracy increased substantially. These results suggest that multiple fall risk metrics must be combined to obtain a useful measure of stability. As expected, as the number of steps used to calculate the fall risk metrics increased, the accuracy and precision increased. This led to a corresponding increase in the accuracy and precision of the combined fall risk model. 300 step simulations seemed to provide the best tradeoff between accuracy and using as few steps as possible.
Collapse
Affiliation(s)
- Daniel Williams
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - Anne E Martin
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| |
Collapse
|
31
|
Udina C, Avtzi S, Mota-Foix M, Rosso AL, Ars J, Kobayashi Frisk L, Gregori-Pla C, Durduran T, Inzitari M. Dual-task related frontal cerebral blood flow changes in older adults with mild cognitive impairment: A functional diffuse correlation spectroscopy study. Front Aging Neurosci 2022; 14:958656. [PMID: 36605362 PMCID: PMC9807627 DOI: 10.3389/fnagi.2022.958656] [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: 05/31/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction In a worldwide aging population with a high prevalence of motor and cognitive impairment, it is paramount to improve knowledge about underlying mechanisms of motor and cognitive function and their interplay in the aging processes. Methods We measured prefrontal cerebral blood flow (CBF) using functional diffuse correlation spectroscopy during motor and dual-task. We aimed to compare CBF changes among 49 older adults with and without mild cognitive impairment (MCI) during a dual-task paradigm (normal walk, 2- forward count walk, 3-backward count walk, obstacle negotiation, and heel tapping). Participants with MCI walked slower during the normal walk and obstacle negotiation compared to participants with normal cognition (NC), while gait speed during counting conditions was not different between the groups, therefore the dual-task cost was higher for participants with NC. We built a linear mixed effects model with CBF measures from the right and left prefrontal cortex. Results MCI (n = 34) showed a higher increase in CBF from the normal walk to the 2-forward count walk (estimate = 0.34, 95% CI [0.02, 0.66], p = 0.03) compared to participants with NC, related to a right- sided activation. Both groups showed a higher CBF during the 3-backward count walk compared to the normal walk, while only among MCI, CFB was higher during the 2-forward count walk. Discussion Our findings suggest a differential prefrontal hemodynamic pattern in older adults with MCI compared to their NC counterparts during the dual-task performance, possibly as a response to increasing attentional demand.
Collapse
Affiliation(s)
- Cristina Udina
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Research Institute (VHIR), Barcelona, Spain,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Cristina Udina,
| | - Stella Avtzi
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Miriam Mota-Foix
- Statistics and Bioinformatics Unit, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Andrea L. Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joan Ars
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Research Institute (VHIR), Barcelona, Spain,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lisa Kobayashi Frisk
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Clara Gregori-Pla
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Turgut Durduran
- ICFO – Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Research Institute (VHIR), Barcelona, Spain,Faculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| |
Collapse
|
32
|
Luo Y, Lu X, Grimaldi NS, Ahrentzen S, Hu B. Salient Targets and Fear of Falling Changed the Gait Pattern and Joint Kinematic of Older Adults. SENSORS (BASEL, SWITZERLAND) 2022; 22:9352. [PMID: 36502056 PMCID: PMC9740332 DOI: 10.3390/s22239352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fear of falling and environmental barriers in the home are two major factors that cause the incidence of falling. Poor visibility at night is one of the key environmental barriers that contribute to falls among older adult residents. Ensuring their visual perception of the surroundings, therefore, becomes vital to prevent falling injuries. However, there are limited works in the literature investigating the impact of the visibility of the target on older adults' walking destinations and how that impact differs across them with different levels of fear of falling. OBJECTIVE The purpose of the study was to examine the effects of target salience on older adults' walking performance and investigate whether older adults with varying levels of fear of falling behave differently. METHODS The salient target was constructed with LED strips around the destination of walking. Fifteen older adults (aged 75 years old and above), seven with low fear of falling and eight with high fear of falling, volunteered for the study. Participants walked from the designated origin (i.e., near their beds) to the destination (i.e., near the bathroom entrance), with the target turned on or off around the destination of the walking trials. Spatiotemporal gait variables and lower-body kinematics were recorded by inertial sensors and compared by using analysis of variance methods. RESULTS Data from inertial sensors showed that a more salient target at the destination increased older adults' gait speed and improved their walking stability. These changes were accompanied by less hip flexion at heel strikes and toe offs during walking. In addition, older adults with low fear of falling showed more substantial lower-body posture adjustments with the salient target presented in the environment. CONCLUSIONS Older adults with a low fear of falling can potentially benefit from a more salient target at their walking destination, whereas those with a high fear of falling were advised to implement a more straightforward falling intervention in their living areas.
Collapse
Affiliation(s)
- Yue Luo
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Xiaojie Lu
- Shimberg Center for Housing Studies, University of Florida, Gainesville, FL 32611, USA
- Microelectronics Thrust, Function Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou 511453, China
| | - Nicolas S. Grimaldi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Sherry Ahrentzen
- Shimberg Center for Housing Studies, University of Florida, Gainesville, FL 32611, USA
| | - Boyi Hu
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL 32611, USA
| |
Collapse
|
33
|
Tripathi S, Verghese J, Callisaya M, Mahoney JR, Srikanth V, Blumen HM. Brain patterns of pace - but not rhythm - are associated with vascular disease in older adults. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100154. [PMID: 36389342 PMCID: PMC9646823 DOI: 10.1016/j.cccb.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
Background Distinct domains of gait such as pace and rhythm are linked to an increased risk for cognitive decline, falls, and dementia in aging. The brain substrates supporting these domains and underlying diseases, however, remain relatively unknown. The current study aimed to identify patterns of gray matter volume (GMV) associated with pace and rhythm, and whether these patterns vary as a function of vascular and non-vascular comorbidities. Methods A cross-sectional sample of 297 older adults (M Age = 72.5 years ± 7.2 years, 43% women) without dementia was drawn from the Tasmanian Study of Cognition and Gait (TASCOG). Factor analyses were used to reduce eight quantitative gait variables into two domains. The "pace" domain was primarily composed of gait speed, stride length, and double support time. The "rhythm" domain was composed of swing time, stance time, and cadence. Multivariate covariance-based analyses adjusted for age, sex, education, total intracranial volume, and presence of mild cognitive impairment identified gray matter volume (GMV) patterns associated with pace and rhythm, as well as participant-specific expression (or factor) scores for each pattern. Results Pace was positively associated with GMV in the right superior temporal sulcus, bilateral supplementary motor areas (SMA), and bilateral cerebellar regions. Rhythm was positively associated with GMV in bilateral SMA, prefrontal, cingulate, and paracingulate cortices. The GMV pattern associated with pace was less expressed in participants with any vascular disease; this association was also found independently with hypertension, diabetes, and myocardial infarction. Conclusion Both pace and rhythm domains of gait were associated with the volume of brain structures that have been linked to controlled and automatic aspects of gait control, as well as with structures involved in multisensory integration. Only the brain structures associated with pace, however, were associated with vascular disease.
Collapse
Affiliation(s)
- Susmit Tripathi
- Department of Neurology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Michele Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Jeannette R. Mahoney
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia,Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Helena M. Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Corresponding author at: Department of Medicine (Geriatrics), Department of Neurology (Cognitive & Motor Aging), Albert Einstein College of Medicine, 1225 Morris Park Avenue, Van Etten Building, Room 319 Bronx, NY 10461, USA.
| |
Collapse
|
34
|
Grabowska W, Burton W, Kowalski MH, Vining R, Long CR, Lisi A, Hausdorff JM, Manor B, Muñoz-Vergara D, Wayne PM. A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research. BMC Musculoskelet Disord 2022; 23:844. [PMID: 36064383 PMCID: PMC9442928 DOI: 10.1186/s12891-022-05783-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis. CONCLUSION Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.
Collapse
Affiliation(s)
- Weronika Grabowska
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Wren Burton
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA.
| | - Matthew H Kowalski
- Osher Clinical Center for Integrative Medicine, Brigham and Women's Healthcare Center, 850 Boylston Street, Suite 422, Chestnut Hill, MA, 02445, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Anthony Lisi
- Yale University Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Dennis Muñoz-Vergara
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| |
Collapse
|
35
|
Dapp U, Vinyard D, Golgert S, Krumpoch S, Freiberger E. Reference values of gait characteristics in community-dwelling older persons with different physical functional levels. BMC Geriatr 2022; 22:713. [PMID: 36038832 PMCID: PMC9422159 DOI: 10.1186/s12877-022-03373-0] [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: 03/22/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mobility is one major component of healthy ageing of older persons. It includes gait speed, nowadays valued as the sixth vital sign of ageing. Quantitative gait analysis can support clinical diagnostics, monitor progression of diseases and provide information about the efficacy of interventions. Fast gait speed is an additional marker in the area of functional ability. Our aim was to contribute reference values of gait parameters of older persons based on their functional ability. Methods We visualised and combined three different established frameworks that assess gait characteristics into a new framework based approach that comprises eight gait parameters: gait speed, stride length, walk ratio, single and double support time, step width, step width CV (coefficient of variance), stride length CV. Gait parameters were stratified by two instruments that indicate levels of functional ability: First, the LUCAS Functional Ability Index (FAI), a self-administered screening tool easy to apply to a public-health orientated approach and second the Short Physical Performance Battery (SPPB), an established performance test widely used in comprehensive geriatric assessments (CGA). Gait parameters of older community-dwelling persons were measured with an objective Gait system (GAITRite) across differing functional ability ranging from robust to transient (postrobust and prefrail) to frail physical status. Results Of 642 community-dwelling participants (age 78.5 ± 4.8; n = 233 male, n = 409 female) categorisations by SPPB were 27.1% for robust (11–12 points), 44.2% for transient (8–10 points), 28.7% for frail (0–7 points), and 16.2, 50.3, 33.5% for robust, transient, frail by LUCAS FAI. Overall, our results showed that distinction by functional level only uncovers a wide spectrum of functional decline for all investigated gait parameters. Stratification by functional ability (biological age) revealed a greater range of differentiation than chronological age. Conclusions Gait parameters, carefully selected by literature, showed clinically meaningful differences between the functional featuring a gradient declining from robust over transient to frail in most gait parameters. We found discriminative power of stratifications by SPPB to be the highest, closely followed by LUCAS FAI, age groups and dichotomous age making the application of the LUCAS FAI more cost and time effective than conducting SPPB. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03373-0.
Collapse
Affiliation(s)
- Ulrike Dapp
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany.
| | - Dominic Vinyard
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany
| | - Stefan Golgert
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany
| | - Sebastian Krumpoch
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nürnberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nürnberg, Germany.
| |
Collapse
|
36
|
The world is at our feet with video-based quantitative gait analysis. Parkinsonism Relat Disord 2022; 100:45-46. [PMID: 35725545 DOI: 10.1016/j.parkreldis.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
|
37
|
Acute effect of traditional and adaptive metronomes on gait variability in older individuals with a history of falls. Aging Clin Exp Res 2022; 34:1349-1356. [PMID: 35020171 PMCID: PMC9151579 DOI: 10.1007/s40520-021-02066-9] [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: 06/30/2021] [Accepted: 12/26/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metronome cueing has been shown to reduce gait variability and thereby potentially reduce falls risk in individuals with Parkinson's disease. It is unclear however, if metronome cueing has a similar effect in healthy older adults with a history of falls. AIM To investigate whether a traditional and/or an adaptive metronome, based on an individual's gait pattern, were effective in reducing gait variability in older adults with a history of falls. METHODS Twenty older adults (15 women, 71 ± 4.9 years) with a history of falls were included in this cross-over study. Participants received two types of cueing (adaptive and traditional metronome) 1 week apart. The variability of the participants' stride time, stride length, walking speed and duration of double leg support were recorded during three walking conditions (baseline, during feedback and post-feedback gait). Repeated-measures ANOVA was used to assess the possible effects of the two cueing strategies on gait variables. RESULTS Compared with the baseline condition, participants had significantly increased stride time variability during feedback (F (2) = 9.83, p < 0.001) and decreased double leg support time variability post-feedback (F (2) 3.69, p = 0.034). Increased stride time variability was observed with the adaptive metronome in comparison to the traditional metronome. CONCLUSION Metronome cueing strategies may reduce double leg support variability in older adults with a history of falls but seem to increase stride time variability. Further studies are needed to investigate if metronome cueing is more beneficial for individuals with greater baseline gait variability than those included in the current study.
Collapse
|
38
|
Vega D, Huang HJ, Arellano CJ. Step-to-step variability indicates disruption to balance control when linking the arms and legs during treadmill walking. PLoS One 2022; 17:e0265750. [PMID: 35320305 PMCID: PMC8942237 DOI: 10.1371/journal.pone.0265750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
We recently discovered that a rope-pulley system that mechanically coupling the arms, legs and treadmill during walking can assist with forward propulsion in healthy subjects, leading to significant reductions in metabolic cost. However, walking balance may have been compromised, which could hinder the potential use of this device for gait rehabilitation. We performed a secondary analysis by quantifying average step width, step length, and step time, and used their variability to reflect simple metrics of walking balance (n = 8). We predicted an increased variability in at least one of these metrics when using the device, which would indicate disruptions to walking balance. When walking with the device, subjects increased their average step width (p < 0.05), but variability in step width and step length remained similar (p's > 0.05). However, the effect size for step length variability when compared to that of mechanical perturbation experiments suggest a minimal to moderate disruption in balance (Rosenthal ES = 0.385). The most notable decrement in walking balance was an increase in step time variability (p < 0.05; Cohen's d = 1.286). Its effect size reveals a moderate disruption when compared to the effect sizes observed in those with balance deficits (effect sizes ranged between 0.486 to 1.509). Overall, we conclude that healthy subjects experienced minimal to moderate disruptions in walking balance when using with this device. These data indicate that in future clinical experiments, it will be important to not only consider the mechanical and metabolic effects of using such a device but also its potential to disrupt walking balance, which may be exacerbated in patients with poor balance control.
Collapse
Affiliation(s)
- Daisey Vega
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research Laboratory, University of Houston, Houston, Texas, United States of America
| | - Helen J. Huang
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Florida, United States of America
- Disability, Aging, and Technology (DAT) Cluster, University of Central Florida, Orlando, Florida, United States of America
| | - Christopher J. Arellano
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research Laboratory, University of Houston, Houston, Texas, United States of America
| |
Collapse
|
39
|
Hupfeld KE, Geraghty JM, McGregor HR, Hass CJ, Pasternak O, Seidler RD. Differential Relationships Between Brain Structure and Dual Task Walking in Young and Older Adults. Front Aging Neurosci 2022; 14:809281. [PMID: 35360214 PMCID: PMC8963788 DOI: 10.3389/fnagi.2022.809281] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/31/2022] [Indexed: 12/13/2022] Open
Abstract
Almost 25% of all older adults experience difficulty walking. Mobility difficulties for older adults are more pronounced when they perform a simultaneous cognitive task while walking (i.e., dual task walking). Although it is known that aging results in widespread brain atrophy, few studies have integrated across more than one neuroimaging modality to comprehensively examine the structural neural correlates that may underlie dual task walking in older age. We collected spatiotemporal gait data during single and dual task walking for 37 young (18-34 years) and 23 older adults (66-86 years). We also collected T 1-weighted and diffusion-weighted MRI scans to determine how brain structure differs in older age and relates to dual task walking. We addressed two aims: (1) to characterize age differences in brain structure across a range of metrics including volumetric, surface, and white matter microstructure; and (2) to test for age group differences in the relationship between brain structure and the dual task cost (DTcost) of gait speed and variability. Key findings included widespread brain atrophy for the older adults, with the most pronounced age differences in brain regions related to sensorimotor processing. We also found multiple associations between regional brain atrophy and greater DTcost of gait speed and variability for the older adults. The older adults showed a relationship of both thinner temporal cortex and shallower sulcal depth in the frontal, sensorimotor, and parietal cortices with greater DTcost of gait. Additionally, the older adults showed a relationship of ventricular volume and superior longitudinal fasciculus free-water corrected axial and radial diffusivity with greater DTcost of gait. These relationships were not present for the young adults. Stepwise multiple regression found sulcal depth in the left precentral gyrus, axial diffusivity in the superior longitudinal fasciculus, and sex to best predict DTcost of gait speed, and cortical thickness in the superior temporal gyrus to best predict DTcost of gait variability for older adults. These results contribute to scientific understanding of how individual variations in brain structure are associated with mobility function in aging. This has implications for uncovering mechanisms of brain aging and for identifying target regions for mobility interventions for aging populations.
Collapse
Affiliation(s)
- Kathleen E. Hupfeld
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Justin M. Geraghty
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Heather R. McGregor
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - C. J. Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Ofer Pasternak
- Departments of Psychiatry and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachael D. Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
- University of Florida Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States
| |
Collapse
|
40
|
Jayakody O, Blumen HM, Breslin M, Ayers E, Lipton RB, Verghese J, Callisaya ML. Longitudinal associations between falls and future risk of cognitive decline, the Motoric Cognitive Risk syndrome and dementia: the Einstein Ageing Study. Age Ageing 2022; 51:afac058. [PMID: 35290430 PMCID: PMC8923158 DOI: 10.1093/ageing/afac058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND falls share risk factors with cognitive decline but whether falls predict cognitive decline, pre-dementia syndromes and dementia is poorly understood. OBJECTIVES this study aimed to examine if falls are associated with cognitive decline in specific domains and the risk of Motoric Cognitive Risk (MCR) syndrome and dementia. DESIGN cross-sectional study. METHODS in older people (age 80.6 ± 5.3 years) free of dementia at baseline, the number of falls (none, one or multiple) during the year before enrolment and the first year of follow-up (exposure) were recorded. Decline in specific cognitive functions (global cognition, episodic verbal memory, verbal fluency, working memory, response inhibition and processing speed-attention), incident MCR and incident dementia were outcome measures. Linear mixed effects models were used to examine the associations between falls and cognitive decline, adjusting for confounders. Cox proportional hazards models were used to determine if falls predicted risk of incident MCR or dementia. RESULTS of 522 eligible participants, 140 had a single fall and 70 had multiple falls. Multiple falls were associated with a greater decline in global cognition, episodic memory, verbal fluency and processing speed-attention compared to those with no falls (P < 0.05). Over a median follow-up of 1.0 years 36 participants developed MCR and 43 participants developed dementia. Those with multiple falls had a two-fold increased risk of MCR compared to those with no falls, but no increased risk of developing dementia. CONCLUSIONS multiple falls may be an important marker to identify older people at greater risk of future cognitive decline and incident MCR.
Collapse
Affiliation(s)
- Oshadi Jayakody
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Helena M Blumen
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
41
|
Association between fear of falling and spatial and temporal parameters of gait in older adults: the FIBRA-RJ study. Eur Geriatr Med 2022; 13:407-413. [DOI: 10.1007/s41999-021-00601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
|
42
|
Zhu S, Wang Y, Jiang Y, Gu R, Zhong M, Jiang X, Shen B, Zhu J, Yan J, Pan Y, Zhang L. Clinical Features in Parkinson's Disease Patients with Hyperechogenicity in Substantia Nigra: A Cross-Sectional Study. Neuropsychiatr Dis Treat 2022; 18:1593-1601. [PMID: 35942277 PMCID: PMC9356622 DOI: 10.2147/ndt.s374370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transcranial ultrasound (TCS) can be used to reveal structural changes in the substantia nigra (SN) and is a potential tool for the early diagnosis of Parkinson's disease (PD). This study aimed to explore the relationship between substantia nigra hyperechogenicity (SNH) and the clinical features of PD patients. METHODS A total of 96 PD patients were included in our study. All patients were detected by TCS and divided into two groups: PD patients with SNH (PDSN+) and those with normal SN echogenicity (PDSN-). The Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn & Yahr stage were used to assess the extent of disease-related disability of the PD patients. Non-motor symptoms were evaluated by using several scales. The instrumented stand and walk test was performed on all subjects, and gait data were gathered using a JiBuEn gait analysis system. RESULTS Seventy-five PD patients were successfully assessed by TCS. We found that SNH was associated with a higher UPDRS II scores (p = 0.028). In addition, compared with PDSN- group, the PDSN+ group exhibited more severe gait impairment, including increased variability in stride length (p = 0.042), decreased heel strike angle (p = 0.017), decreased range of motion of hip joints (p = 0.031), and a more asymmetrical walking pattern (p = 0.028). CONCLUSION Our study demonstrated that SNH significantly correlated with activities of daily living and gait impairment in Chinese patients with PD, suggesting the formation of SNH might be a dynamic biomarker reflecting disease severity.
Collapse
Affiliation(s)
- Sha Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yaxi Wang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yinyin Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Ruxin Gu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Min Zhong
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xu Jiang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Bo Shen
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun Zhu
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jun Yan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Yang Pan
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Li Zhang
- Department of Geriatric Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| |
Collapse
|
43
|
The Role of Daily Step Count in Determining Risk Factors for Falls. J Aging Phys Act 2022; 31:400-407. [DOI: 10.1123/japa.2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
Falls risk is often assessed without considering exposure to risk. We examined the risk factors associated with falls in those with greater and lower levels of daily step count. Falls were recorded over 12 months using bimonthly calendars in community-dwelling older people (mean age 72.0, SD 6.9). Daily step count was measured using a pedometer worn consecutively for 7 days. A cut score of <5,575.5 steps/day was used to identify people with lower step count. Negative binominal models were used to identify cognitive, medical, and sensorimotor factors associated with falls in those with higher versus lower levels of daily step count. In those with lower daily step count, poorer executive function, slower gait speed, and lower steps per day were associated with increased falls risk. In those with higher step count, only mood was associated with increased falls risk. Considering daily step count is important when assessing falls risk in older people.
Collapse
|
44
|
Jin H, Kang I, Choi G, Molinaro DD, Young AJ. Wearable Sensor-Based Step Length Estimation During Overground Locomotion Using a Deep Convolutional Neural Network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4897-4900. [PMID: 34892306 DOI: 10.1109/embc46164.2021.9630060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Step length is a critical gait parameter that allows a quantitative assessment of gait asymmetry. Gait asymmetry can lead to many potential health threats such as joint degeneration, difficult balance control, and gait inefficiency. Therefore, accurate step length estimation is essential to understand gait asymmetry and provide appropriate clinical interventions or gait training programs. The conventional method for step length measurement relies on using foot-mounted inertial measurement units (IMUs). However, this may not be suitable for real-world applications due to sensor signal drift and the potential obtrusiveness of using distal sensors. To overcome this challenge, we propose a deep convolutional neural network-based step length estimation using only proximal wearable sensors (hip goniometer, trunk IMU, and thigh IMU) capable of generalizing to various walking speeds. To evaluate this approach, we utilized treadmill data collected from sixteen able-bodied subjects at different walking speeds. We tested our optimized model on the overground walking data. Our CNN model estimated the step length with an average mean absolute error of 2.89 ± 0.89 cm across all subjects and walking speeds. Since wearable sensors and CNN models are easily deployable in real-time, our study findings can provide personalized real-time step length monitoring in wearable assistive devices and gait training programs.
Collapse
|
45
|
Bailey CA, Hill A, Graham RB, Nantel J. Effects of arm swing amplitude and lower limb asymmetry on motor variability patterns during treadmill gait. J Biomech 2021; 130:110855. [PMID: 34749161 DOI: 10.1016/j.jbiomech.2021.110855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
Motor variability is a fundamental feature of gait. Altered arm swing and lower limb asymmetry (LLA) may be contributing factors having been shown to affect the magnitude and dynamics of variability in spatiotemporal and trunk motion. However, the effects on lower limb joints remain unclear. Full-body kinematics of 15 healthy young adults were recorded during treadmill walking using the Computer-Assisted Rehabilitation Environment system. Participants completed six trials, combining three arm swing (AS) amplitude (normal, active, held) and two LLA (symmetrical, asymmetrical) conditions. The mean standard deviation (meanSD), maximum Lyapunov exponent (λmax), detrended fluctuation analysis scaling exponent of range of motion (DFAα), and sample entropy (SaEn) were computed for tridimensional trunk, pelvis, and lower limb joint angles, and compared using repeated-measures ANOVAs. Relative to normal AS, active AS increased meanSD of all joint angles, λmax of frontal plane hip and ankle angles, and SaEn of sagittal plane ankle angles. Active AS, however, did not affect λmax or SaEn of trunk or pelvis angles. LLA increased meanSD of sagittal plane joint angles, λmax of Euclidean norm trunk angle and of lower limb joint angles, and SaEn of ankle dorsiflexion/ plantarflexion, but decreased SaEn of tridimensional trunk angles and hip rotation in the slower moving leg. Alterations in lower limb variability with active AS and LLA suggest that young adults actively exploit their lower limb redundancies to maintain gait. This appears to preserve trunk stability and regularity during active AS but not during LLA.
Collapse
Affiliation(s)
| | - Allen Hill
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Ryan B Graham
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
46
|
Influence of Different Dual-Task Conditions During Straight or Curved Walking on Gait Performance of Physically Active Older Women With Cognitive Decline. J Aging Phys Act 2021; 30:411-420. [PMID: 34510022 DOI: 10.1123/japa.2021-0099] [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: 03/11/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
Real-world walking requires shifting attention from different cognitive demands to adapt gait. This study aims to evaluate the effect of dual tasking on spatiotemporal gait parameters of older adults. Participants were asked to perform a primary complex single-walking task, consisting of a fast-paced linear and a curved gait. Primary task was performed separately and simultaneously with different motor and cognitive secondary tasks. Spatiotemporal gait parameters, walk ratio, and walk stability ratio were measured. Apart from stride length, which stood relatively unchanged, gait speed and cadence were strongly affected by cognitive dual tasking. Cadence seems to be the most impacted by dual tasking during curved gait as it combines challenges of both primary and secondary tasks. Also, during curved phase, walking ratio was significantly lower and stability ratio was greater demonstrating that participants adopted a cautious gait where maintenance of stability took preference over efficiency.
Collapse
|
47
|
Jayakody O, Breslin M, Beare R, Siejka TP, Gujjari S, Srikanth VK, Blumen HM, Callisaya ML. The association between simple reaction time variability and gait variability: The Tasmanian Study of Cognition and Gait. Gait Posture 2021; 89:206-210. [PMID: 34340157 DOI: 10.1016/j.gaitpost.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/22/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Greater double support time (DST) variability is associated with falls and memory decline. The underlying neurophysiological mechanisms of DST variability are poorly understood. Simple reaction time (SRT) variability, a measure of attention-processing speed is associated with falls and dementia and, may underlie greater DST variability. The aims of this study were to examine the association between SRT and DST variability and if SRT variability mediates the associations between poorer cognition/brain structure and DST variability. METHODS Participants (n = 408) were community-dwelling older people without dementia (mean age 72.0 ± 7.0). DST variability was the standard deviation (SD) of DST, assessed with a walkway and averaged across steps of 6 walks. SRT variability was the SD of a button pressing task in response to a visual stimulus. Executive function and processing speed were assessed with neuropsychological tests. Magnetic Resonance Imaging was used to obtain cortical thickness (total and in frontal regions) and cerebral small vessel disease (cSVD). Multivariable linear regression models were used to examine the association between SRT and DST variability and if SRT variability mediated any associations of cognition/brain structure with DST variability. RESULTS Greater SRT variability was associated with greater DST variability (p = 0.002). SRT variability partially mediated the association between poorer executive function and greater DST variability. Smaller mean thickness in orbitofrontal regions and greater cSVD burden were only associated with DST variability (p < 0.05), not with SRT variability (p > 0.05). CONCLUSIONS Greater SRT variability, which may occur due to inefficient executive functioning, could be an underlying neurophysiological mechanism of greater DST variability.
Collapse
Affiliation(s)
- Oshadi Jayakody
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Richard Beare
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia; Developmental Imaging, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | | | - Velandai K Srikanth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
48
|
Lin YC, Tseng IJ, Lu YC, Yang SW, Wu CC, Lin YN, Chan WP. Muscle Mass and Gait Characteristics in Older Women Fallers vs. Non-Fallers. J Clin Med 2021; 10:jcm10173924. [PMID: 34501372 PMCID: PMC8432046 DOI: 10.3390/jcm10173924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Falling is a major public health concern of elderly people. We aimed to determine if lean mass and spatiotemporal gait parameters could predict the risk of falling in elderly women and also study the relationships between lean mass and gait characteristics. Methods: Twenty-four community women were prospectively recruited (mean age, 72.30 ± 5.31 years). Lean mass was measured using dual-energy fan-beam X-ray absorptiometry. Gait characteristics were assessed using spatiotemporal analysis. Fall risks were assessed using the Berg Balance Scale (BBS) and the Falls Efficacy Scale-International. Fall histories were recorded. Appropriate statistical analyses were applied to determine lean mass and gait characteristics in predicting the risk of fall and the associations between lean mass and gait characteristics. Results: There were 14 participants (58.33%) with fall histories. Patients with fall histories had a significantly narrower base of support and lower BBS score. However, only the base of support was significantly associated with fall risk (odds ratio, 0.415; p = 0.022). Lean mass was significantly negatively associated with proportion of swing phase and positively associated with proportions of stance and double-support phases. Conclusion: Fall risk among elderly women can be predicted using base of support, where a narrower base predicts a greater fall risk. Although the lean mass was not related to risk of fall, lean mass is still related to some gait characteristics.
Collapse
Affiliation(s)
- Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Tayoun 33001, Taiwan;
| | - Ing-Jy Tseng
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan;
| | - Yi-Chien Lu
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-C.L.); (S.-W.Y.)
| | - Shao-Wei Yang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-C.L.); (S.-W.Y.)
| | - Chia-Chi Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan;
- Institute of Injury Prevention and Control, Taipei Medical University, Taipei 11031, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; (Y.-C.L.); (S.-W.Y.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11696, Taiwan
- Correspondence: ; Tel.: +886-6(2)29307930 (ext. 1300); Fax: +886-6(2)29316809
| |
Collapse
|
49
|
Three-Day Remote Monitoring of Gait Among Young and Older Adults Using Participants' Personal Smartphones. J Aging Phys Act 2021; 29:1026-1033. [PMID: 34348231 DOI: 10.1123/japa.2020-0353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/18/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
Conventional one-time gait analyses do not evaluate walking across more than a few steps, cannot monitor changes longitudinally, and do not reflect performance in real-life environments. To successfully quantify age-related gait decrement, technology that can continuously monitor gait is vital. This study examined the feasibility and validity for participant smartphones to remotely assess gait. In addition, the authors investigated whether smartphone-derived measures could differentiate between young and older adults (fallers and nonfallers). A total of 63 adults completed clinical and gait assessment in the laboratory and donned their smartphones for 3 days in the real-life environment. A custom-built Android application collected triaxial accelerations with spatiotemporal gait measures computed and compared between groups. Across 11 brands and 10 Android versions, smartphone-derived gait parameters were valid. Furthermore, results indicated age-related differences in walking during the 3-day assessment. However, no disparities were found between older adult groups. Smartphone-based evaluations may improve real-life screening of adults with gait deficits.
Collapse
|
50
|
Ravi DK, Heimhofer CC, Taylor WR, Singh NB. Adapting Footfall Rhythmicity to Auditory Perturbations Affects Resilience of Locomotor Behavior: A Proof-of-Concept Study. Front Neurosci 2021; 15:678965. [PMID: 34393705 PMCID: PMC8358836 DOI: 10.3389/fnins.2021.678965] [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: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
For humans, the ability to effectively adapt footfall rhythm to perturbations is critical for stable locomotion. However, only limited information exists regarding how dynamic stability changes when individuals modify their footfall rhythm. In this study, we recorded 3D kinematic activity from 20 participants (13 males, 18–30 years old) during walking on a treadmill while synchronizing with an auditory metronome sequence individualized to their baseline walking characteristics. The sequence then included unexpected temporal perturbations in the beat intervals with the subjects required to adapt their footfall rhythm accordingly. Building on a novel approach to quantify resilience of locomotor behavior, this study found that, in response to auditory perturbation, the mean center of mass (COM) recovery time across all participants who showed deviation from steady state (N = 15) was 7.4 (8.9) s. Importantly, recovery of footfall synchronization with the metronome beats after perturbation was achieved prior (+3.4 [95.0% CI +0.1, +9.5] s) to the recovery of COM kinematics. These results highlight the scale of temporal adaptation to perturbations and provide implications for understanding regulation of rhythm and balance. Thus, our study extends the sensorimotor synchronization paradigm to include analysis of COM recovery time toward improving our understanding of an individual’s resilience to perturbations and potentially also their fall risk.
Collapse
Affiliation(s)
- Deepak K Ravi
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - Caroline C Heimhofer
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - William R Taylor
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - Navrag B Singh
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| |
Collapse
|