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Kim K, Deller L, Vinent M, Zijlstra W. Age-related effects of repeated task switching in a novel voluntary gait adaptability task. Exp Brain Res 2023; 241:1533-1542. [PMID: 37099143 DOI: 10.1007/s00221-023-06623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 04/27/2023]
Abstract
Age-related effects of task switching have been extensively studied based on cognitive tasks and simple motor tasks, but less on complex cognitive-motor tasks involving dynamic balance control while walking. The latter tasks may especially be difficult and relevant for older adults in terms of safe mobility in daily life. The aim of the present study was, therefore, to examine age-related changes in task-switching adaptability using a novel voluntary gait adaptability test protocol. Fifteen healthy young (27.5 ± 2.9 years) and 16 healthy old (70.9 ± 7.6 years) adults carried out 2 different visual target stepping tasks (either target avoidance or stepping) twice in a block (A-B-A-B, 2 min per task; three blocks in total) without any intrablock breaks. Our results showed that old adults showed significantly more step errors both in Tasks A and B as well as more interference effects than young adults. Age-related differences in step accuracy were significant in the anterior-posterior direction both in Task A and B but not in the mediolateral direction. Both in step errors and accuracy, no interaction effects of age and trial were shown. Our results suggest that old adults could not cope with rapid and direct task changes in our voluntary gait adaptability task as young adults. Since the significant main effect of trial for Task B, but not Task A appears to be due to different task complexity, further studies may determine the effect of task complexity or task switch timing.
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Affiliation(s)
- Kyungwan Kim
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, Germany.
| | - Lena Deller
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, Germany
| | - Marie Vinent
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, Germany
| | - Wiebren Zijlstra
- Institute of Movement and Sport Gerontology, German Sport University, Cologne, Germany
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Kondo R, Okada K, Wakasa M, Saito A, Kimoto M, Terui Y. Foot pressure-based analysis of gait while using a smartphone. Gait Posture 2023; 100:196-200. [PMID: 36603325 DOI: 10.1016/j.gaitpost.2022.12.020] [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: 06/28/2022] [Revised: 12/06/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The number of incidents related to walking while using smartphones is rising. However, it is not clear how smartphone usage might affect a gait pattern in terms of the foot pressure, and this may address the mechanism leading to incidents while using smartphones. RESEARCH QUESTION How do the characteristics of walking while using a smartphone affect foot pressure patterns? METHODS In this cross-sectional study, we recruited 40 healthy young participants and investigated the walking speed, step length, coefficient of variance of the walking cycle (CV), anteroposterior length of the center of pressure (COP) trajectory (%Long), partial foot pressure ratios (% partial foot pressure [%PFP]), and COP existence time (COPexT) under the following four conditions: normal walking, screen gazing, while using social networking services (SNS), and while using a cognitive application. Parameters were compared among the four conditions using a repeated-measures ANOVA. Further, according to the presence or absence of an incident history (e.g. stumbles, collisions), participants were divided into either the incident or non-incident group. Parameters were compared between the two groups using a two-way repeated-measures ANOVA. RESULTS Under the SNS and cognitive application conditions, the walking speed, step length, %Long, %PFP, and COPexT in the heel were significantly lower, and the CV and %PFP in the metatarsal region were higher than those under normal walking or screen gazing. %PFP in the heel and metatarsal regions showed a significant group-by-condition interaction; the incident group had lower %PFP in the heel region and higher %PFP in the metatarsal region than the non-incident group. SIGNIFICANCE These findings indicate a trend of loading more pressure on the forefoot than on the heel. This pattern was markedly evident in individuals with a history of incidents related to the smartphone usage and may be one of the factors causing stumbles and collisions.
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Affiliation(s)
- Ryohei Kondo
- Nakadori Rehabilitation Hospital, 6-1-58 Nakadori, Akita city, Akita 010-0001, Japan.
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 44-2 Hasunuma, Hiroomote, Akita city, Akita 010-0825, Japan
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 44-2 Hasunuma, Hiroomote, Akita city, Akita 010-0825, Japan
| | - Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 44-2 Hasunuma, Hiroomote, Akita city, Akita 010-0825, Japan
| | - Minoru Kimoto
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 44-2 Hasunuma, Hiroomote, Akita city, Akita 010-0825, Japan
| | - Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 44-2 Hasunuma, Hiroomote, Akita city, Akita 010-0825, Japan
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Booij M, van Royen B, Nolte P, Twisk J, Harlaar J, van den Noort J. Total knee arthroplasty improves gait adaptability in osteoarthritis patients; a pilot study. J Orthop 2022; 34:304-309. [PMID: 36176586 PMCID: PMC9513089 DOI: 10.1016/j.jor.2022.08.003] [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: 02/02/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Gait adaptability is of utmost importance for keeping balance during gait in patients with knee osteoarthritis, also after total knee arthroplasty (TKA). The aims of this explorative study are: (1) assess the effect of age, knee osteoarthritis and TKA on gait adaptability; (2) assess changes in gait adaptability pre-to post-TKA and (3) their relation to functional outcomes. Methods Gait adaptability was measured using a Target Stepping Test (TST) in knee osteoarthritis patients before (preTKA) and 12 months after TKA (postTKA) and compared to asymptomatic old (AsOld) and young adults (AsYng). TST imposed an asymmetrical gait pattern with projected stepping targets at high walking speed. Gait adaptability was determined through stepping accuracy on the targets. The Oxford Knee Score (OKS) and Timed-Up-and-Go test (TUG) measured patients' physical function. Results 12 preTKA, 8 postTKA, 18 AsYng, 21 AsOld were tested. Age showed no effect on TST-stepping accuracy. PreTKA showed worse TST-stepping accuracy compared to AsYng and AsOld (7.7; 6.2 cm difference). PostTKA showed an improvement of 52% in TST-stepping accuracy compared to preTKA (3.2 cm).Higher stepping accuracy preTKA predicted higher stepping accuracy post-TKA. In addition, low preTKA stepping accuracy predicted more improvement postTKA. Pre-to post-TKA improvement of stepping accuracy was related to improvement on the TUG (Beta = 0.17, p = 0.024), but not to OKS. Conclusions Gait adaptability is improved following TKA in knee osteoarthritis patients and no longer significantly worse than asymptomatic adults. The relation of gait adaptability to function is shown by its relation to the TUG and shows to have predictive value pre-to post-TKA.
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Affiliation(s)
- M.J. Booij
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan, 1117, Amsterdam, the Netherlands
| | - B.J. van Royen
- Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P.A. Nolte
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, Hoofddorp, the Netherlands
| | - J.W.R. Twisk
- VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - J. Harlaar
- Delft University of Technology, Department of Biomechanical Engineering, Mekelweg 2, Delft, the Netherlands
- Erasmus Medical Center, Department of Orthopedics and Sports Medicine, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - J.C. van den Noort
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Medical Imaging Quantification Center, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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Delbes L, Mascret N, Goulon C, Montagne G. Validation of an immersive virtual reality device accepted by seniors that preserves the adaptive behavior produced in the real world. Front Bioeng Biotechnol 2022; 10:917486. [PMID: 36118569 PMCID: PMC9479106 DOI: 10.3389/fbioe.2022.917486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Falls in the elderly are a major societal issue. Virtual reality appears as a relevant tool to propose gait training programs to prevent the occurrence of falls. The use of a head-mounted display allows overground walking during fully immersive virtual training sessions. Our long-term ambition is to develop gait training programs with a head-mounted display to propose enjoyable and personalized training content for the elderly. Before proposing these programs, several methodological precautions must be taken. The first concerns the supposed similarity of the adaptive behavior produced in the real world and in virtual reality. The second concerns the acceptance of the virtual reality device before and after use. Twenty older adults performed a locomotor pointing task in three conditions including a real-world condition, a virtual-world condition consisting in a replica of the real-world condition, and a virtual condition in which the locomotor pointing task was performed in a different context. From feet positions in relation to the position of a target, gait adaptability behavior was investigated. In line with previous studies, step adjustments (needed and produced) were investigated through a combination of inter-trial and trial-by-trial analyses. The results highlighted that participants adopted the same gait adaptability behavior whatever the type of environment (real vs. virtual). Gait analyses suggested the use of a generic control mechanism based on information-movement coupling. We also demonstrated that older adults accepted the virtual reality device before and after use. With these methodological locks removed, it is now possible to design training programs in virtual reality to prevent falls in the elderly.
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Maeda Y, Sudo D, Shimotori D. Age-Related Changes in Accuracy and Speed of Lateral Crossing Motion: Focus on Stepping from Leaning Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159056. [PMID: 35897437 PMCID: PMC9331433 DOI: 10.3390/ijerph19159056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022]
Abstract
Fall incidents are increasing every year and prevention is necessary. Preventing falls can increase the quality of life of the elderly and decrease medical costs. Stumbling and tripping are the main causes of falls and falls in the lateral direction, causing the hip fracture. This study aimed to analyze the accuracy and speed of lateral obstacle crossing in the elderly, especially from leaning posture. Twenty healthy older adults (6 men and 14 women, aged 71.7 ± 1.5 years) and 20 healthy young adults (5 men and 15 women, aged 21.4 ± 1.2 years) participated in this study. We set four conditions (normal, fast, leaning, and leaning fast), and participants crossed the obstacle laterally ten times under each condition. The crossing motion was captured using a three-dimensional analysis system. The trajectory of the foot, landed position, step time, center of gravity of the body, and moment of the lower extremity during the swing phase were calculated and compared between older and younger adults. In the leaning condition, the step time and knee moment of the elderly were significantly longer and larger than those of young adults. From the results of the trajectory of the foot and landed position in the leaning condition, motion inconsistency of the foot was found in the elderly. We believe that it is difficult for the elderly to perform the intended crossing motion and swing quickly because of aging. This inconsistency in motion is a serious cause of falls in the elderly.
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Affiliation(s)
- Yusuke Maeda
- Department of Physical Therapy, School of Health Sciences at Odawara, International University of Health and Welfare, Yokosuka 250-8588, Japan;
- Correspondence: ; Tel.: +81-465-21-6671
| | - Daisuke Sudo
- Department of Physical Therapy, School of Health Sciences at Odawara, International University of Health and Welfare, Yokosuka 250-8588, Japan;
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Palmisano C, Kullmann P, Hanafi I, Verrecchia M, Latoschik ME, Canessa A, Fischbach M, Isaias IU. A Fully-Immersive Virtual Reality Setup to Study Gait Modulation. Front Hum Neurosci 2022; 16:783452. [PMID: 35399359 PMCID: PMC8983870 DOI: 10.3389/fnhum.2022.783452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/03/2022] [Indexed: 01/10/2023] Open
Abstract
Objective: Gait adaptation to environmental challenges is fundamental for independent and safe community ambulation. The possibility of precisely studying gait modulation using standardized protocols of gait analysis closely resembling everyday life scenarios is still an unmet need. Methods: We have developed a fully-immersive virtual reality (VR) environment where subjects have to adjust their walking pattern to avoid collision with a virtual agent (VA) crossing their gait trajectory. We collected kinematic data of 12 healthy young subjects walking in real world (RW) and in the VR environment, both with (VR/A+) and without (VR/A-) the VA perturbation. The VR environment closely resembled the RW scenario of the gait laboratory. To ensure standardization of the obstacle presentation the starting time speed and trajectory of the VA were defined using the kinematics of the participant as detected online during each walking trial. Results: We did not observe kinematic differences between walking in RW and VR/A-, suggesting that our VR environment per se might not induce significant changes in the locomotor pattern. When facing the VA all subjects consistently reduced stride length and velocity while increasing stride duration. Trunk inclination and mediolateral trajectory deviation also facilitated avoidance of the obstacle. Conclusions: This proof-of-concept study shows that our VR/A+ paradigm effectively induced a timely gait modulation in a standardized immersive and realistic scenario. This protocol could be a powerful research tool to study gait modulation and its derangements in relation to aging and clinical conditions.
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Affiliation(s)
- Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- *Correspondence: Chiara Palmisano
| | - Peter Kullmann
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marta Verrecchia
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Marc Erich Latoschik
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Andrea Canessa
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genova, Italy
| | - Martin Fischbach
- Human-Computer Interaction, Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis Ugo Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Pini-CTO, Milano, Italy
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Okubo Y, Schoene D, Caetano MJD, Pliner EM, Osuka Y, Toson B, Lord SR. Stepping impairment and falls in older adults: A systematic review and meta-analysis of volitional and reactive step tests. Ageing Res Rev 2021; 66:101238. [PMID: 33352293 DOI: 10.1016/j.arr.2020.101238] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/31/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To systematically examine stepping performance as a risk factor for falls. More specifically, we examined (i) if step tests can distinguish fallers from non-fallers and (ii) the type of step test (e.g. volitional vs reactive stepping) that is required to distinguish fallers from non-fallers. DATA SOURCE PubMed, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and reference lists of included articles. STUDY SELECTION Cross-sectional and cohort studies that assessed the association between at least one step test and falls in older people (age ≥ 60 and/or mean age of 65). RESULTS A meta-analysis of 61 studies (n = 9536) showed stepping performance was significantly worse in fallers compared to non-fallers (Cohen'sd 0.56, 95 % CI 0.48 to 0.64, p < 0.001, I2 66 %). This was the case for both volitional and reactive step tests. Twenty-three studies (n = 3615) were included in a diagnostic meta-analysis that showed that step tests have moderate sensitivity (0.70, 95 % CI 0.62 to 0.77), specificity (0.68, 95 % CI 0.58 to 0.77) and area under the receiver operating characteristics curve (AUC) (0.75, 95 % CI 0.59 to 0.86) in discriminating fallers from non-fallers. CONCLUSIONS This large systematic review demonstrated that both volitional and reactive stepping impairments are significant fall risk factors among older adults. Step tests can identify fallers from non-fallers with moderate accuracy.
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Hauer K, Litz E, Günther-Lange M, Ball C, de Bruin ED, Werner C. Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial. Eur Rev Aging Phys Act 2020; 17:17. [PMID: 33005256 PMCID: PMC7525984 DOI: 10.1186/s11556-020-00248-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Training effects reported for stepping exergames on stepping performances in older adults often based on not comprehensively validated outcomes measures, and follow-up data on their sustainability are lacking. The aim of this study is to evaluate the effectiveness and sustainability of a motor-cognitive stepping exergame training on the stepping performance in older adults. Methods Fifty-eight older adults (78.3 ± 6.5 years) participated in the randomized controlled trial with a 10-week intervention and 10-week follow-up period. The intervention group (IG: n = 29) took part in a once-weekly exercise program including strength and balance exercises supplemented with an additional stepping exergame training. The control group (CG: n = 29) only performed the strength and balance exercises. Outcome measures included stepping reaction times (SRTs) and games scores for individual stepping exergame levels and for the overall exergame performance, as measured by an assessment strategy previously validated in older adults. Results SRTs and/or games scores for 7 out of 10 levels and the overall exergame performance significantly improved in the IG compared to the CG during the intervention (p ≤ 0.001–0.039, ηp2 = 0.090–0.445). Training gains were sustained for 2 levels and for the overall exergame performance (p = 0.017–0.033, ηp2 = 0.127–0.193). Conclusion The study demonstrates that the additional stepping exergame training effectively and sustainably improves the performance in complex motor-cognitive stepping exergame tasks in older adults, which can be relevant for preventing falls. Future research is needed to evaluate the effectiveness of such training on reducing the number of falls. Trial registration ISRCTN registry, ISRCTN14855620, 06/06/2019 (retrospectively registered).
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Affiliation(s)
- Klaus Hauer
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Elena Litz
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Michaela Günther-Lange
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Caroline Ball
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, HCP H 25.1, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Christian Werner
- AGAPLESION Bethanien Hospital, Geriatric Center of Heidelberg University, Heidelberg, Germany.,Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
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Kondo Y, Fukuhara K, Suda Y, Higuchi T. Training older adults with virtual reality use to improve collision-avoidance behavior when walking through an aperture. Arch Gerontol Geriatr 2020; 92:104265. [PMID: 33011429 DOI: 10.1016/j.archger.2020.104265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 11/18/2022]
Abstract
Many older adults perform collision-avoidance behavior either insufficiently (i.e., frequent collision) or inefficiently (i.e., exaggerated behavior to ensure collision-avoidance). The present study examined whether a training system using virtual reality (VR) simulation enhanced older adults' collision-avoidance behavior in response to a VR image of an aperture during real walking. Twenty-five (n = 13 intervention group and n = 12 control group) older individuals participated. During training, a VR image of walking through an aperture was projected onto a large screen. Participants in the intervention group tried to avoid virtual collision with the minimum body rotation required to walk on the spot through a variety of narrow apertures. Participants in the control group remained without body rotation while walking on the spot through a wide aperture. A comparison between pre-test and post-test performances in the real environment indicated that after the training, significantly smaller body rotation angles were observed in the intervention group. This suggests that the training led participants to modify their behavior to try to move efficiently during real walking. However, although not significant, collision rates also tended to be greater, suggesting that, at least for some participants, the modification required to avoid collision was too difficult. Transfer of the learned behavior using the VR environment to real walking is discussed.
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Affiliation(s)
- Yuki Kondo
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan; Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazunobu Fukuhara
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuki Suda
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan.
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Older but not younger adults rely on multijoint coordination to stabilize the swinging limb when performing a novel cued walking task. Exp Brain Res 2020; 238:1441-1454. [PMID: 32385736 DOI: 10.1007/s00221-020-05822-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022]
Abstract
Motor flexibility, the ability to employ multiple motor strategies to meet task demands, may facilitate ambulation in complex environments that constrain movements; loss of motor flexibility may impair mobility. The purpose of this study was to determine the effects of obesity (a specific model of mobility impairment) and advanced age on motor flexibility during a task that constrained foot placement while walking. Twenty-one community-dwelling obese (OB) and 25 normal weight (NW) older adults (46 total older adults-OA) and 10 younger adults (YA) walked normally on a treadmill (baseline) then walked while stepping on lighted cues projected onto the treadmill at locations corresponding to average foot placement during normal walking (cued). The uncontrolled manifold (UCM) analysis was used to partition total variance in a set of seven lower-limb segment angles into components that did ("bad" variance) and did not ("good" variance) affect step-to-step variance in the trajectory of the swing foot. Motor flexibility was operationalized as an increase (baseline to cued) in total variance with an increase in good variance that exceeded the change in bad variance. There was no significant group × walking task interaction for total and good variance for OB vs NW, but there was a strong and significant interaction effect for OA vs YA (p < 0.01; Cohen's d > 1.0). Whereas YA reduced both good and bad variance, OA increased good variance beyond the change in bad variance. In OA, these changes were associated with several functional measures of mobility. Cued walking may place greater demands on OA requiring greater reliance on motor flexibility, although otherwise healthy older obese adults may be able to compensate for functional and cognitive declines associated with obesity by increasing motor flexibility under such tasks. The extent to which motor flexibility is employed during novel or constrained tasks may be a biomarker of healthy aging and a target for (re)habilitation.
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Osuka Y, Kojima N, Sakurai R, Watanabe Y, Kim H. Reliability and construct validity of a novel motor-cognitive dual-task test: A Stepping Trail Making Test. Geriatr Gerontol Int 2020; 20:291-296. [PMID: 32064719 DOI: 10.1111/ggi.13878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/15/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
Abstract
AIM This study aimed to examine the reliability and construct validity of the Stepping Trail Making Test (S-TMT) in community-dwelling older adults. METHODS This study comprised a cross-sectional study based on a population sample. Participants comprised 1224 community-dwelling older Japanese women aged 65-81 years without functional disability, dementia, depression, Parkinson's disease, or cognitive and visual impairments. The S-TMT measured the time taken to step on a sequence of numbers (1-16) positioned on a mat (1 m2 ). Participants were instructed to step as quickly and accurately as possible. Motor functions were assessed by walking speed and knee extensor strength tests, while cognitive functions were assessed by the Symbol Digit Substitution Task (SDST) test, verbal and logical memory test, and TMT-A and -B. RESULTS As a result of test-retest reliability over 6 months, the intraclass correlation coefficients of the S-TMT was 0.82 (95% confidence interval, 0.68-0.90). An adjusted multiple regression model indicated that the S-TMT was significantly associated with walking speed for motor function, and associated with the SDST, TMT-A and TMT-B for cognitive functions (P < 0.001). CONCLUSIONS These results suggest that the S-TMT is a reliable dual-task test comprising mobility for motor function and a visual-dependent execution function for cognitive function in older women. Geriatr Gerontol Int 2020; 20: 291-296.
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Affiliation(s)
- Yosuke Osuka
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Narumi Kojima
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ryota Sakurai
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yutaka Watanabe
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Hunkyung Kim
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Gunn SM, Lajoie K, Zebehazy KT, Strath RA, Neima DR, Marigold DS. Mobility-Related Gaze Training in Individuals With Glaucoma: A Proof-of-Concept Study. Transl Vis Sci Technol 2019; 8:23. [PMID: 31612095 PMCID: PMC6785840 DOI: 10.1167/tvst.8.5.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Older adults with glaucoma show inappropriate gaze strategies during routine mobility tasks. Furthermore, glaucoma is a risk factor for falling and colliding with objects when walking. However, effective interventions to rectify these strategies and prevent these adverse events are scarce. We designed a gaze training program with the goal of providing proof-of-concept that we could modify mobility-related gaze behavior in this population. Methods A total of 13 individuals with moderate glaucoma participated in this study. We taught participants general and task-specific gaze strategies over two 1-hour sessions. To determine the efficacy of this gaze training program, participants performed walking tasks that required accurate foot placement onto targets and circumventing obstacles before and after training. We used a mobile eye tracker to quantify gaze and a motion-capture system to quantify body movement. Results After training, we found changes in the timing between gaze shifts away from targets relative to stepping on them (P < 0.05). In the obstacle negotiation task, we found a greater range of gaze shifts early in walking trials and changes in the timing between gaze shifts away from obstacles after training (P < 0.05), each suggesting better route planning. A posttraining reduction in foot-placement error and obstacle collisions accompanied these changes (P < 0.05). Conclusions Our results demonstrated that it is possible to modify mobility-related gaze behavior and mobility performance in older adults with glaucoma. Translational Relevance This study provides proof-of-concept for a gaze training program for glaucoma. A larger, randomized controlled trial is warranted.
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Affiliation(s)
- Shaila M. Gunn
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kim Lajoie
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kim T. Zebehazy
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert A. Strath
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - David R. Neima
- Ophthalmology Private Practice, New Westminster, British Columbia, Canada
| | - Daniel S. Marigold
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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13
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McCarthy I, Suzuki T, Holloway C, Poole T, Frost C, Carton A, Tyler N, Crutch S, Yong K. Detection and localisation of hesitant steps in people with Alzheimer's disease navigating routes of varying complexity. Healthc Technol Lett 2019; 6:42-47. [PMID: 31119037 PMCID: PMC6498402 DOI: 10.1049/htl.2018.5034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022] Open
Abstract
People with Alzheimer's disease (AD) have characteristic problems navigating everyday environments. While patients may exhibit abnormal gait parameters, adaptive gait irregularities when navigating environments are little explored or understood. The aim of this study was to assess adaptive locomotor responses of AD subjects in a complex environment requiring spatial navigation. A controlled environment of three corridors was set up: straight (I), U-shaped (U) and dog-leg (S). Participants were asked to walk along corridors as part of a counterbalanced repeated-measures design. Three groups were studied: 11 people with posterior cortical atrophy (PCA), 10 with typical Alzheimer's disease (tAD) and 13 controls. Spatio-temporal gait parameters and position within the corridors were monitored with shoe-mounted inertial measurement units (IMUs). Hesitant steps were identified from statistical analysis of the distribution of step time data. Walking paths were generated from position data calculated by double integration of IMU acceleration. People with PCA and tAD had similar gait characteristics, having shorter steps and longer step times than controls. Hesitant steps tended to be clustered within certain regions of the walking paths. IMUs enabled identification of key gait characteristics in this clinical population (step time, length and step hesitancy) and environmental conditions (route complexity) modifying their expression.
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Affiliation(s)
- Ian McCarthy
- Pedestrian Accessibility and Movement Environment Laboratory, Department of Civil Environmental and Geomatic Engineering, University College London, London N19 5UN, UK
| | - Tatsuto Suzuki
- Pedestrian Accessibility and Movement Environment Laboratory, Department of Civil Environmental and Geomatic Engineering, University College London, London N19 5UN, UK
| | - Catherine Holloway
- UCL Interaction Centre, Department of Computer Science, University College London, London, UK
| | - Teresa Poole
- Department of Medical Statistics, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.,Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Chris Frost
- Department of Medical Statistics, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.,Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Amelia Carton
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Nick Tyler
- Pedestrian Accessibility and Movement Environment Laboratory, Department of Civil Environmental and Geomatic Engineering, University College London, London N19 5UN, UK
| | - Sebastian Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Keir Yong
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
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14
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Lord SR, Close JCT. New horizons in falls prevention. Age Ageing 2018; 47:492-498. [PMID: 29697780 DOI: 10.1093/ageing/afy059] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/19/2018] [Indexed: 12/13/2022] Open
Abstract
Falls pose a major threat to the well-being and quality of life of older people. Falls can result in fractures and other injuries, disability and fear and can trigger a decline in physical function and loss of autonomy. This article synthesises recent published findings on fall risk and mobility assessments and fall prevention interventions and considers how this field of research may evolve in the future. Fall risk topics include the utility of remote monitoring using wearable sensors and recent work investigating brain activation and gait adaptability. New approaches for exercise for fall prevention including dual-task training, cognitive-motor training with exergames and reactive step training are discussed. Additional fall prevention strategies considered include the prevention of falls in older people with dementia and Parkinson's disease, drugs for fall prevention and safe flooring for preventing fall-related injuries. The review discusses how these new initiatives and technologies have potential for effective fall prevention and improved quality of life. It concludes by emphasising the need for a continued focus on translation of evidence into practice including robust effectiveness evaluations of so that resources can be appropriately targeted into the future.
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Affiliation(s)
- Stephen R Lord
- Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jacqueline C T Close
- Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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15
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The cognitive complexity of concurrent cognitive-motor tasks reveals age-related deficits in motor performance. Sci Rep 2018; 8:6094. [PMID: 29666388 PMCID: PMC5904104 DOI: 10.1038/s41598-018-24346-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/29/2018] [Indexed: 01/16/2023] Open
Abstract
Aging reduces cognitive functions, and such impairments have implications in mental and motor performance. Cognitive function has been recently linked to the risk of falls in older adults. Physical activities have been used to attenuate the declines in cognitive functions and reduce fall incidence, but little is known whether a physically active lifestyle can maintain physical performance under cognitively demanding conditions. The aim of this study was to verify whether physically active older adults present similar performance deficits during upper limb response time and precision stepping walking tasks when compared to younger adults. Both upper limb and walking tasks involved simple and complex cognitive demands through decision-making. For both tasks, decision-making was assessed by including a distracting factor to the execution. The results showed that older adults were substantially slower than younger individuals in the response time tasks involving decision-making. Similarly, older adults walked slower and extended the double support periods when precision stepping involved decision-making. These results suggest that physically active older adults present greater influence of cognitive demanding contexts to perform a motor task when compared to younger adults. These results underpin the need to develop interventions combining cognitive and motor contexts.
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16
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Cognitive Processing for Step Precision Increases Beta and Gamma Band Modulation During Overground Walking. Brain Topogr 2018; 31:661-671. [DOI: 10.1007/s10548-018-0633-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/07/2018] [Indexed: 01/29/2023]
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17
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Executive functioning, concern about falling and quadriceps strength mediate the relationship between impaired gait adaptability and fall risk in older people. Gait Posture 2018; 59:188-192. [PMID: 29055270 DOI: 10.1016/j.gaitpost.2017.10.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 09/26/2017] [Accepted: 10/13/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reduced ability to adapt gait, particularly under challenging conditions, may be an important reason why older adults have an increased risk of falling. This study aimed to identify cognitive, psychological and physical mediators of the relationship between impaired gait adaptability and fall risk in older adults. METHODS Fifty healthy older adults (mean±SD: 74±7years) were categorised as high or low fall risk, based on past falls and their performance in the Physiological Profile Assessment. High and low-risk groups were then compared in the gait adaptability test, i.e. an assessment of the ability to adapt gait in response to obstacles and stepping targets under single and dual task conditions. Quadriceps strength, concern about falling and executive function were also measured. RESULTS The older adults who made errors on the gait adaptability test were 4.76 (95%CI=1.08-20.91) times more likely to be at high risk of falling. Furthermore, each standard deviation reduction in gait speed while approaching the targets/obstacle increased the odds of being at high risk of falling approximately three fold: single task - OR=3.10,95%CI=1.43-6.73; dual task - 3.42,95%CI=1.56-7.52. Executive functioning, concern about falling and quadriceps strength substantially mediated the relationship between the gait adaptability measures and fall risk status. CONCLUSION Impaired gait adaptability is associated with high risk of falls in older adults. Reduced executive function, increased concern about falling and weaker quadriceps strength contribute significantly to this relationship. Training gait adaptability directly, as well as addressing the above mediators through cognitive, behavioural and physical training may maximise fall prevention efficacy.
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18
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Coordination of Gaze Behavior and Foot Placement During Walking in Persons With Glaucoma. J Glaucoma 2018; 27:55-63. [DOI: 10.1097/ijg.0000000000000819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Abstract
Our activities of daily living inherently involve interacting with the physical environment. This interaction involves both reactive (feedback) and proactive (feedforward) gait adaptations. Reactive adaptations involve responses to mechanical perturbations and occur, for instance, when we stumble over a doorstep or slip on an icy spot on the pavement. Examples of proactive adaptations in response to visual stimuli include stepping over an obstacle, targeting precise foot placements when walking on rough terrain, stepping up to the pavement, or making a turn for going around a corner. These adaptations have to be implemented in our steady-state gait pattern, thus posing a challenge to center-of-mass control and maintenance of forward progression. Yet, despite the apparent complexity of adaptive bipedal walking, we commonly do this with remarkable ease. This chapter will provide a comprehensive overview of the behavioral strategies and control mechanisms that we apply for executing these common, yet complex, gait adaptations. In addition, how we use visual information for guiding proactive gait adaptations and path selection will be discussed. Finally, cognitive involvement during gait adaptations will also be addressed.
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Affiliation(s)
- Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Sint Maartenskliniek Research, Nijmegen, The Netherlands.
| | - Kristen L Hollands
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Mark A Hollands
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
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20
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Caetano MJD, Menant JC, Schoene D, Pelicioni PHS, Sturnieks DL, Lord SR. Sensorimotor and Cognitive Predictors of Impaired Gait Adaptability in Older People. J Gerontol A Biol Sci Med Sci 2017; 72:1257-1263. [PMID: 27573810 DOI: 10.1093/gerona/glw171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 08/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background The ability to adapt gait when negotiating unexpected hazards is crucial to maintain stability and avoid falling. This study investigated whether impaired gait adaptability in a task including obstacle and stepping targets is associated with cognitive and sensorimotor capacities in older adults. Methods Fifty healthy older adults (74±7 years) were instructed to either (a) avoid an obstacle at usual step distance or (b) step onto a target at either a short or long step distance projected on a walkway two heel strikes ahead and then continue walking. Participants also completed cognitive and sensorimotor function assessments. Results Stroop test and reaction time performance significantly discriminated between participants who did and did not make stepping errors, and poorer Trail-Making test performance predicted shorter penultimate step length in the obstacle avoidance condition. Slower reaction time predicted poorer stepping accuracy; increased postural sway, weaker quadriceps strength, and poorer Stroop and Trail-Making test performances predicted increased number of steps taken to approach the target/obstacle and shorter step length; and increased postural sway and higher concern about falling predicted slower step velocity. Conclusions Superior executive function, fast processing speed, and good muscle strength and balance were all associated with successful gait adaptability. Processing speed appears particularly important for precise foot placements; cognitive capacity for step length adjustments; and early and/or additional cognitive processing involving the inhibition of a stepping pattern for obstacle avoidance. This information may facilitate fall risk assessments and fall prevention strategies.
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Affiliation(s)
- Maria Joana D Caetano
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Paulo H S Pelicioni
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Daina L Sturnieks
- Neuroscience Research Australia.,School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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21
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Wang D, Zhang J, Sun Y, Zhu W, Tian S, Liu Y. Evaluating the fall risk among elderly population by choice step reaction test. Clin Interv Aging 2016; 11:1075-82. [PMID: 27563238 PMCID: PMC4986678 DOI: 10.2147/cia.s106606] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Falls during daily activities are often associated with injuries and physical disabilities, thereby affecting quality of life among elder adults. Balance control, which is crucial in avoiding falls, is composed of two elements: muscle strength and central nervous system (CNS) control. A number of studies have reported that reduced muscle strength raises the risk of falling. However, to date there has been only limited research focused on the relationship between fall risk and the CNS. This study aimed to investigate the relationship between CNS and risk of falling among the elderly. A total of 140 elderly people (92 females and 48 males) were divided into faller and nonfaller groups based on questionnaire responses concerning falls in their daily life. Participants undertook a choice step reaction test in which they were required to respond to random visual stimuli using foot movements as fast as possible in the left or right directions. Response time was quantified as premotor time (PMT) and motor time (MT). In addition, the participants’ electro-myography data were recorded during the choice step reaction test. A maximal isokinetic torque test was also performed. PMT was greater in the fallers than in the nonfallers group. There was a significant difference between fall status and direction on PMT. PMT of the left limb in nonfallers was faster than the right, but in fallers there was no difference between left and right limbs. A similar phenomenon was also observed for MT. There were significant differences between fallers and nonfallers in maximum isokinetic torque at knee and ankle joints. The correct rate of PMT was higher than other variables, such as MT and maximal isokinetic torque, in evaluating elderly fall risk by using logistic regression analyses. The results suggest that PMT in the choice step reaction test could be a useful parameter to assess risk of fall among elder adults. In addition, decreased maximal isokinetic torque was related to greater PMT and disappearance of asymmetry in older adults who were at higher risk of fall, especially in the lower limb.
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Affiliation(s)
- Donghai Wang
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Jian Zhang
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Yuliang Sun
- School of Physical Education, Shaanxi Normal University, Xian, People's Republic of China
| | - Wenfei Zhu
- School of Physical Education, Shaanxi Normal University, Xian, People's Republic of China
| | - Shiliu Tian
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of the Ministry of Education, Shanghai University of Sport, Shanghai, People's Republic of China
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22
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23
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Caetano MJD, Lord SR, Schoene D, Pelicioni PHS, Sturnieks DL, Menant JC. Age-related changes in gait adaptability in response to unpredictable obstacles and stepping targets. Gait Posture 2016; 46:35-41. [PMID: 27131174 DOI: 10.1016/j.gaitpost.2016.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/28/2016] [Accepted: 02/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND A large proportion of falls in older people occur when walking. Limitations in gait adaptability might contribute to tripping; a frequently reported cause of falls in this group. OBJECTIVE To evaluate age-related changes in gait adaptability in response to obstacles or stepping targets presented at short notice, i.e.: approximately two steps ahead. METHODS Fifty older adults (aged 74±7 years; 34 females) and 21 young adults (aged 26±4 years; 12 females) completed 3 usual gait speed (baseline) trials. They then completed the following randomly presented gait adaptability trials: obstacle avoidance, short stepping target, long stepping target and no target/obstacle (3 trials of each). RESULTS Compared with the young, the older adults slowed significantly in no target/obstacle trials compared with the baseline trials. They took more steps and spent more time in double support while approaching the obstacle and stepping targets, demonstrated poorer stepping accuracy and made more stepping errors (failed to hit the stepping targets/avoid the obstacle). The older adults also reduced velocity of the two preceding steps and shortened the previous step in the long stepping target condition and in the obstacle avoidance condition. CONCLUSION Compared with their younger counterparts, the older adults exhibited a more conservative adaptation strategy characterised by slow, short and multiple steps with longer time in double support. Even so, they demonstrated poorer stepping accuracy and made more stepping errors. This reduced gait adaptability may place older adults at increased risk of falling when negotiating unexpected hazards.
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Affiliation(s)
- Maria Joana D Caetano
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | - Daniel Schoene
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Institute for Biomedicine of Aging, Friedrich-Alexander-University Erlangen-Nuremberg, Nuremberg, Germany
| | - Paulo H S Pelicioni
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; UNESP Univ Estadual Paulista, Instituto de Biociências de Rio Claro, Departamento de Educação Física, Posture and Gait Studies Laboratory, Rio Claro, Brazil
| | - Daina L Sturnieks
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia.
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24
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Hollands KL, Pelton TA, van der Veen S, Alharbi S, Hollands MA. A novel and simple test of gait adaptability predicts gold standard measures of functional mobility in stroke survivors. Gait Posture 2016; 43:170-5. [PMID: 26455475 DOI: 10.1016/j.gaitpost.2015.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 09/03/2015] [Accepted: 09/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although there is evidence that stroke survivors have reduced gait adaptability, the underlying mechanisms and the relationship to functional recovery are largely unknown. We explored the relationships between walking adaptability and clinical measures of balance, motor recovery and functional ability in stroke survivors. METHODS Stroke survivors (n=42) stepped to targets, on a 6m walkway, placed to elicit step lengthening, shortening and narrowing on paretic and non-paretic sides. The number of targets missed during six walks and target stepping speed was recorded. Fugl-Meyer (FM), Berg Balance Scale (BBS), self-selected walking speed (SWWS) and single support (SS) and step length (SL) symmetry (using GaitRite when not walking to targets) were also assessed. Stepwise multiple-linear regression was used to model the relationships between: total targets missed, number missed with paretic and non-paretic legs, target stepping speed, and each clinical measure. RESULTS Regression revealed a significant model for each outcome variable that included only one independent variable. Targets missed by the paretic limb, was a significant predictor of FM (F(1,40)=6.54, p=0.014,). Speed of target stepping was a significant predictor of each of BBS (F(1,40)=26.36, p<0.0001), SSWS (F(1,40)=37.00, p<0.0001). No variables were significant predictors of SL or SS asymmetry. DISCUSSION Speed of target stepping was significantly predictive of BBS and SSWS and paretic targets missed predicted FM, suggesting that fast target stepping requires good balance and accurate stepping demands good paretic leg function. The relationships between these parameters indicate gait adaptability is a clinically meaningful target for measurement and treatment of functionally adaptive walking ability in stroke survivors.
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Affiliation(s)
- K L Hollands
- School of Health Sciences, University of Salford, Manchester, UK.
| | - T A Pelton
- School of Psychology, University of Birmingham, Birmingham, UK
| | - S van der Veen
- School of Health Sciences, University of Salford, Manchester, UK
| | - S Alharbi
- School of Health Sciences, University of Salford, Manchester, UK
| | - M A Hollands
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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Yorozu A, Nishiguchi S, Yamada M, Aoyama T, Moriguchi T, Takahashi M. Gait measurement system for the multi-target stepping task using a laser range sensor. SENSORS (BASEL, SWITZERLAND) 2015; 15:11151-68. [PMID: 25985161 PMCID: PMC4482006 DOI: 10.3390/s150511151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/02/2015] [Accepted: 05/08/2015] [Indexed: 11/17/2022]
Abstract
For the prevention of falling in the elderly, gait training has been proposed using tasks such as the multi-target stepping task (MTST), in which participants step on assigned colored targets. This study presents a gait measurement system using a laser range sensor for the MTST to evaluate the risk of falling. The system tracks both legs and measures general walking parameters such as stride length and walking speed. Additionally, it judges whether the participant steps on the assigned colored targets and detects cross steps to evaluate cognitive function. However, situations in which one leg is hidden from the sensor or the legs are close occur and are likely to lead to losing track of the legs or false tracking. To solve these problems, we propose a novel leg detection method with five observed leg patterns and global nearest neighbor-based data association with a variable validation region based on the state of each leg. In addition, methods to judge target steps and detect cross steps based on leg trajectory are proposed. From the experimental results with the elderly, it is confirmed that the proposed system can improve leg-tracking performance, judge target steps and detect cross steps with high accuracy.
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Affiliation(s)
- Ayanori Yorozu
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan.
| | - Shu Nishiguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Toshiki Moriguchi
- Research & Development Division, Murata Machinery, Ltd., 136 Takeda-Mukaishiro-cho, Fushimi-ku, Kyoto 612-8686, Japan.
| | - Masaki Takahashi
- Department of System Design Engineering, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama 223-8522, Japan.
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Yamada M, Higuchi T, Nishiguchi S, Yoshimura K, Kajiwara Y, Aoyama T. Multitarget Stepping Program in Combination with a Standardized Multicomponent Exercise Program Can Prevent Falls in Community-Dwelling Older Adults: A Randomized, Controlled Trial. J Am Geriatr Soc 2013; 61:1669-75. [DOI: 10.1111/jgs.12453] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Minoru Yamada
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Takahiro Higuchi
- Department of Health Promotion Science; Graduate School of Human Health Science; Tokyo Metropolitan University; Tokyo Japan
| | - Shu Nishiguchi
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Kazuya Yoshimura
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Yuu Kajiwara
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Tomoki Aoyama
- Department of Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto Japan
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27
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Pichierri G, Diener T, Murer K, de Bruin ED. Assessment of the test-retest reliability of a foot placement accuracy protocol in assisted-living older adults. Gait Posture 2013; 38:784-9. [PMID: 23607995 DOI: 10.1016/j.gaitpost.2013.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 02/25/2013] [Accepted: 03/26/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study assessed the test-retest reliability of a foot placement accuracy protocol in a population of assisted-living elderly. The goal was to evaluate the execution of foot placement performance with increasing complexity of the walking condition. METHODS Twenty-five elderly participants (5 males, 20 females, 80.4±8.6 years) were assessed by one observer in two sessions with 48 h between the measurements. Participants walked at self-selected pace along a pathway with three different walking conditions composed of two rectangular foam target locations and an obstacle on the walking surface. The main outcome measures were foot placement distance error, intra-class correlation coefficients (ICC), and the smallest detectable difference (SDD). RESULTS Mean absolute values of the foot placement distance errors were 14.0±4.5 mm for medio-lateral deviation and 27.2±2.1 mm for anterior-posterior deviation, respectively. ICC values for test-retest reliability showed 'fair to good' to 'excellent' reliability across all conditions with values ranging from 0.63 to 0.94. SDD values were between 3.6 and 37.3mm. CONCLUSION The protocol showed good reliability for test-retest measurements of foot placement accuracy, thus making this protocol a reliable and location-independent tool to assess performance of foot placement in elderly in assisted-living settings. In the future, measurements with elderly fallers and non-fallers should be conducted to assess validity of the protocol.
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Affiliation(s)
- Giuseppe Pichierri
- Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland.
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Nishiguchi S, Yamada M, Uemura K, Matsumura T, Takahashi M, Moriguchi T, Aoyama T. A novel infrared laser device that measures multilateral parameters of stepping performance for assessment of fall risk in elderly individuals [corrected]. Aging Clin Exp Res 2013; 25:311-6. [PMID: 23740583 DOI: 10.1007/s40520-013-0042-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Avoiding falls requires fast and appropriate step responses in real-life situations. We developed a step-tracking device that uses an infrared laser sensor for convenient assessment of stepping performance, including concurrent assessment of temporal and spatial parameters. In the present study, we created a new index for assessment of fall risk that uses step speed and accuracy measurements. The purpose of this study was to determine whether the new index could discriminate between elderly individuals with different risks of falling. METHODS One hundred and fifty-two community-dwelling elderly individuals (73.9 ± 4.6 years) participated and performed stepping tasks as quickly as possible on a plus-shaped mat in response to optical cues. The step-tracking device with the infrared sensor detected the motion and position of both legs in the step field. The device recorded temporal and spatial parameters, foot-off and foot-contact time, step length, and the percentage of correctly executed steps. We used the coefficients of a logistic regression model to develop "stepping-response score" based on the weighted sum of these temporal and spatial parameters. RESULTS The faller group had significantly worse stepping-response score than the non-faller group (p < 0.001). A stepwise logistic regression analysis demonstrated that stepping-response score was independently associated with falling (odds ratio = 0.15; p < 0.001). The ROC curve had a moderate AUC (0.73) for stepping-response score (sensitivity 73.0 %; specificity 69.7 %). CONCLUSIONS This study indicates that the stepping-response score calculated from measurements obtained using the new step-tracking device can identify elderly individuals who are at a risk of falling.
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Affiliation(s)
- Shu Nishiguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Higuchi T. Visuomotor control of human adaptive locomotion: understanding the anticipatory nature. Front Psychol 2013; 4:277. [PMID: 23720647 PMCID: PMC3655271 DOI: 10.3389/fpsyg.2013.00277] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 04/29/2013] [Indexed: 12/02/2022] Open
Abstract
To maintain balance during locomotion, the central nervous system (CNS) accommodates changes in the constraints of spatial environment (e.g., existence of an obstacle or changes in the surface properties). Locomotion while modifying the basic movement patterns in response to such constraints is referred to as adaptive locomotion. The most powerful means of ensuring balance during adaptive locomotion is to visually perceive the environmental properties at a distance and modify the movement patterns in an anticipatory manner to avoid perturbation altogether. For this reason, visuomotor control of adaptive locomotion is characterized, at least in part, by its anticipatory nature. The purpose of the present article is to review the relevant studies which revealed the anticipatory nature of the visuomotor control of adaptive locomotion. The anticipatory locomotor adjustments for stationary and changeable environment, as well as the spatio-temporal patterns of gaze behavior to support the anticipatory locomotor adjustments are described. Such description will clearly show that anticipatory locomotor adjustments are initiated when an object of interest (e.g., a goal or obstacle) still exists in far space. This review also show that, as a prerequisite of anticipatory locomotor adjustments, environmental properties are accurately perceived from a distance in relation to individual’s action capabilities.
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Affiliation(s)
- Takahiro Higuchi
- Department of Health Promotion Science, Tokyo Metropolitan University Tokyo, Japan
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Sakurai R, Fujiwara Y, Ishihara M, Higuchi T, Uchida H, Imanaka K. Age-related self-overestimation of step-over ability in healthy older adults and its relationship to fall risk. BMC Geriatr 2013; 13:44. [PMID: 23651772 PMCID: PMC3660311 DOI: 10.1186/1471-2318-13-44] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
Background Older adults could not safely step over an obstacle unless they correctly estimated their physical ability to be capable of a successful step over action. Thus, incorrect estimation (overestimation) of ability to step over an obstacle could result in severe accident such as falls in older adults. We investigated whether older adults tended to overestimate step-over ability compared with young adults and whether such overestimation in stepping over obstacles was associated with falls. Methods Three groups of adults, young-old (age, 60–74 years; n, 343), old-old (age, >74 years; n, 151), and young (age, 18–35 years; n, 71), performed our original step-over test (SOT). In the SOT, participants observed a horizontal bar at a 7-m distance and estimated the maximum height (EH) that they could step over. After estimation, they performed real SOT trials to measure the actual maximum height (AH). We also identified participants who had experienced falls in the 1 year period before the study. Results Thirty-nine young-old adults (11.4%) and 49 old-old adults (32.5%) failed to step over the bar at EH (overestimation), whereas all young adults succeeded (underestimation). There was a significant negative correlation between actual performance (AH) and self-estimation error (difference between EH and AH) in the older adults, indicating that older adults with lower AH (SOT ability) tended to overestimate actual ability (EH > AH) and vice versa. Furthermore, the percentage of participants who overestimated SOT ability in the fallers (28%) was almost double larger than that in the non-fallers (16%), with the fallers showing significantly lower SOT ability than the non-fallers. Conclusions Older adults appear unaware of age-related physical decline and tended to overestimate step-over ability. Both age-related decline in step-over ability, and more importantly, overestimation or decreased underestimation of this ability may raise potential risk of falls.
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Affiliation(s)
- Ryota Sakurai
- Health Promotion Science, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo 192-0397, Japan.
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Yamada M, Higuchi T, Mori S, Uemura K, Nagai K, Aoyama T, Ichihashi N. Maladaptive turning and gaze behavior induces impaired stepping on multiple footfall targets during gait in older individuals who are at high risk of falling. Arch Gerontol Geriatr 2012; 54:e102-8. [DOI: 10.1016/j.archger.2011.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Revised: 08/18/2011] [Accepted: 08/20/2011] [Indexed: 11/30/2022]
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