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Agathos CP, Velisar A, Shanidze NM. A Comparison of Walking Behavior during the Instrumented TUG and Habitual Gait. SENSORS (BASEL, SWITZERLAND) 2023; 23:7261. [PMID: 37631797 PMCID: PMC10459909 DOI: 10.3390/s23167261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.
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Cloutier M, DeLucia PR. Topical Review: Impact of Central Vision Loss on Navigation and Obstacle Avoidance while Walking. Optom Vis Sci 2022; 99:890-899. [PMID: 36594757 PMCID: PMC9813875 DOI: 10.1097/opx.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
SIGNIFICANCE Individuals with central vision loss are at higher risk of injury when walking and thus may limit trips outside the home. Understanding the mobility challenges associated with central vision loss (CVL) can lead to more effective interventions.A systematic literature review focusing on mobility in CVL was conducted. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, 2424 articles were identified in 4 databases (PsycINFO, APA PsycArticles, PubMed, and Web of Science). To be included within this review, the study methodology needed to be related to the three components of walking: (1) navigation, defined as the ability to reach a target destination; (2) obstacle avoidance, defined as the ability to avoid collisions with obstacles located at various heights and directions; and (3) street crossing, defined as the ability to both navigate a path and avoid collisions in a traffic environment. The methodology also needed to be empirical. Case studies, unstructured observational studies, studies based on self-report, research proposals, and existing systematic reviews were excluded. Titles, abstracts, and full text of identified articles were screened, yielding 26 articles included in the review. Results showed that, in many tasks, individuals with CVL can accomplish a level of performance comparable with individuals with normal vision. Differences between normal and impaired vision were due to either age or how the groups completed the task. For example, individuals with CVL could cross a street successfully but did so less safely (i.e., smaller safety margins) than individuals with normal vision. To identify new interventions for CVL, future research should focus on the differences in the mechanisms underlying mobility between individuals with normal and impaired vision rather than solely on performance differences.
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Affiliation(s)
- Melissa Cloutier
- Department of Psychological Sciences, Rice University, Houston, Texas
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Jeanvoine H, Labriffe M, Tannou T, Navasiolava N, Ter Minassian A, Girot JB, Leiber LM, Custaud MA, Annweiler C, Dinomais M. Specific age-correlated activation of top hierarchical motor control areas during gait-like plantar stimulation: An fMRI study. Hum Brain Mapp 2021; 43:833-843. [PMID: 34738281 PMCID: PMC8720193 DOI: 10.1002/hbm.25691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 12/26/2022] Open
Abstract
A better understanding of gait disorders that are associated with aging is crucial to prevent adverse outcomes. The functional study of gait remains a thorny issue due to technical constraints inherent to neuroimaging procedures, as most of them require to stay supine and motionless. Using an MRI‐compatible system of boots reproducing gait‐like plantar stimulation, we investigated the correlation between age and brain fMRI activation during simulated gait in healthy adults. Sixty‐seven right‐handed healthy volunteers aged between 20 and 77 years old (49.2 ± 18.0 years; 35 women) were recruited. Two paradigms were assessed consecutively: (a) gait‐like plantar stimulation and (b) chaotic and not gait‐related plantar stimulation. Resulting statistical parametric maps were analyzed with a multiple‐factor regression that included age and a threshold determined by Monte‐Carlo simulation to fulfill a family‐wise error rate correction of p < .05. In the first paradigm, there was an age‐correlated activation of the right pallidum, thalamus and putamen. The second paradigm showed an age‐correlated deactivation of both primary visual areas (V1). The subtraction between results of the first and second paradigms showed age‐correlated activation of the right presupplementary motor area (Brodmann Area [BA] 6) and right mid‐dorsolateral prefrontal cortex (BA9‐10). Our results show age‐correlated activity in areas that have been associated with the control of gait, highlighting the relevance of this simulation model for functional gait study. The specific progressive activation of top hierarchical control areas in simulated gait and advancing age corroborate a progressive loss of automation in healthy older adults.
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Affiliation(s)
- Henry Jeanvoine
- Department of Radiology, Angers University Hospital, University of Angers, Angers, France
| | - Matthieu Labriffe
- Department of Radiology, Angers University Hospital, University of Angers, Angers, France.,Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers, Angers, France
| | - Thomas Tannou
- Department of Geriatrics, Besançon University Hospital, University of Franche-Comté, Besançon, France.,Integrative and Clinical Neurosciences, EA 481, University of Franche-Comté, Besançon, France.,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - Nastassia Navasiolava
- Clinical Research Center, Angers University Hospital, University of Angers, Angers, France
| | - Aram Ter Minassian
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers, Angers, France.,Department of Anesthesia and Critical Care, Angers University Hospital, Angers, France
| | - Jean-Baptiste Girot
- Department of Radiology, Angers University Hospital, University of Angers, Angers, France.,Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers, Angers, France
| | - Louis-Marie Leiber
- Department of Radiology, Angers University Hospital, University of Angers, Angers, France.,Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers, Angers, France
| | - Marc-Antoine Custaud
- Clinical Research Center, Angers University Hospital, University of Angers, Angers, France.,Laboratoire de Biologie Neuro-Vasculaire et Mitochondriale Intégrée, UMR CNRS 6214 INSERM U1083, University of Angers, Angers, France
| | - Cédric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic-Angers University Hospital, UPRES EA 4638-University of Angers, Angers, France.,Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Mickaël Dinomais
- Laboratoire Angevin de Recherche en Ingénierie des Systèmes, EA7315, University of Angers, Angers, France.,Department of Physical and Rehabilitation Medicine, Angers University Hospital, University of Angers, Angers, France
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Bicket AK, Mihailovic A, E JY, Nguyen A, Mukherjee MR, Friedman DS, Ramulu PY. Gait in Elderly Glaucoma: Impact of Lighting Conditions, Changes in Lighting, and Fear of Falling. Transl Vis Sci Technol 2020; 9:23. [PMID: 33364078 PMCID: PMC7745602 DOI: 10.1167/tvst.9.13.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose The purpose of this study was to characterize the impact of lighting changes on gait in elderly patients with glaucoma and evaluate whether associations are mediated by fear of falling (FOF). Methods Gait initiation and parameters measured with the GAITRite Electronic Walkway were captured in normal indoor light, then in dim light, and again in normal light (normal post dim [NPD]). Participants’ right and left eye visual fields (VFs) were merged into integrated VF (IVF) sensitivities. FOF was evaluated using a Rasch-analyzed questionnaire. Multivariable regression models evaluated whether IVF sensitivity was associated with lighting-dependent gait changes and if this relationship was mediated by FOF. Results In 213 participants (mean age = 71.4 years), gait initiation in dim light took longer with more VF damage (P = 0.02). Greater VF damage was associated with slower gait in dim (P < 0.001) and NPD (P = 0.003) lighting, as well as shorter strides (P = 0.02), broader stance (P = 0.003), and more variable stride velocity and length in all lighting (all P < 0.03). When moving from normal to dim lighting, those with more VF damage slowed gait and cadence, shortened stride length, and lengthened double support time (all P < 0.001). Velocity, cadence, and double support time did not return to baseline in NPD lighting (all P < 0.05). Fear of falling did not appear to mediate the relationship between IVF sensitivity and lighting-dependent gait changes. Conclusions Patients with more VF damage demonstrate gait degradation in extreme or changing lighting, which is not mediated by FOF. Translational Relevance Quantitative spatiotemporal gait evaluation reveals lighting-associated impairment, supporting patient-reported difficulty with nonideal lighting and equipping providers to advise patients about limitations.
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Affiliation(s)
- Amanda K Bicket
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aleksandra Mihailovic
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jian-Yu E
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angeline Nguyen
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - David S Friedman
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Pradeep Y Ramulu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Petty LS, Foster JEG, Rigby P. Identifying community-dwelling older adults' vision loss during mobility assessments: A scoping review. Can J Occup Ther 2019; 86:95-105. [PMID: 30862231 DOI: 10.1177/0008417419831800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Co-occurring mobility issues and vision loss are prevalent in older adults. Vision loss can cause ambulation difficulties and falls. Community-dwelling older adults frequently require mobility-aids assessment by occupational therapists. However, therapists often lack access to medical documentation on vision or training in vision assessment to ensure that clients have adequate vision for safe mobility-aid use. PURPOSE. This study aimed to identify screening and assessment approaches to identify functional vision loss to guide mobility-aid prescription. METHOD. A scoping review following Arksey and O'Malley's five stages was undertaken using Medline and CINAHL databases. A data-charting form was used for extraction of information about each article, including the population, vision diagnosis, and the methodology for vision screening. The data regarding vision loss and mobility of older adults were summarized for each article. FINDINGS. Twenty-three papers were included in the study, describing screening questions and questionnaires or assessment tools to screen for vision loss in community settings. IMPLICATIONS. The various tools identified can better prepare therapists to prescribe mobility aids appropriate for seniors' level of functional vision and to refer clients for further assessment and intervention if warranted.
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Taylor DJ, Hobby AE, Binns AM, Crabb DP. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review. BMJ Open 2016; 6:e011504. [PMID: 27913556 PMCID: PMC5168634 DOI: 10.1136/bmjopen-2016-011504] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/21/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature. DESIGN Systematic review. METHODS A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT). RESULTS From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%. CONCLUSIONS There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Angharad E Hobby
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Skalicky SE, Fenwick E, Martin KR, Crowston J, Goldberg I, McCluskey P. Impact of age-related macular degeneration in patients with glaucoma: understanding the patients' perspective. Clin Exp Ophthalmol 2016; 44:377-87. [DOI: 10.1111/ceo.12672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 08/03/2015] [Accepted: 10/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Simon E Skalicky
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Ophthalmology Department; Addenbrookes Hospital; Cambridge UK
- Departments of Ophthalmology and Surgery, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Eva Fenwick
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Keith R Martin
- Ophthalmology Department; Addenbrookes Hospital; Cambridge UK
- Cambridge NIHR Biomedical Research Centre; University of Cambridge; Cambridge UK
| | - Jonathan Crowston
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Eye Associates; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
| | - Peter McCluskey
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
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Agarwal A, Rhoades WR, Hanout M, Soliman MK, Sarwar S, Sadiq MA, Sepah YJ, Do DV, Nguyen QD. Management of neovascular age-related macular degeneration: current state-of-the-art care for optimizing visual outcomes and therapies in development. Clin Ophthalmol 2015; 9:1001-15. [PMID: 26089632 PMCID: PMC4467654 DOI: 10.2147/opth.s74959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Contemporary management of neovascular age-related macular degeneration (AMD) has evolved significantly over the last few years. The goal of treatment is shifting from merely salvaging vision to maintaining a high quality of life. There have been significant breakthroughs in the identification of viable drug targets and gene therapies. Imaging tools with near-histological precision have enhanced our knowledge about pathophysiological mechanisms that play a role in vision loss due to AMD. Visual, social, and vocational rehabilitation are all important treatment goals. In this review, evidence from landmark clinical trials is summarized to elucidate the optimum modern-day management of neovascular AMD. Therapeutic strategies currently under development, such as gene therapy and personalized medicine, are also described.
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Affiliation(s)
- Aniruddha Agarwal
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - William R Rhoades
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mostafa Hanout
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Kamel Soliman
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Salman Sarwar
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohammad Ali Sadiq
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yasir Jamal Sepah
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diana V Do
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Quan Dong Nguyen
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
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Clark DJ. Automaticity of walking: functional significance, mechanisms, measurement and rehabilitation strategies. Front Hum Neurosci 2015; 9:246. [PMID: 25999838 PMCID: PMC4419715 DOI: 10.3389/fnhum.2015.00246] [Citation(s) in RCA: 229] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/17/2015] [Indexed: 01/29/2023] Open
Abstract
Automaticity is a hallmark feature of walking in adults who are healthy and well-functioning. In the context of walking, “automaticity” refers to the ability of the nervous system to successfully control typical steady state walking with minimal use of attention-demanding executive control resources. Converging lines of evidence indicate that walking deficits and disorders are characterized in part by a shift in the locomotor control strategy from healthy automaticity to compensatory executive control. This is potentially detrimental to walking performance, as an executive control strategy is not optimized for locomotor control. Furthermore, it places excessive demands on a limited pool of executive reserves. The result is compromised ability to perform basic and complex walking tasks and heightened risk for adverse mobility outcomes including falls. Strategies for rehabilitation of automaticity are not well defined, which is due to both a lack of systematic research into the causes of impaired automaticity and to a lack of robust neurophysiological assessments by which to gauge automaticity. These gaps in knowledge are concerning given the serious functional implications of compromised automaticity. Therefore, the objective of this article is to advance the science of automaticity of walking by consolidating evidence and identifying gaps in knowledge regarding: (a) functional significance of automaticity; (b) neurophysiology of automaticity; (c) measurement of automaticity; (d) mechanistic factors that compromise automaticity; and (e) strategies for rehabilitation of automaticity.
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Affiliation(s)
- David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System Gainesville, FL, USA ; Department of Aging and Geriatric Research, University of Florida Gainesville, FL, USA
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