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Heap-Eldridge KL, Thompson BJ, Fisher C, Louder TJ, Carey J. A Comprehensive Examination of Age-Related Lower Limb Muscle Function Asymmetries across a Variety of Muscle Action Types. Geriatrics (Basel) 2024; 9:79. [PMID: 38920435 PMCID: PMC11202539 DOI: 10.3390/geriatrics9030079] [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: 04/05/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Previous research has found that lower limb muscle asymmetries increase with age and are linked to fall and injury risks. However, past studies lack a wide variety of muscle function modes and measures as well as comparison to a comparable younger age group. The purpose of this study was to examine age-related lower limb muscle function asymmetries across a variety of muscle action types and velocities in young and old adults. Lower limb balance, strength, power, and velocity were evaluated with concentric, isometric, isotonic, and eccentric muscle actions during a single-leg stance test and on single- and multi-joint dynamometers in 29 young (age = 21.45 ± 3.02) and 23 old (age = 77.00 ± 4.60) recreationally active men and women. Most (15 of 17) variables showed no statistical (p > 0.05) or functional (10% threshold) limb asymmetry for either age group. There was a significant main effect (p = 0.046; collapsed across groups) found for asymmetry (dominant > non-dominant) for the isotonic peak velocity variable. There was a significant (p = 0.010) group × limb interaction for single-joint concentric peak power produced at a slow (60 deg/s) velocity due to the non-dominant limb of the young group being 12.2% greater than the dominant limb (p < 0.001), whereas the old group was not asymmetrical (p = 0.965). The findings of this investigation indicate there is largely no age-related asymmetry of the lower limbs across a range of muscle function-related variables and modes, with a couple of notable exceptions. Also, the significant asymmetries for the isotonic peak velocity variable perhaps show the sensitivity of this uncommonly used measure in detecting minimally present muscle function imbalances.
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Affiliation(s)
- Kylee L. Heap-Eldridge
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Brennan J. Thompson
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Cody Fisher
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Talin J. Louder
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
- Movement Research Clinic, Sorenson Legacy Foundation Center for Clinical Excellence, Utah State University, Logan, UT 84322, USA
| | - Jon Carey
- Kinesiology and Health Science Department, Utah State University, Logan, UT 84322, USA
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Liu F, Yu H, Xu Q, Gong J, Huo M, Huang F. Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking. Clin Interv Aging 2024; 19:21-29. [PMID: 38204962 PMCID: PMC10777860 DOI: 10.2147/cia.s438904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Falls are a significant factor affecting the health of older adults and are closely related to cognitive function. Adopting an effective method to evaluate the risk of falls in older adults is essential for improving their healthcare. This study combined cognitive and motor functions to determine a reliable probe reaction time during water-carrying walking. Patients and Methods We divided 100 community-dwelling older adults (aged 65 years and over) into two groups according to their fall history: the fall group and no-fall group. All subjects were tested on fall tasks using the timed up-and-go (TUG) test, 10-m walk timing test, trail marking test part-A (TMT-A), and water-carrying walking probe reaction time (P-RT). Results The fall group showed slower walking speeds and longer TUG, TMT-A, and P-RT times than the no-fall group. In the logistic regression analysis with falls as the dependent variable, water-carrying walking P-RT was identified as a useful factor, and the cut-off value of the water-carrying walking P-RT was 454 ms, which was evaluated using the receiver operating characteristic curve. Conclusion The P-RT of the water-carrying walking test was found to be credible and useful for evaluating the fall risk in older adults. Therefore, it is recommended that the P-RT-based dual-task be used as a predictive indicator of future falls in the older population.
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Affiliation(s)
- Fan Liu
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
| | - Huan Yu
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
| | - Qing Xu
- Yaitai Hospital, Binzhou Medical University, Yantai, People’s Republic of China
| | - Jianwei Gong
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
| | - Ming Huo
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, People’s Republic of China
- Beijing Chaoyang Sanhuan Cancer Hospital, Beijing, 100122, People's Republic of China
| | - Fei Huang
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, People’s Republic of China
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Bohnen NI, Barr J, Vangel R, Roytman S, Paalanen R, Frey KA, Scott PJH, Kanel P. GABA A Receptor Benzodiazepine Binding Sites and Motor Impairments in Parkinson's Disease. Brain Sci 2023; 13:1711. [PMID: 38137159 PMCID: PMC10741877 DOI: 10.3390/brainsci13121711] [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: 11/03/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Flumazenil is an allosteric modulator of the γ-aminobutyric acid-A receptor (GABAAR) benzodiazepine binding site that could normalize neuronal signaling and improve motor impairments in Parkinson's disease (PD). Little is known about how regional GABAAR availability affects motor symptoms. We investigated the relationship between regional availability of GABAAR benzodiazepine binding sites and motor impairments in PD. Methods: A total of 11 Patients with PD (males; mean age 69.0 ± 4.6 years; Hoehn and Yahr stages 2-3) underwent [11C]flumazenil GABAAR benzodiazepine binding site and [11C]dihydrotetrabenazine vesicular monoamine transporter type-2 (VMAT2) PET imaging and clinical assessment. Stepwise regression analysis was used to predict regional cerebral correlates of the four cardinal UPDRS motor scores using cortical, striatal, thalamic, and cerebellar flumazenil binding estimates. Thalamic GABAAR availability was selectively associated with axial motor scores (R2 = 0.55, F = 11.0, β = -6.4, p = 0.0009). Multi-ligand analysis demonstrated significant axial motor predictor effects by both thalamic GABAAR availability (R2 = 0.47, β = -5.2, F = 7.2, p = 0.028) and striatal VMAT2 binding (R2 = 0.30, β = -3.9, F = 9.1, p = 0.019; total model: R2 = 0.77, F = 11.9, p = 0.0056). Post hoc analysis demonstrated that thalamic [11C]methyl-4-piperidinyl propionate cholinesterase PET and K1 flow delivery findings were not significant confounders. Findings suggest that reduced thalamic GABAAR availability correlates with worsened axial motor impairments in PD, independent of nigrostriatal degeneration. These findings may augur novel non-dopaminergic approaches to treating axial motor impairments in PD.
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Affiliation(s)
- Nicolaas I. Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Jaimie Barr
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Robert Vangel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
| | - Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
| | - Rebecca Paalanen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kirk A. Frey
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Peter J. H. Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (J.B.); (R.V.); (S.R.); (K.A.F.); (P.J.H.S.); (P.K.)
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
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Ploegmakers KJ, van Poelgeest EP, Seppala LJ, van Dijk SC, de Groot LCPGM, Oliai Araghi S, van Schoor NM, Stricker B, Swart KMA, Uitterlinden AG, Mathôt RAA, van der Velde N. The role of plasma concentrations and drug characteristics of beta-blockers in fall risk of older persons. Pharmacol Res Perspect 2023; 11:e01126. [PMID: 37885367 PMCID: PMC10603288 DOI: 10.1002/prp2.1126] [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: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 10/28/2023] Open
Abstract
Beta-blocker usage is inconsistently associated with increased fall risk in the literature. However, due to age-related changes and interindividual heterogeneity in pharmacokinetics and dynamics, it is difficult to predict which older adults are more at risk for falls. Therefore, we wanted to explore whether elevated plasma concentrations of selective and nonselective beta-blockers are associated with an increased risk of falls in older beta-blocker users. To answer our research question, we analyzed samples of selective (metoprolol, n = 316) and nonselective beta-blockers (sotalol, timolol, propranolol, and carvedilol, n = 179) users from the B-PROOF cohort. The associations between the beta-blocker concentration and time to first fall were assessed using Cox proportional hazard models. Change of concentration over time in relation to fall risk was assessed with logistic regression models. Models were adjusted for potential confounders. Our results showed that above the median concentration of metoprolol was associated with an increased fall risk (HR 1.55 [1.11-2.16], p = .01). No association was found for nonselective beta-blocker concentrations. Also, changes in concentration over time were not associated with increased fall risk. To conclude, metoprolol plasma concentrations were associated with an increased risk of falls in metoprolol users while no associations were found for nonselective beta-blockers users. This might be caused by a decreased β1-selectivity in high plasma concentrations. In the future, beta-blocker concentrations could potentially help clinicians estimate fall risk in older beta-blockers users and personalize treatment.
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Affiliation(s)
- K. J. Ploegmakers
- Amsterdam UMC Location University of AmsterdamInternal Medicine, Section of Geriatric MedicineAmsterdamThe Netherlands
- Amsterdam Public HealthAging and Later LifeAmsterdamThe Netherlands
| | - E. P. van Poelgeest
- Amsterdam UMC Location University of AmsterdamInternal Medicine, Section of Geriatric MedicineAmsterdamThe Netherlands
- Amsterdam Public HealthAging and Later LifeAmsterdamThe Netherlands
| | - L. J. Seppala
- Amsterdam UMC Location University of AmsterdamInternal Medicine, Section of Geriatric MedicineAmsterdamThe Netherlands
- Amsterdam Public HealthAging and Later LifeAmsterdamThe Netherlands
| | - S. C. van Dijk
- Department of Geriatrics, Franciscus Gasthuis & VlietlandRotterdamthe Netherlands
| | | | - S. Oliai Araghi
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - N. M. van Schoor
- Amsterdam Public HealthAging and Later LifeAmsterdamThe Netherlands
- Amsterdam UMC Location Vrije Universiteit AmsterdamEpidemiology and Data ScienceAmsterdamNetherlands
| | - B. Stricker
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - K. M. A. Swart
- Amsterdam UMC Location Vrije Universiteit Amsterdam General PracticeAmsterdamThe Netherlands
| | - A. G. Uitterlinden
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - R. A. A. Mathôt
- Amsterdam UMC Location University of AmsterdamHospital Pharmacy—Clinical PharmacologyAmsterdamThe Netherlands
| | - N. van der Velde
- Amsterdam UMC Location University of AmsterdamInternal Medicine, Section of Geriatric MedicineAmsterdamThe Netherlands
- Amsterdam Public HealthAging and Later LifeAmsterdamThe Netherlands
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Roytman S, Paalanen R, Griggs A, David S, Pongmala C, Koeppe RA, Scott PJH, Marusic U, Kanel P, Bohnen NI. Cholinergic system correlates of postural control changes in Parkinson's disease freezers. Brain 2023; 146:3243-3257. [PMID: 37086478 PMCID: PMC10393403 DOI: 10.1093/brain/awad134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/16/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023] Open
Abstract
Postural instability and freezing of gait are the most debilitating dopamine-refractory motor impairments in advanced stages of Parkinson's disease because of increased risk of falls and poorer quality of life. Recent findings suggest an inability to efficaciously utilize vestibular information during static posturography among people with Parkinson's disease who exhibit freezing of gait, with associated changes in cholinergic system integrity as assessed by vesicular acetylcholine transporter PET. There is a lack of adequate understanding of how postural control varies as a function of available sensory information in patients with Parkinson's disease with freezing of gait. The goal of this cross-sectional study was to examine cerebral cholinergic system changes that associate with inter-sensory postural control processing features as assessed by dynamic computerized posturography and acetylcholinesterase PET. Seventy-five participants with Parkinson's disease, 16 of whom exhibited freezing of gait, underwent computerized posturography on the NeuroCom© Equitest sensory organization test platform, striatal dopamine, and acetylcholinesterase PET scanning. Findings demonstrated that patients with Parkinson's disease with freezing of gait have greater difficulty maintaining balance in the absence of reliable proprioceptive cues as compared to those without freezing of gait [β = 0.28 (0.021, 0.54), P = 0.034], an effect that was independent of disease severity [β = 0.16 (0.062, 0.26), P < 0.01] and age [β = 0.092 (-0.005, 0.19), P = 0.062]. Exploratory voxel-based analysis revealed an association between postural control and right hemispheric cholinergic network related to visual-vestibular integration and self-motion perception. High anti-cholinergic burden predicted postural control impairment in a manner dependent on right hemispheric cortical cholinergic integrity [β = 0.34 (0.065, 0.61), P < 0.01]. Our findings advance the perspective that cortical cholinergic system might play a role in supporting postural control after nigro-striatal dopaminergic losses in Parkinson's disease. Failure of cortex-dependent visual-vestibular integration may impair detection of postural instability in absence of reliable proprioceptive cues. Better understanding of how the cholinergic system plays a role in this process may augur novel treatments and therapeutic interventions to ameliorate debilitating symptoms in patients with advanced Parkinson's disease.
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Affiliation(s)
- Stiven Roytman
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rebecca Paalanen
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alexis Griggs
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Simon David
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chatkaew Pongmala
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Uros Marusic
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Institute for Kinesiology Research, Science and Research Centre Koper, 6000 Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea—ECM, 2000 Maribor, Slovenia
| | - Prabesh Kanel
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nicolaas I Bohnen
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Parkinson’s Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
- Morris K. Udall Center of Excellence for Parkinson’s Disease Research, University of Michigan, Ann Arbor, MI 48109, USA
- Neurology Service and GRECC, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
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6
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Chepisheva MK. Spatial orientation, postural control and the vestibular system in healthy elderly and Alzheimer's dementia. PeerJ 2023; 11:e15040. [PMID: 37151287 PMCID: PMC10162042 DOI: 10.7717/peerj.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background While extensive research has been advancing our understanding of the spatial and postural decline in healthy elderly (HE) and Alzheimer's disease (AD), much less is known about how the vestibular system contributes to the spatial and postural processing in these two populations. This is especially relevant during turning movements in the dark, such as while walking in our garden or at home at night, where the vestibular signal becomes central. As the prevention of falls and disorientation are of serious concern for the medical service, more vestibular-driven knowledge is necessary to decrease the burden for HE and AD patients with vestibular disabilities. Overview of the article The review briefly presents the current "non-vestibular based" knowledge (i.e. knowledge based on research that does not mention the "vestibular system" as a contributor or does not investigate its effects) about spatial navigation and postural control during normal healthy ageing and AD pathology. Then, it concentrates on the critical sense of the vestibular system and explores the current expertise about the aspects of spatial orientation and postural control from a vestibular system point of view. The norm is set by first looking at how healthy elderly change with age with respect to their vestibular-guided navigation and balance, followed by the AD patients and the difficulties they experience in maintaining their balance or during navigation. Conclusion Vestibular spatial and vestibular postural deficits present a considerable disadvantage and are felt not only on a physical but also on a psychological level by all those affected. Still, there is a clear need for more (central) vestibular-driven spatial and postural knowledge in healthy and pathological ageing, which can better facilitate our understanding of the aetiology of these dysfunctions. A possible change can start with the more frequent implementation of the "vestibular system examination/rehabilitation/therapy" in the clinic, which can then lead to an improvement of future prognostication and disease outcome for the patients.
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Alzaid H, Ethofer T, Kardatzki B, Erb M, Scheffler K, Berg D, Maetzler W, Hobert MA. Gait decline while dual-tasking is an early sign of white matter deterioration in middle-aged and older adults. Front Aging Neurosci 2022; 14:934241. [PMID: 36247983 PMCID: PMC9558904 DOI: 10.3389/fnagi.2022.934241] [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: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
Loss of white matter integrity (WMI) is associated with gait deficits in middle-aged and older adults. However, these deficits are often only apparent under cognitively demanding situations, such as walking and simultaneously performing a secondary cognitive task. Moreover, evidence suggests that declining executive functions (EF) are linked to gait decline, and their co-occurrence may point to a common underlying pathology, i.e., degeneration of shared brain regions. In this study, we applied diffusion tensor imaging (DTI) and a standardized gait assessment under single- and dual-tasking (DT) conditions (walking and subtracting) in 74 middle-aged and older adults without any significant gait or cognitive impairments to detect subtle WM alterations associated with gait decline under DT conditions. Additionally, the Trail Making Test (TMT) was used to assess EF, classify participants into three groups based on their performance, and examine a possible interaction between gait, EF, and WMI. Gait speed and subtracting speed while dual-tasking correlated significantly with the fractional anisotropy (FA) in the bilateral anterior corona radiata (highest r = 0.51/p < 0.0125 FWE-corrected). Dual-task costs (DTC) of gait speed correlated significantly with FA in widespread pathways, including the corpus callosum, bilateral anterior and superior corona radiata, as well as the left superior longitudinal fasciculus (highest r = −0.47/p < 0.0125 FWE-corrected). EF performance was associated with FA in the left anterior corona radiata (p < 0.05); however, EF did not significantly mediate the effects of WMI on DTC of gait speed. There were no significant correlations between TMT and DTC of gait and subtracting speed, respectively. Our findings indicate that gait decline under DT conditions is associated with widespread WM deterioration even in middle-aged and older adults without any significant gait or cognitive impairments. However, this relationship was not mediated by EF.
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Affiliation(s)
- Haidar Alzaid
- Department of Biomedical Magnetic Resonance, Tübingen University Hospital, Tübingen, Germany
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- *Correspondence: Haidar Alzaid,
| | - Thomas Ethofer
- Department of Biomedical Magnetic Resonance, Tübingen University Hospital, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, Tübingen University Hospital, Tübingen, Germany
| | - Bernd Kardatzki
- Department of Biomedical Magnetic Resonance, Tübingen University Hospital, Tübingen, Germany
| | - Michael Erb
- Department of Biomedical Magnetic Resonance, Tübingen University Hospital, Tübingen, Germany
| | - Klaus Scheffler
- Department of Biomedical Magnetic Resonance, Tübingen University Hospital, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Kiel University Hospital, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University Hospital, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, Kiel University Hospital, Kiel, Germany
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Ozcan EB, Saglam M, Vardar-Yagli N, Calik-Kutukcu E, Inal-Ince D, Altinsoy M, Kaya EB. Impaired Balance and Gait Characteristics in Patients With Chronic Heart Failure. Heart Lung Circ 2022; 31:832-840. [PMID: 35177316 DOI: 10.1016/j.hlc.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Heart failure affects most systems of the body and causes various problems in patients. Balance deficits and gait deviations can be a result of these effects. There is little information in the literature about balance and gait parameters in chronic heart failure (CHF). This study aimed to investigate balance abnormalities together with gait deficits for possible associations in patients with CHF and compare them to healthy controls. METHODS Twenty-two (22) patients with CHF (59±2.5 years) and 22 age- and gender-matched healthy subjects (59.4±6.8 years) participated in the study. This study is a cross-sectional/comparison study. Balance was evaluated using the Activity-Specific Balance Confidence Scale (ABC) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) balance battery, which includes the timed up-and-go test (TUG) and dual-task TUG. Gait analysis was performed using a Biodex Gait Trainer. Peripheral muscle strength (quadriceps muscle and handgrip strength) was assessed using a hand dynamometer and exercise capacity using the six-minute walk test (6MWT). RESULTS The CHF patients had significantly lower Mini-BESTest total, reactive postural control, and gait stability scores, significantly longer TUG/dual-task TUG time, and lower ABC score compared to the healthy control group (p<0.05). Chronic heart failure patients also showed significantly lower gait speed, stride length, gait cycle and step length (p<0.05). Dominant-side quadriceps muscle and handgrip strength and 6MWT distance were significantly reduced in CHF (p<0.05). Anticipatory postural adjustments and sensory orientation did not differ between groups. CONCLUSIONS Our study demonstrated impaired balance and gait performance and reduced muscle strength and exercise capacity in patients with CHF. Cardiac rehabilitation including balance and walking training should be planned for CHF patients to eliminate balance disorders, gait impairment and prevent falls in this patient group.
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Affiliation(s)
- Emine Burcu Ozcan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Melda Saglam
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Naciye Vardar-Yagli
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Deniz Inal-Ince
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Meltem Altinsoy
- Saglik Bilimleri University, Gulhane Training and Research Hospital Cardiology Clinic, Ankara, Turkey
| | - Ergun Baris Kaya
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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9
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Li X, Lv C, Liu X, Qin X. Effects of Health Qigong Exercise on Lower Limb Motor Function in Parkinson's Disease. Front Med (Lausanne) 2022; 8:809134. [PMID: 35252225 PMCID: PMC8892581 DOI: 10.3389/fmed.2021.809134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study explored the effects of Health Qigong exercise on lower limb motor function in patients with Parkinson's disease (PD).Patients and MethodsA total of 40 patients with PD were recruited and randomly allocated into the experimental group and the control group. The experimental group completed an intervention of Health Qigong exercise over 12 weeks, while the control group did not perform any regular physical activity. Data relating to gait, lower-limb joint range of motion, Timed Up and Go, as well as scores for motor function scale from the Unified Parkinson's Comprehensive Rating Scale III (UPCRS III) before and after the intervention were collected for Repeated Measure ANOVA.ResultsCompared to the control group, Health Qigong exercise improved the constant- and high-speed stride length and gait velocity of patients, but not constant- and high-speed stride frequency. Left and right hip flexion and extension range were improved as well as left and right knee flexion range. Finally, Timed Up and Go time became significantly slower and UPCRS III score significantly decreased.ConclusionHealth Qigong exercise can improve walking ability and lower limb joint range of motion in patients with PD, lessen motor difficulties, and improve the quality of life. This non-pharmacological exercise intervention may be a useful adjustment treatment for PD.
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Affiliation(s)
- Xiying Li
- School of Physical Education, Yunnan Minzu University, Kunming, China
| | - Chuanfen Lv
- School of Physical Education, Zhengzhou University of Light Industry, Zhengzhou, China
| | - Xiaolei Liu
- Chinese Traditional Regimen Exercise Intervention Research Center, Beijing Sport University, Beijing, China
- *Correspondence: Xiaolei Liu
| | - Xia Qin
- Foreign Language School, Yunnan Minzu University, Kunming, China
- Xia Qin
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10
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Kashezheva AA, Zamergrad MV, Levin OS. [Dizziness in Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:64-68. [PMID: 34870916 DOI: 10.17116/jnevro202112110264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study clinical features of vestibular disorders in patients with Parkinson's disease (PD) and to develop methods of their treatment. MATERIAL AND METHODS The study included 90 patients with PD who were divided into two groups: the main group (60 patients with PD and vestibular symptoms (VS)) and the control group (30 patients with PD without VS). All patients underwent clinical neurological examination, assessment of cognitive functions, affective and autonomic disorders as well as neurovestibular examination. RESULTS In some cases, dizziness was due to concomitant diseases of the vestibular system. Among the rest of the patients of the main group, signs of disorders of the central mechanisms of gaze control, otolith dysfunction, anxiety disorder and visuospatial dysfunction were recorded significantly more often than in the control group. The addition of vestibular rehabilitation to the complex treatment of patients of the main group helped to reduce postural instability and decreased the risk of falls. CONCLUSION Vestibular disorders are significantly more common in patients with PD who complain of dizziness. An early detection of these disorders is feasible with the help of neurovestibular research. It is reasonable to add individually selected vestibular exercises to the complex treatment of these disorders.
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Affiliation(s)
- A A Kashezheva
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - M V Zamergrad
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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11
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Gaßner H, List J, Martindale CF, Regensburger M, Klucken J, Winkler J, Kohl Z. Functional gait measures correlate to fear of falling, and quality of life in patients with Hereditary Spastic Paraplegia: A cross-sectional study. Clin Neurol Neurosurg 2021; 209:106888. [PMID: 34455170 DOI: 10.1016/j.clineuro.2021.106888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/12/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Gait impairment is the cardinal motor symptom in hereditary spastic paraplegias (HSPs) possibly linked to increased fear of falling and reduced quality of life (QoL). Disease specific symptoms in HSP are rated using the Spastic Paraplegia Rating Scale (SPRS). However, limited studies evaluated more objectively easy-to-apply gait measures by comparing these standardized assessments with patients' self-perceived impairment and clinically established scores. Therefore, the aim of this study was to correlate functional gait measures with self-rating questionnaires for fear of falling and QoL, and with the SPRS as clinical gold standard. METHODS HSP patients ("pure" phenotype, n = 22) fulfilling the clinical diagnostic criteria for HSP and age-and gender-matched healthy subjects (n = 22) were included in this study. Motor impairment was evaluated using the SPRS, fear of falling by the Falls Efficacy Scale-International (FES-I), and QoL by SF-12. Functional gait measures included gait speed and step length (10-meter-walk-test), the Timed up and go test (TUG), and maximum walking distance (2-min-walking-test). RESULTS Functional gait measures correlated to fear of falling (gait speed: r = -0.726; step length: r = -0.689; TUG: r = 0.721; 2-min: r = -0.709) and the physical component of QoL (gait speed: r = 0.541; step length: r = 0.531; TUG: r = -0.512; 2-min: r = 0.548). Furthermore, FES-I (r = 0.767) and QoL (r = -0.728) correlated with the clinical gold standard (SPRS). Gait measures strongly correlated with SPRS (gait speed: r = -0.787; step length: r = -0.821; TUG: r = 0.756; 2-min: r = -0.791). CONCLUSION Functional gait measures reflect fear of falling, QoL, and mobility in HSP. The metric, semi-quantitative gait measures complement the clinician's evaluation and support the clinical workup by more objective parameters.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Julia List
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | | | - Martin Regensburger
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Jochen Klucken
- Medical Valley - Digital Health Application Center GmbH, Bamberg, Germany; Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany
| | - Zacharias Kohl
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany; Department of Neurology, University of Regensburg, Regensburg, Germany.
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12
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Oh C, Morris RJ, LaPointe LL, Stierwalt JAG. Spatial-Temporal Parameters of Gait Associated With Alzheimer Disease: A Longitudinal Analysis. J Geriatr Psychiatry Neurol 2021; 34:46-59. [PMID: 32129132 DOI: 10.1177/0891988720901779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease (AD) is one of the biggest social and medical concerns in the aging world. A dual task of walking and talking is a particularly practical means to assess AD considering the cognitive and behavioral changes that characterize the disease. The purpose of the study was to assess the effect of the dual task of walking and talking on people with early stage AD under differing cognitive load levels of talking. Participants (9 women and 5 men, mean age (years) = 78.03, standard deviation [SD] = 12.06) with mild or moderate AD (mean Dementia Rating Scale 2 score = 88.14, SD = 7.07) completed 12 monthly walking sessions under no, low, or high cognitive load. They also completed the low and high cognitive load tasks while seated. Linear mixed-effects modeling revealed that values in the Functional Ambulation Profile, stride length, and velocity decreased as tasks became more complex and double support time increased at the same rate. The walking and seated conditions comparison indicated that participants' performance on both low and high cognitive tasks was poor when they were walking rather than seated. The results show that people with early stage AD exhibited gait impairments that increased over time and when completing tasks with greater cognitive load.
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Affiliation(s)
- Chorong Oh
- School of Rehabilitation and Communication Sciences, 1354Ohio University, Athens, OH, USA
| | - Richard J Morris
- School of Communication Science and Disorders, 7823Florida State University, Tallahassee, FL, USA
| | - Leonard L LaPointe
- School of Communication Science and Disorders, 7823Florida State University, Tallahassee, FL, USA
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13
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Venhovens J, Meulstee J, Bloem BR, Verhagen WIM. Neurovestibular Dysfunction and Falls in Parkinson's Disease and Atypical Parkinsonism: A Prospective 1 Year Follow-Up Study. Front Neurol 2020; 11:580285. [PMID: 33193032 PMCID: PMC7658339 DOI: 10.3389/fneur.2020.580285] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
Our primary aim was to determine whether neurovestibular laboratory tests can predict future falls in patients with either Parkinson's disease (PD) or atypical parkinsonism (AP). We included 25 healthy subjects, 30 PD patients (median Hoehn and Yahr stage 2.5, range 1–4), and 14 AP patients (6 multiple system atrophy, 3 progressive supranuclear palsy, and 5 vascular parkinsonism) in a case-control study design (all matched for age and gender). At baseline, all subjects underwent clinical neurological and neurotological assessments, cervical and ocular vestibular evoked myogenic potentials (VEMP), brainstem auditory evoked potentials (BAEP), subjective visual vertical measurements (SVV), and video nystagmography with caloric and rotary test stimulation. After 1 year follow-up, all subjects were contacted by telephone for an interview about their fall frequency (based upon fall diaries) and about their balance confidence (according to the ABC-16 questionnaire); only one participant was lost to follow-up (attrition bias of 1.4%). Cervical and ocular VEMPs combined with clinical tests for postural imbalance predicted future fall incidents in both PD and AP groups with a sensitivity of 100%. A positive predictive value of 68% was achieved, if only one VEMP test was abnormal, and of 83% when both VEMP tests were abnormal. The fall frequency at baseline and after 1 year was significantly higher and the balance confidence scale (ABC-16) was significantly lower in both the PD and AP groups compared to healthy controls. Therefore, VEMP testing can predict the risk of future fall incidents in PD and AP patients with postural imbalance.
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Affiliation(s)
- Jeroen Venhovens
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.,Department of Neurology and Clinical Neurophysiology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Jan Meulstee
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Bas R Bloem
- Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Behaviour and Cognition, Nijmegen, Netherlands
| | - Wim I M Verhagen
- Department of Neurology and Clinical Neurophysiology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
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14
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Xin Y, Ashburn A, Pickering RM, Seymour KC, Hulbert S, Fitton C, Kunkel D, Marian I, Roberts HC, Lamb SE, Goodwin VA, Rochester L, McIntosh E. Cost-effectiveness of the PDSAFE personalised physiotherapy intervention for fall prevention in Parkinson's: an economic evaluation alongside a randomised controlled trial. BMC Neurol 2020; 20:295. [PMID: 32781987 PMCID: PMC7418432 DOI: 10.1186/s12883-020-01852-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/01/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND PDSAFE is an individually-tailored, physiotherapist-delivered, balance, strength and strategy training programme aimed at preventing falls among people with Parkinson's. We evaluated the cost-effectiveness of PDSAFE compared with usual care for people with Parkinson's at higher risk of falling, from a UK National Health Service and Personal Social Service perspective. METHODS Resource use and quality of life data (EQ-5D-3L) were collected from 238 participants randomised to the PDSAFE intervention and 236 participants randomised to control, at baseline, 3 months, 6 months (primary outcome), and 12 months. Adjusted cost and quality-adjusted life-years (QALYs) were estimated using generalised linear models and uncertainty estimated using a non-parametric bootstrap. RESULTS Over 6 months, the PDSAFE intervention was associated with an incremental cost of £925 (95% CI £428 to £1422) and a very small and statistically insignificant QALY gain of 0.008 (95% CI - 0.006 to 0.021). The resulting incremental cost-effectiveness ratio (ICER) was £120,659 per QALY and the probability of the intervention being cost-effective at a UK threshold of £30,000/QALY was less than 1%. The ICER varied substantially across subgroups although no subgroup had an ICER lower than the £30,000 threshold. The result was sensitive to the time horizon with the ICER reducing to £55,176 per QALY when adopting a 12-month time horizon and assuming a sustained treatment effect on QoL, nevertheless, the intervention was still not cost-effective according to the current UK threshold. CONCLUSIONS Evidence from this trial suggests that the PDSAFE intervention is unlikely to be cost-effective at 6 months. The 12-month analysis suggested that the intervention became closer to being cost-effective if quality of life effects were sustained beyond the intervention period, however this would require confirmation. Further research, including qualitative studies, should be conducted to better understand the treatment effect of physiotherapy and its impact on quality of life in people with Parkinson's given existing mixed evidence on this topic. TRIAL REGISTRATION ISRCTN48152791. Registered 17 April 2014. http://www.isrctn.com/ISRCTN48152791.
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Affiliation(s)
- Yiqiao Xin
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank gardens, Glasgow, G12 8RZ, UK
| | - Ann Ashburn
- School of Health Science, University of Southampton, Southampton, UK
| | | | | | - Sophia Hulbert
- School of Health Science, University of Southampton, Southampton, UK
| | - Carolyn Fitton
- School of Health Science, University of Southampton, Southampton, UK
| | - Dorit Kunkel
- School of Health Science, University of Southampton, Southampton, UK
| | - Ioana Marian
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah E Lamb
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit (OCTRU), University of Oxford, Oxford, UK
| | | | - Lynn Rochester
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank gardens, Glasgow, G12 8RZ, UK.
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15
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Cogliati M, Cudicio A, Toscani F, Gaffurini P, Bissolotti LM, Orizio C, Negro F. Normalized maximal rate of torque development during voluntary and stimulated static contraction in human tibialis anterior: Influence of age. Exp Gerontol 2020; 138:110999. [PMID: 32512142 DOI: 10.1016/j.exger.2020.110999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/25/2022]
Abstract
The risk of falling in older adults has been related, among other factors, to the reduction of the rate of torque development (RTD) with age. It is well known that both structural/peripheral and neural factors can influence the RTD. The purpose of this study was to compare the normalized RTD in young and older participants obtained during a) rapid voluntary tension production and b) neuromuscular electrical stimulation. The tibialis anterior of 19 young subjects (10 males and 9 females; age 21-33 years old) and 19 older participants (10 males and 9 females; age 65-80 years old) was studied. The subjects performed a series of maximal isometric explosive dorsiflexions and underwent trains of supra-maximal electrical stimulations (35 Hz) on the tibialis anterior motor point. Muscle shortening was indirectly measured using a laser (surface mechanomyogram, MMG). Both torque and MMG were normalized to their maximum value. Using a 20 ms sliding window on the normalized torque signal, the normalized maximum RTD was calculated for both voluntary and stimulated contractions. Active stiffness of the muscle- tendon unit was calculated as the area of the normalized torque with respect to the normalized MMG. Normalized maximum RTD was found significantly lower in older adults during voluntary activity (young: 751.9 ± 216.3%/s and old: 513.9 ± 173.9%/s; P < .001), and higher during stimulated contractions (young: 753.1 ± 225.9%/s and old: 890.1 ± 221.3%/s; P = .009). Interestingly, active stiffness was also higher in older adults (young: 3524.6 ± 984.6‰ and old 4144.6 ± 816.6‰; P = .041) and significantly correlated to the normalized maximum RTD during stimulated contractions. This dichotomy suggests that modifications in the structural/peripheral muscle properties are not sufficient to counteract the age-related decrease in neural drive to the muscle during voluntary isometric contractions in aged participants.
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Affiliation(s)
- M Cogliati
- Centre of Research on the Neuromuscular Function and the Adapted Motor Activity, "Teresa Camplani" University of Brescia, Viale Europa, 11, 25123 Brescia, Italy
| | - A Cudicio
- Centre of Research on the Neuromuscular Function and the Adapted Motor Activity, "Teresa Camplani" University of Brescia, Viale Europa, 11, 25123 Brescia, Italy
| | - F Toscani
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11, 25123 Brescia, Italy
| | - P Gaffurini
- Rehabilitation Service, Fondazione Teresa Camplani-Casa di Cura Domus Salutis, Via Lazzaretto, 3, 25123 Brescia, Italy
| | - L M Bissolotti
- Rehabilitation Service, Fondazione Teresa Camplani-Casa di Cura Domus Salutis, Via Lazzaretto, 3, 25123 Brescia, Italy
| | - C Orizio
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11, 25123 Brescia, Italy; Centre of Research on the Neuromuscular Function and the Adapted Motor Activity, "Teresa Camplani" University of Brescia, Viale Europa, 11, 25123 Brescia, Italy.
| | - F Negro
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11, 25123 Brescia, Italy; Centre of Research on the Neuromuscular Function and the Adapted Motor Activity, "Teresa Camplani" University of Brescia, Viale Europa, 11, 25123 Brescia, Italy
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16
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Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. SENSORS 2020; 20:s20113247. [PMID: 32517315 PMCID: PMC7308812 DOI: 10.3390/s20113247] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.
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17
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Elangovan N, Cheung C, Mahnan A, Wyman JF, Tuite P, Konczak J. Hatha yoga training improves standing balance but not gait in Parkinson's disease. SPORTS MEDICINE AND HEALTH SCIENCE 2020; 2:80-88. [PMID: 35784178 PMCID: PMC9219298 DOI: 10.1016/j.smhs.2020.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 12/01/2022] Open
Abstract
Background and purpose Complementary therapies, such as yoga, have been proposed to address gait and balance problems in Parkinson's disease (PD). However, the effects of yoga on gait and static balance have not been studied systematically in people with PD (PWP). Here we evaluated the effects of a 12-week long Hatha yoga intervention on biomechanical parameters of gait and posture in PWP. Methods We employed a pilot randomized controlled trial design with two groups of mild-to-moderate PWP (immediate treatment, waitlist control; N = 10 each; Mean Hoehn and Yahr score = 2 for each group). Baseline Unified Parkinson's Disease Rating Scale (UPDRS) motor scores, and gait and postural kinematics including postural sway path length, cadence, walking speed, and turning time were obtained. The immediate treatment group received a 60-min Hatha yoga training twice a week for 12 weeks, while the waitlisted control group received no training. After 12 weeks, gait and postural kinematics were assessed (post-test for treatment group and second-baseline for waitlist group). Then, the waitlist group received the same yoga training and was evaluated post-training. Results After Hatha yoga training, UPDRS motor scores improved with an 8-point mean decrease which is considered as a moderate clinically important change for mild-moderate PD. Sway path length during stance decreased significantly (mean reduction: -34.4%). No significant between-group differences or improvements in gait kinematics were observed. Conclusion This study showed that a 12-week Hatha yoga training can improve static balance in PWP. We found no evidence that it systematically improves gait performance in PWP.
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Affiliation(s)
- Naveen Elangovan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA
- Corresponding author. Human Sensorimotor Control Laboratory School of Kinesiology, University of Minnesota, 1900 University Ave. SE, Minneapolis, MN, 55455, USA.
| | - Corjena Cheung
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Department of Health, Hong Kong Adventist College, Hong Kong, China
| | - Arash Mahnan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Jean F. Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Paul Tuite
- Department of Neurology, University of Minnesota Health, Minneapolis, MN, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
- Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA
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18
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Duncan RP, Van Dillen LR, Garbutt JM, Earhart GM, Perlmutter JS. Low Back Pain--Related Disability in Parkinson Disease: Impact on Functional Mobility, Physical Activity, and Quality of Life. Phys Ther 2019; 99:1346-1353. [PMID: 31343700 PMCID: PMC6821152 DOI: 10.1093/ptj/pzz094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/08/2018] [Accepted: 02/20/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND People with Parkinson disease (PD) frequently experience low back pain (LBP), yet the impact of LBP on functional mobility, physical activity, and quality of life (QOL) has not been described in PD. OBJECTIVE The objectives of this study were to describe body positions and functional activities associated with LBP and to determine the relationships between LBP-related disability and PD motor sign severity, physical activity level, and QOL. DESIGN The study was a cross-sectional study. METHODS Thirty participants with idiopathic PD (mean age = 64.6 years [SD = 10.3]; 15 women) completed the Revised Oswestry Disability Questionnaire (RODQ), a measure of LBP-related disability. PD motor symptom severity was measured using the Movement Disorder Society-Unified Parkinson Disease Rating Scale Part III (MDS-UPRDS III). The Physical Activity Scale for the Elderly (PASE) was used to measure self-reported physical activity. The Parkinson Disease Questionnaire-39 (PDQ-39) was used to measure QOL. Descriptive statistics were used to characterize LBP intensity and LBP-related disability. Spearman correlations were used to determine relationships between the RODQ and the MDS-UPDRS III, PASE, and PDQ-39. RESULTS LBP was reported to be of at least moderate intensity by 63.3% of participants. LBP most frequently impaired standing, sleeping, lifting, and walking. The RODQ was significantly related to the MDS-UPDRS III (r = 0.38), PASE (r = -0.37), PDQ-39 summary index (r = 0.55), PDQ-39 mobility subdomain (r = 0.54), and PDQ-39 bodily pain subdomain (r = 0.44). LIMITATIONS Limitations included a small sample of people with mild to moderate PD severity, the fact that RODQ is a less frequently used measure of LBP-related disability, and the lack of a non-PD control group. CONCLUSIONS LBP affected walking, sleeping, standing, and lifting in this small sample of people with mild to moderate PD. Greater LBP-related disability was associated with greater motor sign severity, lower physical activity level, and lower QOL in people with PD.
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Affiliation(s)
- Ryan P Duncan
- Program in Physical Therapy, Washington University School of Medicine in Saint Louis, 4444 Forest Park Blvd, Campus Box 8502, St Louis, MO 63108 (USA)
- Department of Neurology, Washington University School of Medicine in Saint Louis
| | - Linda R Van Dillen
- Program in Physical Therapy, and Department of Orthopaedic Surgery, Washington University School of Medicine in Saint Louis
| | - Jane M Garbutt
- Department of Medicine, and Department of Pediatrics, Washington University School of Medicine in Saint Louis
| | - Gammon M Earhart
- Program in Physical Therapy, Department of Neurology, and Department of Neuroscience, Washington University School of Medicine in Saint Louis
| | - Joel S Perlmutter
- Department of Neurology, Program in Physical Therapy, Department of Neuroscience, Department of Radiology, and Program in Occupational Therapy, Washington University School of Medicine in Saint Louis
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19
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Müller MLTM, Marusic U, van Emde Boas M, Weiss D, Bohnen NI. Treatment options for postural instability and gait difficulties in Parkinson's disease. Expert Rev Neurother 2019; 19:1229-1251. [PMID: 31418599 DOI: 10.1080/14737175.2019.1656067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Gait and balance disorders in Parkinson's disease (PD) represent a major therapeutic challenge as frequent falls and freezing of gait impair quality of life and predict mortality. Limited dopaminergic therapy responses implicate non-dopaminergic mechanisms calling for alternative therapies.Areas covered: The authors provide a review that encompasses pathophysiological changes involved in axial motor impairments in PD, pharmacological approaches, exercise, and physical therapy, improving physical activity levels, invasive and non-invasive neurostimulation, cueing interventions and wearable technology, and cognitive interventions.Expert opinion: There are many promising therapies available that, to a variable degree, affect gait and balance disorders in PD. However, not one therapy is the 'silver bullet' that provides full relief and ultimately meaningfully improves the patient's quality of life. Sedentariness, apathy, and emergence of frailty in advancing PD, especially in the setting of medical comorbidities, are perhaps the biggest threats to experience sustained benefits with any of the available therapeutic options and therefore need to be aggressively treated as early as possible. Multimodal or combination therapies may provide complementary benefits to manage axial motor features in PD, but selection of treatment modalities should be tailored to the individual patient's needs.
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Affiliation(s)
- Martijn L T M Müller
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Uros Marusic
- Institute for Kinesiology Research, Science and Research Centre of Koper, Koper, Slovenia.,Department of Health Sciences, Alma Mater Europaea - ECM, Maribor, Slovenia
| | - Miriam van Emde Boas
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolaas I Bohnen
- Functional Neuroimaging, Cognitive and Mobility Laboratory, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.,Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Neurology, University of Michigan, Ann Arbor, USA
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Grimmer M, Riener R, Walsh CJ, Seyfarth A. Mobility related physical and functional losses due to aging and disease - a motivation for lower limb exoskeletons. J Neuroeng Rehabil 2019; 16:2. [PMID: 30606194 PMCID: PMC6318939 DOI: 10.1186/s12984-018-0458-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 10/18/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Physical and functional losses due to aging and diseases decrease human mobility, independence, and quality of life. This study is aimed at summarizing and quantifying these losses in order to motivate solutions to overcome them with a special focus on the possibilities by using lower limb exoskeletons. METHODS A narrative literature review was performed to determine a broad range of mobility-related physical and functional measures that are affected by aging and selected cardiovascular, respiratory, musculoskeletal, and neurological diseases. RESULTS The study identified that decreases in limb maximum muscle force and power (33% and 49%, respectively, 25-75 yrs) and in maximum oxygen consumption (40%, 20-80 yrs) occur for older adults compared to young adults. Reaction times more than double (18-90 yrs) and losses in the visual, vestibular, and somatosensory systems were reported. Additionally, we found decreases in steps per day (75%, 60-85 yrs), maximum walking speed (24% 25-75 yrs), and maximum six-minute and self-selected walking speed (38% and 21%, respectively, 20-85 yrs), while we found increases in the number of falls relative to the number of steps per day (800%), injuries due to falls (472%, 30-90 yrs) and deaths caused by fall (4000%, 65-90 yrs). Measures were identified to be worse for individuals with impaired mobility. Additional detrimental effects identified for them were the loss of upright standing and locomotion, freezing in movement, joint stress, pain, and changes in gait patterns. DISCUSSION This review shows that aging and chronic conditions result in wide-ranging losses in physical and sensory capabilities. While the impact of these losses are relatively modest for level walking, they become limiting during more demanding tasks such as walking on inclined ground, climbing stairs, or walking over longer periods, and especially when coupled with a debilitating disease. As the physical and functional parameters are closely related, we believe that lost functional capabilities can be indirectly improved by training of the physical capabilities. However, assistive devices can supplement the lost functional capabilities directly by compensating for losses with propulsion, weight support, and balance support. CONCLUSIONS Exoskeletons are a new generation of assistive devices that have the potential to provide both, training capabilities and functional compensation, to enhance human mobility.
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Affiliation(s)
- Martin Grimmer
- Lauflabor Locomotion Lab, Technische Universität Darmstadt, Magdalenenstr. 27, Darmstadt, 64289 Germany
| | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology, ETH Zurich, Tannenstr. 1, Zurich, 8092 Switzerland
| | - Conor James Walsh
- Harvard Biodesign Lab, John A. Paulson School of Engineering and Applied Sciences, Wyss Institute for Biologically Inspired Engineering, Harvard University, 60 Oxford Street, Cambridge, 02138 MA United States
| | - André Seyfarth
- Lauflabor Locomotion Lab, Technische Universität Darmstadt, Magdalenenstr. 27, Darmstadt, 64289 Germany
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Toro P, Ceballos ME, Pesenti J, Inostroza M, Valenzuela D, Henríquez F, Forno G, Herold C, Schröder J, Calderón J. Neurological soft signs as a marker of cognitive impairment severity in people living with HIV. Psychiatry Res 2018; 266:138-142. [PMID: 29870954 DOI: 10.1016/j.psychres.2018.04.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/19/2018] [Accepted: 04/22/2018] [Indexed: 12/24/2022]
Abstract
HIV-associated neurocognitive disorders (HAND) include asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia. Early recognition of HAND is crucial, and usually requires thorough neuropsychological testing. Neurological soft signs (NSS), i.e. minor motor and sensory changes, a common feature in severe psychiatric disorders, may facilitate early diagnosis. NSS were examined using the Heidelberg NSS Scale in 18 patients with ANI, 21 with MND, 28 HIV positive patients without HAND, and 39 healthy controls matched for age, gender, and education. The highest NSS scores were obtained in the MND patients (13.3 ± 10.0, p < 0.0001) followed by those with ANI (11.7 ± 10.6), the HIV positive subjects without neurocognitive deficits (8.0 ± 4.1) and the healthy controls (3.8 ± 3.2). This result was confirmed when age and years of school education were entered as covariates. No significant correlations between NSS and CD4 counts or any other clinical variables were found among the HIV positive groups. Our results demonstrate that NSS are frequently found in both ANI and MND but not HIV positive patients without neurocognitive deficits. NSS may facilitate the screening of HIV positive patients for ANI and MND as an easier and less expensive clinical tool.
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Affiliation(s)
- Pablo Toro
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile; Advanced Center for Chronic Disease (ACCDiS), Medicine School, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - María Elena Ceballos
- Department of Infectious Diseases, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - José Pesenti
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - María Inostroza
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Daniela Valenzuela
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Fernando Henríquez
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gonzalo Forno
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Christina Herold
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Jorge Calderón
- Department of Psychiatry, Medicine School, Pontificia Universidad Catolica de Chile, Santiago, Chile
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22
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Franco MR, Pinto RZ, Delbaere K, Eto BY, Faria MS, Aoyagi GA, Steffens D, Pastre CM. Cross-cultural adaptation and measurement properties testing of the Iconographical Falls Efficacy Scale (Icon-FES). Braz J Phys Ther 2018; 22:291-303. [PMID: 29486980 DOI: 10.1016/j.bjpt.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Iconographical Falls Efficacy Scale (Icon-FES) is an innovative tool to assess concern of falling that uses pictures as visual cues to provide more complete environmental contexts. Advantages of Icon-FES over previous scales include the addition of more demanding balance-related activities, ability to assess concern about falling in highly functioning older people, and its normal distribution. OBJECTIVE To perform a cross-cultural adaptation and to assess the measurement properties of the 30-item and 10-item Icon-FES in a community-dwelling Brazilian older population. METHODS The cross-cultural adaptation followed the recommendations of international guidelines. We evaluated the measurement properties (i.e. internal consistency, test-retest reproducibility, standard error of the measurement, minimal detectable change, construct validity, ceiling/floor effect, data distribution and discriminative validity), in 100 community-dwelling people aged ≥60 years. RESULTS The 30-item and 10-item Icon-FES-Brazil showed good internal consistency (alpha and omega >0.70) and excellent intra-rater reproducibility (ICC2,1=0.96 and 0.93, respectively). According to the standard error of the measurement and minimal detectable change, the magnitude of change needed to exceed the measurement error and variability were 7.2 and 3.4 points for the 30-item and 10-item Icon-FES, respectively. We observed an excellent correlation between both versions of the Icon-FES and Falls Efficacy Scale - International (rho=0.83, p<0.001 [30-item version]; 0.76, p<0.001 [10-item version]). Icon-FES versions showed normal distribution, no floor/ceiling effects and were able to discriminate between groups relating to fall risk factors. CONCLUSION Icon-FES-Brazil is a semantically and linguistically appropriate tool with acceptable measurement properties to evaluate concern about falling among the community-dwelling older population.
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Affiliation(s)
- Marcia Rodrigues Franco
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil.
| | - Rafael Zambelli Pinto
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais UFMG, Belo Horizonte, MG, Brazil
| | - Kim Delbaere
- Neuroscience Research Australia (Neura), University of New South Wales, Sydney, NSW, Australia
| | - Bianca Yumie Eto
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Maíra Sgobbi Faria
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Giovana Ayumi Aoyagi
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Carlos Marcelo Pastre
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista UNESP, Presidente Prudente, SP, Brazil
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Gergova AA, Zamergrad MV, Artemiev DV, Levin OS. Vestibular disorders in patients with Parkinson's disease. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:73-76. [DOI: 10.17116/jnevro201811806273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Gaßner H, Marxreiter F, Steib S, Kohl Z, Schlachetzki JCM, Adler W, Eskofier BM, Pfeifer K, Winkler J, Klucken J. Gait and Cognition in Parkinson's Disease: Cognitive Impairment Is Inadequately Reflected by Gait Performance during Dual Task. Front Neurol 2017; 8:550. [PMID: 29123499 PMCID: PMC5662548 DOI: 10.3389/fneur.2017.00550] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/28/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction Cognitive and gait deficits are common symptoms in Parkinson’s disease (PD). Motor-cognitive dual tasks (DTs) are used to explore the interplay between gait and cognition. However, it is unclear if DT gait performance is indicative for cognitive impairment. Therefore, the aim of this study was to investigate if cognitive deficits are reflected by DT costs of spatiotemporal gait parameters. Methods Cognitive function, single task (ST) and DT gait performance were investigated in 67 PD patients. Cognition was assessed by the Montreal Cognitive Assessment (MoCA) followed by a standardized, sensor-based gait test and the identical gait test while subtracting serial 3’s. Cognitive impairment was defined by a MoCA score <26. DT costs in gait parameters [(DT − ST)/ST × 100] were calculated as a measure of DT effect on gait. Correlation analysis was used to evaluate the association between MoCA performance and gait parameters. In a linear regression model, DT gait costs and clinical confounders (age, gender, disease duration, motor impairment, medication, and depression) were correlated to cognitive performance. In a subgroup analysis, we compared matched groups of cognitively impaired and unimpaired PD patients regarding differences in ST, DT, and DT gait costs. Results Correlation analysis revealed weak correlations between MoCA score and DT costs of gait parameters (r/rSp ≤ 0.3). DT costs of stride length, swing time variability, and maximum toe clearance (|r/rSp| > 0.2) were included in a regression analysis. The parameters only explain 8% of the cognitive variance. In combination with clinical confounders, regression analysis showed that these gait parameters explained 30% of MoCA performance. Group comparison revealed strong DT effects within both groups (large effect sizes), but significant between-group effects in DT gait costs were not observed. Conclusion These findings suggest that DT gait performance is not indicative for cognitive impairment in PD. DT effects on gait parameters were substantial in cognitively impaired and unimpaired patients, thereby potentially overlaying the effect of cognitive impairment on DT gait costs. Limits of the MoCA in detecting motor-function specific cognitive performance or variable individual response to the DT as influencing factors cannot be excluded. Therefore, DT gait parameters as marker for cognitive performance should be carefully interpreted in the clinical context.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Franz Marxreiter
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Simon Steib
- Institute for Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Zacharias Kohl
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes C M Schlachetzki
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bjoern M Eskofier
- Chair for Machine Learning and Data Analytics, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Klaus Pfeifer
- Institute for Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Costamagna E, Thies SB, Kenney LPJ, Howard D, Liu A, Ogden D. A generalisable methodology for stability assessment of walking aid users. Med Eng Phys 2017; 47:167-175. [PMID: 28684213 DOI: 10.1016/j.medengphy.2017.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
To assist balance and mobility, older adults are often prescribed walking aids. Nevertheless, surprisingly their use has been associated with increased falls-risk. To address this finding we first need to characterise a person's stability while using a walking aid. Therefore, we present a generalisable method for the assessment of stability of walking frame (WF) users. Our method, for the first time, considers user and device as a combined system. We define the combined centre of pressure (CoPsystem) of user and WF to be the point through which the resultant ground reaction force for all feet of both the WF and user acts if theresultant moment acts only around an axisperpendicular tothe ground plane. We also define the combined base of support (BoSsystem) to be the convex polygon formed by the boundaries of the anatomical and WF feet in contact with the ground and interconnecting lines between them. To measure these parameters we have developed an instrumented WF with a load cell in each foot which we use together with pressure-sensing insoles and a camera system, the latter providing the relative position of the WF and anatomical feet. Software uses the resulting data to calculate the stability margin of the combined system, defined as the distance between CoPsystem and the nearest edge of BoSsystem. Our software also calculates the weight supported through the frame and when each foot (of user and/or frame) is on the floor. Finally, we present experimental work demonstrating the value of our approach.
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Affiliation(s)
- E Costamagna
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK .
| | - S B Thies
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK
| | - L P J Kenney
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK
| | - D Howard
- School of Computing, Science and Engineering, Salford University, Newton Bldg, Salford, Greater Manchester M5 4WT, UK
| | - A Liu
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK
| | - D Ogden
- School of Engineering, University of Edinburgh, Sanderson Bldg, Edinburgh EH9 3FB, UK
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Microstructural integrity of white matter tracts amongst older fallers: A DTI study. PLoS One 2017; 12:e0179895. [PMID: 28658309 PMCID: PMC5489210 DOI: 10.1371/journal.pone.0179895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/06/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives This study assesses the whole brain microstructural integrity of white matter tracts (WMT) among older individuals with a history of falls compared to non-fallers. Methods 85 participants (43 fallers, 42 non-fallers) were evaluated with conventional MRI and diffusion tensor imaging (DTI) sequences of the brain. DTI metrics were obtained from selected WMT using tract-based spatial statistics (TBSS) method. This was followed by binary logistic regression to investigate the clinical variables that could act as confounding elements on the outcomes. The TBSS analysis was then repeated, but this time including all significant predictor variables from the regression analysis as TBSS covariates. Results The mean diffusivity (MD) and axial diffusivity (AD) and to a lesser extent radial diffusivity (RD) values of the projection fibers and commissural bundles were significantly different in fallers (p < 0.05) compared to non-fallers. However, the final logistic regression model obtained showed that only functional reach, white matter lesion volume, hypertension and orthostatic hypotension demonstrated statistical significant differences between fallers and non-fallers. No significant differences were found in the DTI metrics when taking into account age and the four variables as covariates in the repeated analysis. Conclusion This DTI study of 85 subjects, do not support DTI metrics as a singular factor that contributes independently to the fall outcomes. Other clinical and imaging factors have to be taken into account.
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Dual-Task Does Not Increase Slip and Fall Risk in Healthy Young and Older Adults during Walking. Appl Bionics Biomech 2017; 2017:1014784. [PMID: 28255224 PMCID: PMC5307248 DOI: 10.1155/2017/1014784] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/16/2016] [Accepted: 12/28/2016] [Indexed: 12/04/2022] Open
Abstract
Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants' fall risks are modified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task walking have no destabilizing effect on gait and slip responses in healthy individuals. We also found that, during dual-tasking, healthy individuals adopted cautious gait mode (CGM) strategy that is characterized by reduced walking speed, shorter step length, increased step width, and reduced heel contact velocity and is likely to be an adaptation to minimize attentional demand and decrease slip and fall risk during limited available attentional resources. Exploring interactions between gait variability and cognitive functions while walking may lead to designing appropriate fall interventions among healthy and patient population with fall risk.
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Jessop RT, Horowicz C, Dibble LE. Motor Learning and Parkinson Disease: Refinement of Movement Velocity and Endpoint Excursion in a Limits of Stability Balance Task. Neurorehabil Neural Repair 2016; 20:459-67. [PMID: 17082501 DOI: 10.1177/1545968306287107] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate the effects of practice on performance and retention of a balance task in persons with Parkinson disease (PD). Methods. Ten persons with PD and 10 age and gender-matched healthy control subjects were tested on an anticipatory, static base of support, limits of stability (LOS) balance task on a force plate. The motor learning paradigm utilized for all subjects included an acquisition phase and retention tests at 24 h and 1 week after acquisition. A force plate was used for testing and to collect outcome measures including movement velocity (MVL), endpoint excursion (EPE), and directional control. Data were analyzed for differences between groups and change over time. Results.Persons with PD demonstrated performance deficits relative to controls for MVL at all testing periods ( P < 0.05), and initially for EPE ( P < 0.05), but were able to maintain significant improvements through retention testing relative to baseline ( P < 0.05). Conclusions. Persons with PD demonstrated unimpaired capacity for motor learning in a LOS balance task for MVL and EPE, although performance deficits remained for MVL. The results concur with previous motor learning research of upper extremity tasks by suggesting that individuals with mild to moderate PD exhibit a preserved ability to benefit from practice as a means of improving balance task performance.
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Artigas NR, Franco C, Leão P, Rieder CRM. Postural instability and falls are more frequent in Parkinson’s disease patients with worse trunk mobility. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:519-23. [DOI: 10.1590/0004-282x20160074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/06/2016] [Indexed: 11/21/2022]
Abstract
ABSTRACT Postural instability and axial rigidity are frequent symptoms of the Parkinson’s disease (PD). Objective Correlate the occurrence of falls and the activity of rolling over in bed with performance on the Trunk Mobility Scale (TMS) in patients with PD, and determine whether this instrument score can predict the risk of falls. Method This is a cross-sectional study. Assessed patients reported the frequency of falls in the previous year and whether they had difficulties rolling over in bed. Then, the following scales were applied: TMS, Hoehn and Yahr, Unified Parkinson’s Disease Rating Scale-III and Schwab and England Activities of Daily Living. Results Eighty-five patients were analyzed. Patients with a history of falling showed worse performance in the TMS (p < 0.01). There is a significant correlation between TMS and the activity of rolling over in bed (p < 0.01). Conclusion PD fallers present worse scores in TMS, and there is a significant correlation between difficulty rolling over in bed and TMS score.
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Affiliation(s)
| | | | - Paula Leão
- Centro Universitário Metodista do IPA, Brasil
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Donat H, Ozcan A. Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise. Clin Rehabil 2016; 21:273-83. [PMID: 17329285 DOI: 10.1177/0269215506069486] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare the effectiveness of unsupervised home and supervised group exercise on parameters related to risk of falling among older adults. Design: Prospective, single-blind, randomized and controlled trial. Setting: Nursing home. Subjects: The subjects were selected from 535 independent individuals who resided in a nursing home. Forty-two older adults, aged > 65 years, with risk of falling were recruited, and 32 of them completed the study. Intervention: The 42 subjects were divided into two groups (unsupervised home exercise and supervised exercise group) randomly. Exercise sessions were performed three times a week for a period of eight weeks. Main measures: Measurements were taken at baseline and after the completion of the exercise programme. The fear of falling was evaluated using a visual analogue scale, quadriceps muscle strength was measured with a dynamometer, flexibility was assessed with the sit and reach test, functional mobility was determined using the Timed Up and Go Test, balance was evaluated using one-leg and tandem standing, and Berg Balance Scale and proprioception was assessed with knee position sense. Results: Thirty-two subjects (unsupervised home exercise n = 15, supervised group exercise n = 17) completed the exercise programme and all of the measurements. The unsupervised home exercise group showed significant improvement in balance, functional mobility and flexibility (P > 0.05). In addition to balance, functional mobility and flexibility, the supervised exercise group also showed significant improvements in both strength and proprioception (P > 0.05). Conclusions: Supervised group exercise is more effective at reducing the risk factors related to falling among older adults living in a nursing home than is unsupervised home exercise.
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Affiliation(s)
- Hülya Donat
- Republic of Turkey Emekli Sandigi Narlidere Nursing Home, Izmir, Turkey
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Venhovens J, Meulstee J, Bloem BR, Verhagen WIM. Neurovestibular analysis and falls in Parkinson's disease and atypical parkinsonism. Eur J Neurosci 2016; 43:1636-46. [DOI: 10.1111/ejn.13253] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/07/2016] [Accepted: 03/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J. Venhovens
- Department of Neurology and Clinical Neurophysiology; Canisius Wilhelmina Hospital; Nijmegen the Netherlands
- Department of Neurology and Clinical Neurophysiology; Albert Schweitzer Hospital; Albert Schweitzerplaats 25 PO Box 444 3300 AK Dordrecht the Netherlands
| | - J. Meulstee
- Department of Neurology and Clinical Neurophysiology; Canisius Wilhelmina Hospital; Nijmegen the Netherlands
| | - B. R. Bloem
- Donders Institute for Brain; Behaviour and Cognition; Department of Neurology; Radboud University Medical Centre; Nijmegen the Netherlands
| | - W. I. M. Verhagen
- Department of Neurology and Clinical Neurophysiology; Canisius Wilhelmina Hospital; Nijmegen the Netherlands
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Hofheinz M, Mibs M. The Prognostic Validity of the Timed Up and Go Test With a Dual Task for Predicting the Risk of Falls in the Elderly. Gerontol Geriatr Med 2016; 2:2333721416637798. [PMID: 28138492 PMCID: PMC5119801 DOI: 10.1177/2333721416637798] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/04/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022] Open
Abstract
Objective: The aim is to examine the prognostic validity of the Timed Up and Go Test with a cognitive and a manual dual task for predicting the risk of falls. Method: A follow-up study was performed. The data were recorded for 120 volunteers in an outpatient physiotherapy center, with a 12-month follow-up. The sample included 120 elderly men and women aged 60 to 87 years (M age = 72.2 years) living at home. The main measurements were as follows: The Timed Up and Go Test (TUG), the TUG with a cognitive dual task (TUGcog), and the TUG with a manual dual task (TUGman) and falls. Results: In the 12-month follow-up, 37 persons (30.8%) had a locomotive fall. The receiver operating characteristic (ROC) curve shows significant results for the TUGcog. The area under the curve is 0.65 (p = .008), with a 95% confidence interval (CI) = [0.55, 0.76]. For the TUGman, the area under the curve is 0.57 with a 95% CI = [0.45, 0.68], which is not significant (p = .256). For the TUG, the area under the curve is 0.58, which is not significant (p = .256), 95% CI = [0.47, 0.69]. Conclusion: The TUGcog is a valid prognostic assessment to predict falls in community-dwelling elderly people.
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Affiliation(s)
| | - Michael Mibs
- Neuromuskuläres Therapiezentrum Dresden, Germany
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Porciuncula FS, Rao AK, McIsaac TL. Aging-related decrements during specific phases of the dual-task Timed Up-and-Go test. Aging Clin Exp Res 2016; 28:121-30. [PMID: 25995166 PMCID: PMC4654985 DOI: 10.1007/s40520-015-0372-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/05/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is unclear how young and older adults modulate dual-task mobility under changing postural challenges. AIM To examine age-related changes in dual-task processing during specific phases of dual-task Timed Up-and-Go (TUGdual-task). METHOD Healthy young and older adults performed the Timed Up-and-Go (TUG) with the following dual-task conditions: (1) serial-three subtractions, (2) carrying cup of water, (3) combined subtraction and carrying water, and (4) dialing cell phone. The primary outcome was the dual-task cost on performance of TUG (percent change from single- to dual-task) based on duration and peak trunk velocity of each phase: (a) straight-walk, (b) sit-to-stand, (c) turn, (d) turn-to-sit. Mixed-design univariate analysis of variance was performed for each type of task. RESULTS Older adults had more pronounced mobility decrements than young adults during straight-ahead walking and turns when the secondary task engaged both cognitive and manual modalities. Simple cognitive or manual tasks during TUGdual-task did not differentiate young from older participants. Subtraction performance during simple and complex cognitive conditions differed by phase of the TUG. Manual task performance of carrying water did not vary by phase or age. DISCUSSION Our findings suggest that dual-task processing is dynamic across phases of TUGdual-task. Aging-related dual-task decrements are demonstrated during straight-ahead walking and turning, particularly when the secondary task is more complex. CONCLUSION Older adults are susceptible to reduced dual-task mobility during straight-ahead walking and turning particularly when attentional loading was increased.
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Affiliation(s)
- Franchino S Porciuncula
- Department of Biobehavioral Sciences, Teachers College Columbia University, Movement Sciences, Box 199, 525 West 120th St., New York, NY, 10027, USA.
| | - Ashwini K Rao
- Department of Biobehavioral Sciences, Teachers College Columbia University, Movement Sciences, Box 199, 525 West 120th St., New York, NY, 10027, USA.
- Department of Rehabilitation and Regenerative Medicine (Physical Therapy) and G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 710 West 168th St., 8th Floor, New York, NY, 10032, USA.
| | - Tara L McIsaac
- Department of Biobehavioral Sciences, Teachers College Columbia University, Movement Sciences, Box 199, 525 West 120th St., New York, NY, 10027, USA.
- Department of Physical Therapy, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
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Abu Samah Z, Mohd Nordin NA, Shahar S, Singh DKA. Can gait speed test be used as a falls risk screening tool in community dwelling older adults? A review. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.poamed.2015.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Srulijes K, Mack DJ, Klenk J, Schwickert L, Ihlen EAF, Schwenk M, Lindemann U, Meyer M, Srijana KC, Hobert MA, Brockmann K, Wurster I, Pomper JK, Synofzik M, Schneider E, Ilg U, Berg D, Maetzler W, Becker C. Association between vestibulo-ocular reflex suppression, balance, gait, and fall risk in ageing and neurodegenerative disease: protocol of a one-year prospective follow-up study. BMC Neurol 2015; 15:192. [PMID: 26452640 PMCID: PMC4600299 DOI: 10.1186/s12883-015-0447-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/29/2015] [Indexed: 11/26/2022] Open
Abstract
Background Falls frequency increases with age and particularly in neurogeriatric cohorts. The interplay between eye movements and locomotion may contribute substantially to the occurrence of falls, but is hardly investigated. This paper provides an overview of current approaches to simultaneously measure eye and body movements, particularly for analyzing the association of vestibulo-ocular reflex (VOR) suppression, postural deficits and falls in neurogeriatric risk cohorts. Moreover, VOR suppression is measured during head-fixed target presentation and during gaze shifting while postural control is challenged. Using these approaches, we aim at identifying quantitative parameters of eye-head-coordination during postural balance and gait, as indicators of fall risk. Methods/Design Patients with Progressive Supranuclear Palsy (PSP) or Parkinson’s disease (PD), age- and sex-matched healthy older adults, and a cohort of young healthy adults will be recruited. Baseline assessment will include a detailed clinical assessment, covering medical history, neurological examination, disease specific clinical rating scales, falls-related self-efficacy, activities of daily living, neuro-psychological screening, assessment of mobility function and a questionnaire for retrospective falls. Moreover, participants will simultaneously perform eye and head movements (fixating a head-fixed target vs. shifting gaze to light emitting diodes in order to quantify vestibulo-ocular reflex suppression ability) under different conditions (sitting, standing, or walking). An eye/head tracker synchronized with a 3-D motion analysis system will be used to quantify parameters related to eye-head-coordination, postural balance, and gait. Established outcome parameters related to VOR suppression ability (e.g., gain, saccadic reaction time, frequency of saccades) and motor related fall risk (e.g., step-time variability, postural sway) will be calculated. Falls will be assessed prospectively over 12 months via protocols and monthly telephone interviews. Discussion This study protocol describes an experimental setup allowing the analysis of simultaneously assessed eye, head and body movements. Results will improve our understanding of the influence of the interplay between eye, head and body movements on falls in geriatric high-risk cohorts. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0447-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin Srulijes
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - David J Mack
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,Clinic for Neurology, University Hospital Zurich, Zurich, Switzerland.
| | - Jochen Klenk
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany. .,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| | - Lars Schwickert
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
| | - Espen A F Ihlen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Michael Schwenk
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
| | - Ulrich Lindemann
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
| | - Miriam Meyer
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - K C Srijana
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. srijana.k.c.@student.uni-tuebingen.de
| | - Markus A Hobert
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - Kathrin Brockmann
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - Isabel Wurster
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - Jörn K Pomper
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus -Senftenberg, Cottbus, Germany.
| | - Uwe Ilg
- Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Daniela Berg
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - Walter Maetzler
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany. .,German Research Center for Neurodegenerative Diseases (DZNE), University of Tuebingen, Tuebingen, Germany.
| | - Clemens Becker
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany.
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Duncan RP, Leddy AL, Cavanaugh JT, Dibble LE, Ellis TD, Ford MP, Foreman KB, Earhart GM. Balance differences in people with Parkinson disease with and without freezing of gait. Gait Posture 2015; 42:306-9. [PMID: 26141905 PMCID: PMC4591177 DOI: 10.1016/j.gaitpost.2015.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/10/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Freezing of gait (FOG) is a relatively common and remarkably disabling impairment associated with Parkinson disease (PD). Laboratory-based measures indicate that individuals with FOG (PD+FOG) have greater balance deficits than those without FOG (PD-FOG). Whether such differences also can be detected using clinical balance tests has not been investigated. We sought to determine if balance and specific aspects of balance, measured using Balance Evaluation Systems Test (BESTest), differs between PD+FOG and PD-FOG. Furthermore, we aimed to determine if time-efficient clinical balance measures (i.e. Mini-BESTest, Berg Balance Scale (BBS)) could detect balance differences between PD+FOG and PD-FOG. METHODS Balance of 78 individuals with PD, grouped as either PD+FOG (n=32) or PD-FOG (n=46), was measured using the BESTest, Mini-BESTest, and BBS. Between-groups comparisons were conducted for these measures and for the six sections of the BESTest using analysis of covariance. A PD composite score was used as a covariate. RESULTS Controlling for motor sign severity, PD duration, and age, PD+FOG had worse balance than PD-FOG when measured using the BESTest (p=0.008, F=7.35) and Mini-BESTest (p=0.002, F=10.37), but not the BBS (p=0.27, F=1.26). BESTest section differences were noted between PD+FOG and PD-FOG for reactive postural responses (p<0.001, F=14.42) and stability in gait (p=0.003, F=9.18). CONCLUSIONS The BESTest and Mini-BESTest, which specifically assessed reactive postural responses and stability in gait, were more likely than the BBS to detect differences in balance between PD+FOG and PD-FOG. Because it is more time efficient to administer, the Mini-BESTest may be the preferred tool for assessing balance deficits associated with FOG.
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Affiliation(s)
- Ryan P. Duncan
- Washington University School of Medicine in Saint Louis, Program in Physical Therapy,Washington University School of Medicine in Saint Louis, Department of Neurology
| | - Abigail L. Leddy
- Rehabilitation Hospital of the Pacific, Department of Physical Therapy
| | | | | | - Terry D. Ellis
- Boston University, Department of Physical Therapy and Athletic Training
| | - Matthew P. Ford
- University of Alabama at Birmingham School of Health Professions, Department of Physical Therapy
| | | | - Gammon M. Earhart
- Washington University School of Medicine in Saint Louis, Program in Physical Therapy,Washington University School of Medicine in Saint Louis, Department of Neurology,Washington University School of Medicine in Saint Louis, Department of Anatomy & Neurobiology
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Cruz-Díaz D, Martínez-Amat A, De la Torre-Cruz MJ, Casuso RA, de Guevara NML, Hita-Contreras F. Effects of a six-week Pilates intervention on balance and fear of falling in women aged over 65 with chronic low-back pain: A randomized controlled trial. Maturitas 2015; 82:371-6. [PMID: 26277254 DOI: 10.1016/j.maturitas.2015.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the effects of six weeks of Pilates regarding functional balance, fear of falling and pain in community living women older than 65 years old with chronic low-back pain. STUDY DESIGN A single blind controlled randomized trial of six weeks of Pilates in addition to physiotherapy treatment (n=50) vs. physiotherapy treatment alone (n=47) was conducted on 97 community living women (71.14 ± 3.30 years) with chronic low-back pain (CLBP). MAIN OUTCOME MEASURES Main outcome measures were fear of falling (FoF), assessed by the Falls Efficacy Scale-international; functional mobility and balance, measured with the Timed up and Go Test; and pain, evaluated using the numeric rating scale. RESULTS Only the Pilates group showed improvement in FoF (ES; d=.68) and functional mobility and balance (ES; d=1.12) after treatment, and also had better results in pain (ES; d=1.46) than the physiotherapy-only group. CONCLUSIONS Six weeks of Pilates exercises may be effective in fall prevention through the improvement of FoF, functional balance, and pain in Spanish women over 65 years old with CLBP.
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Affiliation(s)
- David Cruz-Díaz
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain
| | | | - Rafael A Casuso
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain
| | | | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain.
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Palmer TB, Thiele RM, Williams KB, Adams BM, Akehi K, Smith DB, Thompson BJ. The identification of fall history using maximal and rapid isometric torque characteristics of the hip extensors in healthy, recreationally active elderly females: a preliminary investigation. Aging Clin Exp Res 2015; 27:431-8. [PMID: 25539974 DOI: 10.1007/s40520-014-0305-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 12/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Maximal and rapid torque characteristics of the hip extensor muscles play an important role in fall prevention and other balance-related performances; however, few studies have investigated the ability of these variables at identifying fall-history status in healthy, recreationally active elderly adults. This study aimed to examine the effectiveness of maximal and rapid isometric torque characteristics of the hip extensor muscles to differentiate between healthy, recreationally active elderly females with (fallers) and without (non-fallers) a history a falls. METHODS Six elderly female fallers (mean ± SD: age = 73 ± 7 year; mass = 68 ± 16 kg; height = 160 ± 5 cm) and nine elderly female non-fallers (age = 71 ± 7 year; mass = 66 ± 16 kg; height = 157 ± 6 cm) performed two isometric maximal voluntary contractions (MVCs) of the hip extensor muscles. Peak torque (PT) and absolute and relative rate of torque development (RTD) at the early (0-50 ms) and late (100-200 ms) phases of muscle contraction were examined during each MVC. RESULTS Absolute and relative RTD at 0-50 ms were greater (P = 0.039 and 0.011, respectively) in the non-fallers compared to the fallers. However, no group-related differences (P = 0.160-0.573) were observed for PT nor absolute and relative RTD at 100-200 ms. CONCLUSIONS Early rapid strength production of the hip extensor muscles may be a sensitive and effective measure for discriminating between elderly females of different fall histories. These findings may provide important insight regarding implications for the assessment of fall risk and in the development of proper training programs aimed at minimizing the occurrence of falls and other balance-related injuries in the elderly.
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Affiliation(s)
- Ty B Palmer
- School of Health Sciences, Kent State University, Kent, OH, USA
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Goodwin VA, Pickering R, Ballinger C, Roberts H, McIntosh E, Lamb S, Nieuwboer A, Rochester L, Ashburn A. A multi-centre, randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's: study protocol. BMC Neurol 2015; 15:81. [PMID: 25971244 PMCID: PMC4431174 DOI: 10.1186/s12883-015-0332-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/30/2015] [Indexed: 03/24/2023] Open
Abstract
Background Falls amongst people with Parkinson’s (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population. The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP. Methods/Design A UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ≥24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible. The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care. Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants. The primary outcome is risk of repeat falling at six months post-randomisation. Discussion The aims of this trial are to establish the effectiveness and cost-effectiveness of a novel, home-delivered physiotherapy intervention (PDSAFE) compared with usual care on risk of falling for PwP who have a history of falling. PDSAFE is a novel intervention that builds upon the existing literature and targeting known risk factors, being the first study that uses a novel delivery modus (technology) in conjunction with traditional physiotherapeutic approaches. Trial registration Current Controlled Trials ISRCTN48152791
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Urbanowitsch N, Degen C, Toro P, Schröder J. Neurological soft signs in aging, mild cognitive impairment, and Alzheimer's disease - the impact of cognitive decline and cognitive reserve. Front Psychiatry 2015; 6:12. [PMID: 25717306 PMCID: PMC4324002 DOI: 10.3389/fpsyt.2015.00012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/22/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Neurological soft signs (NSS), i.e., minor motor and sensory changes, are a common feature in severe psychiatric disorders. We sought to establish the frequency of NSS in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) on basis of a large population-based sample and to identify their neuropsychological correlates including cognitive reserve. METHODS Neurological soft signs were examined using an abbreviated version of the Heidelberg NSS Scale in 221 "old" participants born between 1930 and 1932 (63 with MCI, 15 with AD, 143 healthy old controls) and 256 healthy "young" participants (born between 1950 and 1952) of the population-based interdisciplinary longitudinal study of aging. Subjects received thorough neuropsychological testing; years of school education were used as a proxy for cognitive reserve. RESULTS Neurological soft signs scores were significantly (p < 0.001) higher in the AD patients (5.6 ± 3.11) than in the healthy old controls (2.8 ± 1.90) and in the MCI patients (3.0 ± 1.96). This result was confirmed after years of school education, which were inversely correlated (r = -0.25; p < 0.001) with NSS were entered as a covariate. In the patients, but not in the controls, NSS were significantly correlated with deficits in executive functioning and visuospatial functioning. Comparison of NSS scores between "old" (2.84 ± 1.9) and "young" (2.46 ± 1.97) controls yielded only minor, non-significant differences after education (13.86 ± 3.0 vs. 14.61 ± 2.48 years, respectively) was controlled for. CONCLUSION Our results demonstrate that NSS are frequently found in mild AD, but not in MCI. NSS refer to frontal-executive deficits and visuospatial dysfunction rather than age per se and can be partly compensated for by cognitive reserve.
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Affiliation(s)
- Nadja Urbanowitsch
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christina Degen
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Pablo Toro
- Department of Psychiatry, Centro Interdisciplinario de Neurociencias, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Johannes Schröder
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
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Hita-Contreras F, Martínez-López E, González-Matarín P, Mendoza N, Cruz-Díaz D, Ruiz-Ariza A, Martínez-Amat A. Association of bone mineral density with postural stability and the fear of falling in Spanish postmenopausal women. Maturitas 2014; 79:322-8. [DOI: 10.1016/j.maturitas.2014.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
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Obayashi K, Araki T, Nakamura K, Kurabayashi M, Nojima Y, Hara K, Nakamura T, Yamamoto K. Risk of falling and hypnotic drugs: retrospective study of inpatients. Drugs R D 2014; 13:159-64. [PMID: 23760758 PMCID: PMC3689908 DOI: 10.1007/s40268-013-0019-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Falls and related injuries remain a concern for patient safety in many hospitals and nursing care facilities. In particular, reports examining the relationship between accidents and drugs with a sedative effect have been increasing; however, the analysis of correlation between the background factors of fall accidents and the detailed therapeutic category of drugs is insufficient. Objectives Our objective was to estimate fall risk following the administration of hypnotics in inpatients within an acute hospital. We assessed the relationship between falls and hypnotic drugs compared with other medicines. Study Design and Setting An inpatient population-based study was carried out at Gunma University Hospital, where all inpatients admitted between 1 October and 31 December 2007 were included. Over a 3-month follow-up period, all reports of falling accidents from ward medical staff were investigated. Results and Discussion Falls occurred in 1.8 % of males and 1.3 % of females in the study population (n = 3,683). The mean age of patients who experienced falls (64.7 ± 19.5 years) was significantly higher than that of patients who did not (56.2 ± 20.2 years). Multivariate analysis revealed the following drugs as high-risk factors for falling: hypnotics (odds ratio [OR] 2.17, 95 % CI 1.44–3.28), antiepileptics (OR 5.06, 95 % CI 2.70–9.46), opioids (OR 3.91, 95 % CI 2.16–7.10), anti-Alzheimer’s (OR 5.74, 95 % CI 1.62–20.3), anti-Parkinson’s (OR 5.06, 95 % CI 1.58–16.24), antidiabetics (OR 3.08, 95 % CI 1.63–5.84), antihypertensives (OR 2.24, 95 % CI 1.41–3.56), and antiarrhythmics (OR 2.82, 95 % CI 1.36–5.86). Multivariate logistic regression analysis of hypnotics, brotizolam, zopiclone, and estazolam revealed a significant association with an increased risk of inpatient falling accidents, while zolpidem, triazolam, flunitrazepam, and nitrazepam did not. Conclusion The present findings suggest that the risk of falling accidents in hospitals differs according to the type of hypnotic drug administered. The appropriate selection of hypnotic drugs, therefore, might be important for reducing the number of patient falls. Electronic supplementary material The online version of this article (doi:10.1007/s40268-013-0019-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyoko Obayashi
- Department of Pharmacy, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Takuya Araki
- Department of Pharmacy, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma 371-8511 Japan
- Department of Clinical Pharmacology, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Katsunori Nakamura
- Department of Clinical Pharmacology, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Yoshihisa Nojima
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Katsuyuki Hara
- Department of Pharmacy, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Tomonori Nakamura
- Department of Pharmacy, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma 371-8511 Japan
- Department of Clinical Pharmacology, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511 Japan
| | - Koujirou Yamamoto
- Department of Pharmacy, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma 371-8511 Japan
- Department of Clinical Pharmacology, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma 371-8511 Japan
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Borrione P, Tranchita E, Sansone P, Parisi A. Effects of physical activity in Parkinson's disease: A new tool for rehabilitation. World J Methodol 2014; 4:133-143. [PMID: 25332912 PMCID: PMC4202452 DOI: 10.5662/wjm.v4.i3.133] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/28/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disease characterized by bradykinesia, tremor, rigidity, and postural instability. Motor disorders are composite and combined, adversely affecting the patient’s health. Tremor and rigidity are correlated with worsening manual dexterity as well as postural changes such as akinesia and camptocormia. Moreover, gait alteration as well as postural instability, with consequent impairment in balance, increase the risk of falls. It is well known that these symptoms respond poorly to pharmacologic therapy in PD patients. Physical therapy is the most effective non-pharmacological aid to PD patients. Available data in the literature indicate that any rehabilitation protocol has to focus on: cognitive movement strategies, cueing strategies, and improved physical capacity and balance. Different training programs for PD patients have been designed and evaluated but only specific training strategies, tailored and individualized for each patient, may produce improvements in gait speed and stride length, decrease motor and balance symptoms and improve quality of life. Furthermore, aerobic training may improve muscle trophism, strength and mobility. It seems reasonable to state that tailored physical activity is a valid tool to be included in the therapeutic program of PD patients, considering that this approach may ameliorate the symptoms as well as the overall physical incapacity, reduce the risk of falls and injuries, and ultimately improve quality of life.
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Gamble KR, Cummings Jr. TJ, Lo SE, Ghosh PT, Howard Jr. JH, Howard DV. Implicit sequence learning in people with Parkinson's disease. Front Hum Neurosci 2014; 8:563. [PMID: 25136303 PMCID: PMC4118028 DOI: 10.3389/fnhum.2014.00563] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/10/2014] [Indexed: 11/13/2022] Open
Abstract
Implicit sequence learning involves learning about dependencies in sequences of events without intent to learn or awareness of what has been learned. Sequence learning is related to striatal dopamine levels, striatal activation, and integrity of white matter connections. People with Parkinson's disease (PD) have degeneration of dopamine-producing neurons, leading to dopamine deficiency and therefore striatal deficits, and they have difficulties with sequencing, including complex language comprehension and postural stability. Most research on implicit sequence learning in PD has used motor-based tasks. However, because PD presents with motor deficits, it is difficult to assess whether learning itself is impaired in these tasks. The present study used an implicit sequence learning task with a reduced motor component, the Triplets Learning Task (TLT). People with PD and age- and education-matched healthy older adults completed three sessions (each consisting of 10 blocks of 50 trials) of the TLT. Results revealed that the PD group was able to learn the sequence, however, when learning was examined using a Half Blocks analysis (Nemeth et al., 2013), which compared learning in the 1st 25/50 trials of all blocks to that in the 2nd 25/50 trials, the PD group showed significantly less learning than Controls in the 2nd Half Blocks, but not in the 1st. Nemeth et al. (2013) hypothesized that the 1st Half Blocks involve recall and reactivation of the sequence learned, thus reflecting hippocampal-dependent learning, while the 2nd Half Blocks involve proceduralized behavior of learned sequences, reflecting striatal-based learning. The present results suggest that the PD group had intact hippocampal-dependent implicit sequence learning, but impaired striatal-dependent learning. Thus, sequencing deficits in PD are likely due to striatal impairments, but other brain systems, such as the hippocampus, may be able to partially compensate for striatal decline to improve performance.
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Affiliation(s)
- Katherine R. Gamble
- Cognitive Aging Lab, Department of Psychology, Georgetown UniversityWashington, DC, USA
| | | | - Steven E. Lo
- Department of Neurology, MedStar Georgetown University HospitalWashington, DC, USA
| | - Pritha T. Ghosh
- Medical Faculty Associates, George Washington UniversityWashington, DC, USA
| | - James H. Howard Jr.
- Cognitive Aging Lab, Department of Psychology, Georgetown UniversityWashington, DC, USA
- Cognitive Aging Lab, Department of Psychology, The Catholic University of AmericaWashington, DC, USA
- Department of Neurology, Georgetown University Medical CenterWashington, DC, USA
| | - Darlene V. Howard
- Cognitive Aging Lab, Department of Psychology, Georgetown UniversityWashington, DC, USA
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Caspers S, Moebus S, Lux S, Pundt N, Schütz H, Mühleisen TW, Gras V, Eickhoff SB, Romanzetti S, Stöcker T, Stirnberg R, Kirlangic ME, Minnerop M, Pieperhoff P, Mödder U, Das S, Evans AC, Jöckel KH, Erbel R, Cichon S, Nöthen MM, Sturma D, Bauer A, Jon Shah N, Zilles K, Amunts K. Studying variability in human brain aging in a population-based German cohort-rationale and design of 1000BRAINS. Front Aging Neurosci 2014; 6:149. [PMID: 25071558 PMCID: PMC4094912 DOI: 10.3389/fnagi.2014.00149] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/17/2014] [Indexed: 12/26/2022] Open
Abstract
The ongoing 1000 brains study (1000BRAINS) is an epidemiological and neuroscientific investigation of structural and functional variability in the human brain during aging. The two recruitment sources are the 10-year follow-up cohort of the German Heinz Nixdorf Recall (HNR) Study, and the HNR MultiGeneration Study cohort, which comprises spouses and offspring of HNR subjects. The HNR is a longitudinal epidemiological investigation of cardiovascular risk factors, with a comprehensive collection of clinical, laboratory, socioeconomic, and environmental data from population-based subjects aged 45–75 years on inclusion. HNR subjects underwent detailed assessments in 2000, 2006, and 2011, and completed annual postal questionnaires on health status. 1000BRAINS accesses these HNR data and applies a separate protocol comprising: neuropsychological tests of attention, memory, executive functions and language; examination of motor skills; ratings of personality, life quality, mood and daily activities; analysis of laboratory and genetic data; and state-of-the-art magnetic resonance imaging (MRI, 3 Tesla) of the brain. The latter includes (i) 3D-T1- and 3D-T2-weighted scans for structural analyses and myelin mapping; (ii) three diffusion imaging sequences optimized for diffusion tensor imaging, high-angular resolution diffusion imaging for detailed fiber tracking and for diffusion kurtosis imaging; (iii) resting-state and task-based functional MRI; and (iv) fluid-attenuated inversion recovery and MR angiography for the detection of vascular lesions and the mapping of white matter lesions. The unique design of 1000BRAINS allows: (i) comprehensive investigation of various influences including genetics, environment and health status on variability in brain structure and function during aging; and (ii) identification of the impact of selected influencing factors on specific cognitive subsystems and their anatomical correlates.
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Affiliation(s)
- Svenja Caspers
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Susanne Moebus
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany
| | - Silke Lux
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Noreen Pundt
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany
| | - Holger Schütz
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Thomas W Mühleisen
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; Department of Genomics, Life & Brain Center, University of Bonn Bonn, Germany ; Institute of Human Genetics, University of Bonn Bonn, Germany
| | - Vincent Gras
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; Institute for Clinical Neuroscience and Medical Psychology, University of Düsseldorf Düsseldorf, Germany
| | - Sandro Romanzetti
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Tony Stöcker
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Rüdiger Stirnberg
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Mehmet E Kirlangic
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Peter Pieperhoff
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Ulrich Mödder
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany
| | - Samir Das
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University Montreal, QC, Canada
| | - Alan C Evans
- McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University Montreal, QC, Canada
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen Essen, Germany
| | - Raimund Erbel
- Department of Cardiology, University of Duisburg-Essen Essen, Germany
| | - Sven Cichon
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; Department of Genomics, Life & Brain Center, University of Bonn Bonn, Germany ; Institute of Human Genetics, University of Bonn Bonn, Germany ; Division of Medical Genetics, Department of Biomedicine, University of Basel Basel, Switzerland
| | - Markus M Nöthen
- Department of Genomics, Life & Brain Center, University of Bonn Bonn, Germany ; Institute of Human Genetics, University of Bonn Bonn, Germany
| | - Dieter Sturma
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; Institute for Science and Ethics, University of Bonn Bonn, Germany
| | - Andreas Bauer
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; Department of Neurology, Heinrich-Heine-University Düsseldorf Düsseldorf, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; JARA-BRAIN, Jülich-Aachen Research Alliance Jülich, Germany ; Department of Neurology, RWTH Aachen University Aachen, Germany
| | - Karl Zilles
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; JARA-BRAIN, Jülich-Aachen Research Alliance Jülich, Germany ; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University Aachen, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine (INM-1, INM-2, INM-4, INM-8), Research Centre Jülich Jülich, Germany ; JARA-BRAIN, Jülich-Aachen Research Alliance Jülich, Germany ; C. and O. Vogt Institute for Brain Research, Heinrich-Heine-University Düsseldorf Düsseldorf, Germany
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Baizer JS. Unique features of the human brainstem and cerebellum. Front Hum Neurosci 2014; 8:202. [PMID: 24778611 PMCID: PMC3985031 DOI: 10.3389/fnhum.2014.00202] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 03/21/2014] [Indexed: 12/28/2022] Open
Abstract
The cerebral cortex is greatly expanded in the human brain. There is a parallel expansion of the cerebellum, which is interconnected with the cerebral cortex. We have asked if there are accompanying changes in the organization of pre-cerebellar brainstem structures. We have examined the cytoarchitectonic and neurochemical organization of the human medulla and pons. We studied human cases from the Witelson Normal Brain Collection, analyzing Nissl sections and sections processed for immunohistochemistry for multiple markers including the calcium-binding proteins calbindin, calretinin, and parvalbumin, non-phosphorylated neurofilament protein, and the synthetic enzyme for nitric oxide, nitric oxide synthase. We have also compared the neurochemical organization of the human brainstem to that of several other species including the chimpanzee, macaque and squirrel monkey, cat, and rodent, again using Nissl staining and immunohistochemistry. We found that there are major differences in the human brainstem, ranging from relatively subtle differences in the neurochemical organization of structures found in each of the species studied to the emergence of altogether new structures in the human brainstem. Two aspects of human cortical organization, individual differences and left–right asymmetry, are also seen in the brainstem (principal nucleus of the inferior olive) and the cerebellum (the dentate nucleus). We suggest that uniquely human motor and cognitive abilities derive from changes at all levels of the central nervous system, including the cerebellum and brainstem, and not just the cerebral cortex.
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Affiliation(s)
- Joan S Baizer
- Department of Physiology and Biophysics, School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY , USA
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Iluz T, Gazit E, Herman T, Sprecher E, Brozgol M, Giladi N, Mirelman A, Hausdorff JM. Automated detection of missteps during community ambulation in patients with Parkinson's disease: a new approach for quantifying fall risk in the community setting. J Neuroeng Rehabil 2014; 11:48. [PMID: 24693881 PMCID: PMC3978002 DOI: 10.1186/1743-0003-11-48] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a leading cause of morbidity and mortality among older adults and patients with neurological disease like Parkinson's disease (PD). Self-report of missteps, also referred to as near falls, has been related to fall risk in patients with PD. We developed an objective tool for detecting missteps under real-world, daily life conditions to enhance the evaluation of fall risk and applied this new method to 3 day continuous recordings. METHODS 40 patients with PD (mean age ± SD: 62.2 ± 10.0 yrs, disease duration: 5.3 ± 3.5 yrs) wore a small device that contained accelerometers and gyroscopes on the lower back while participating in a protocol designed to provoke missteps in the laboratory. Afterwards, the subjects wore the sensor for 3 days as they carried out their routine activities of daily living. An algorithm designed to automatically identify missteps was developed based on the laboratory data and was validated on the 3 days recordings. RESULTS In the laboratory, we recorded 29 missteps and more than 60 hours of data. When applied to this dataset, the algorithm achieved a 93.1% hit ratio and 98.6% specificity. When we applied this algorithm to the 3 days recordings, patients who reported two falls or more in the 6 months prior to the study (i.e., fallers) were significantly more likely to have a detected misstep during the 3 day recordings (p = 0.010) compared to the non-fallers. CONCLUSIONS These findings suggest that this novel approach can be applied to detect missteps during daily life among patients with PD and will likely help in the longitudinal assessment of disease progression and fall risk.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeffrey M Hausdorff
- Laboratory for Gait &Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel.
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48
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van der Marck MA, Klok MP, Okun MS, Giladi N, Munneke M, Bloem BR. Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson's disease. Parkinsonism Relat Disord 2014; 20:360-9. [DOI: 10.1016/j.parkreldis.2013.10.030] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 09/13/2013] [Accepted: 10/02/2013] [Indexed: 11/27/2022]
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49
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Jeter PE, Nkodo AF, Moonaz SH, Dagnelie G. A systematic review of yoga for balance in a healthy population. J Altern Complement Med 2014; 20:221-32. [PMID: 24517304 DOI: 10.1089/acm.2013.0378] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE A systematic review was done of the evidence on yoga for improving balance. DESIGN Relevant articles and reviews were identified in major databases (PubMed, MEDLINE(®), IndMed, Web of Knowledge, EMBASE, EBSCO, Science Direct, and Google Scholar), and their reference lists searched. Key search words were yoga, balance, proprioception, falling, fear of falling, and falls. Included studies were peer-reviewed articles published in English before June 2012, using healthy populations. All yoga styles and study designs were included. Two (2) raters individually rated study quality using the Downs & Black (DB) checklist. Final scores were achieved by consensus. Achievable scores ranged from 0 to 27. Effect size (ES) was calculated where possible. RESULTS Fifteen (15) of 152 studies (age range 10-93, n=688) met the inclusion criteria: 5 randomized controlled trials (RCTs), 4 quasi-experimental, 2 cross-sectional, and 4 single-group designs. DB scores ranged from 10 to 24 (RCTs), 14-19 (quasi-experimental), 6-12 (cross-sectional), and 11-20 (single group). Studies varied by yoga style, frequency of practice, and duration. Eleven (11) studies found positive results (p<0.05) on at least one balance outcome. ES ranged from -0.765 to 2.71 (for 8 studies) and was not associated with DB score. CONCLUSIONS Yoga may have a beneficial effect on balance, but variable study design and poor reporting quality obscure the results. Balance as an outcome is underutilized, and more probing measures are needed.
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Affiliation(s)
- Pamela E Jeter
- 1 Lions Vision Research Center, Wilmer Eye Institute, Johns Hopkins University , Baltimore, MD
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50
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Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 2014; 14:14. [PMID: 24484314 PMCID: PMC3924230 DOI: 10.1186/1471-2318-14-14] [Citation(s) in RCA: 511] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022] Open
Abstract
Background The Timed Up and Go test (TUG) is a commonly used screening tool to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall predictive value of the TUG in community-dwelling older adults. Methods A literature search was performed to identify all studies that validated the TUG test. The methodological quality of the selected studies was assessed using the QUADAS-2 tool, a validated tool for the quality assessment of diagnostic accuracy studies. A TUG score of ≥13.5 seconds was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled estimates of sensitivity and specificity at ≥13.5 seconds. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity. Results Twenty-five studies were included in the systematic review and 10 studies were included in meta-analysis. The TUG test was found to be more useful at ruling in rather than ruling out falls in individuals classified as high risk (>13.5 sec), with a higher pooled specificity (0.74, 95% CI 0.52-0.88) than sensitivity (0.31, 95% CI 0.13-0.57). Logistic regression analysis indicated that the TUG score is not a significant predictor of falls (OR = 1.01, 95% CI 1.00-1.02, p = 0.05). Conclusion The Timed Up and Go test has limited ability to predict falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls in this setting.
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Affiliation(s)
| | - Rose Galvin
- HRB Centre for Primary Care research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St, Stephens Green, Dublin 2, Republic of Ireland.
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