Visual, musculoskeletal and balance symptoms in individuals with visual impairment

Latent transition analysis to explore patterns of physical functional decline among older adults in China: A national 6-year longitudinal study

BACKGROUND AND AIMS

Multiple limitations often co-occur and accumulate, leading to subsequent function decline. However, there is a scarcity of longitudinal studies examining the progression of physical function among the general population of older adults in China. This study aimed to define typical physical function status and its change, which were characterized by the coexistence and accumulation of diverse limitations targeting a Chinese sample of older adults.

METHODS

This study used the three recent public data waves of the Chinese Longitudinal Healthy Longevity Survey during a 6-year follow-up period. 9765 individuals who were over 65 and participated in the 2011 survey were included. Latent transition analysis was used to identify the latent physical function status and explore the transition of older adults among different latent statuses.

RESULTS

Seven latent statuses of physical function were identified, with visual impairment and related limitations being particularly prevalent among older adults. Upper limb mobility appeared to be a differentiated indicator of physical functional status. Physical function decline mainly started with the limitations in squatting, carrying weights and walking, then to the status with intact upper limb mobility and hearing function only, or converted directly into the latter, then to complete dysfunction.

CONCLUSIONS

Our findings suggest some indicative limitations and critical steps in the process of functional decline among older adults. These results may provide insight for researchers and policymakers to develop tailored preventive and rehabilitation care and provide support for physically limited elderly according to their latent status and course of functional decline.

The prevalence of locomotive syndrome and its associated factors in patients with Type 2 diabetes mellitus

OBJECTIVES

We investigated the prevalence of locomotive syndrome (LS) and related musculoskeletal diseases [osteoarthritis (OA), lumbar spondylosis, and spinal alignment] in Type 2 diabetes mellitus (DM) patients.

METHODS

Clinical data were collected from 101 patients (55 males; 46 females) admitted to our hospital for diabetes education from October 2018 to April 2021. Patients underwent full-spine and whole-legs standing radiography and physical measurements (10-m walking and grip strength tests and three LS risk tests).

RESULTS

The estimated prevalence of LS was 86.1% (Stage 1: 44.5%, Stage 2: 41.6%), lumbar spondylosis was 11.9%, and hip, knee, and ankle OA were 16.9%, 51.5%, and 12.9%, respectively. Multiple logistic regression analysis identified grip strength [odds ratio (OR) = 0.89, confidence interval (CI) = 0.83-0.94], diabetic retinopathy (OR = 5.85, CI = 1.64-20.78), knee OA (OR = 3.34, CI = 1.11-10.02), and a sagittal vertical axis >40 mm (OR = 3.42, CI = 1.13-10.39) as significantly associated risk factors for worsening LS in Type 2 DM patients.

CONCLUSIONS

This study clarified the epidemiological indicators of LS and associated factors in DM patients. Exercise therapy and DM management are effective strategies to reduce the occurrence and progression of LS.

Visual disorders and mal de debarquement syndrome: a potential comorbidity questionnaire-based study

Aim: Mal de debarquement syndrome (MdDS) is a neurological condition characterized by a constant sensation of self-motion; onset may be motion-triggered (MT) or non-motion-triggered/spontaneous (NMT/SO). People with MdDS experience similar symptoms to those with vertical heterophoria, a subset of binocular visual dysfunction. Hence, we aimed to explore potential visual symptom overlaps. Methods: MdDS patients (n = 196) and controls (n = 197) completed a visual health questionnaire. Results: Compared with controls, the MdDS group demonstrated higher visual disorder scores and visual complaints. NMT/SO participants reported unique visual symptoms and a higher prevalence of mild traumatic brain injury. Conclusion: Our findings suggest visual disorders may coexist with MdDS, particularly the NMT/SO subtype. The difference in visual dysfunction frequency and medical histories between subtypes, warrants further investigation into differing pathophysiological mechanisms.

Visual fatigue induced by watching virtual reality device and the effect of anisometropia

The effect of small anisometropia on visual fatigue when using virtual reality (VR) devices was investigated. Participants (n = 34) visited three times. In the first visit, VR exposure (10 min) was conducted with the full correction of the refractive error of both eyes. Experimental anisometropia was induced by adding a + 1.0 dioptre spherical lens either on the dominant eyes in the second visit or on the non-dominant eyes in the third visit. At each visit, the participants played a predetermined video game using a head-mounted display VR for 10 min. Visual fatigue was assessed before and after playing VR game using the Virtual Reality Symptom Questionnaire (VRSQ) and high-frequency component of accommodative microfluctuation. Results showed that watching VR induced significant increase of VRSQ score, significant decrease in the maximum accommodation power and objective increase in visual fatigue. Experimental anisometropia induction either on the dominant or non-dominant eyes did not aggravate visual fatigue. Practitioner summary: Mild differences in refractive error (up to 1.0 dioptre) between both eyes do not significantly increase ocular fatigue by viewing virtual reality device (10 min). The impact of small anisometropia may be limited in developing a virtual reality device. Abbreviations: VR: virtual reality; VRSQ: virtual reality symptom questionnaire; HMD: head-mounted display; HFC: high-frequency component.

Healthy Diet for Healthy Aging

Extending healthspan is a major public health challenge. Diet is one of the modifiable factors for preventing age-related diseases and preserving overall good health status during aging. Optimizing individuals’ intrinsic capacity, including domains in cognition, psychological, sensory function, vitality, and locomotion, has been proposed as a model of healthy aging by the World Health Organization. To better understand the relationships between a healthy diet and healthy aging, this review summarizes the recent epidemiologic and clinical data for dietary patterns that have been shown to play a role in (domains of) healthy aging. Regardless of priori or posteriori dietary patterns, it appears that dietary patterns centered on plant-based foods have a beneficial role in (domains of) healthy aging. Our review identified a knowledge gap in dietary patterns and multidimensional concepts of healthy aging. More epidemiological studies should consider intrinsic capacity as an outcome measure to further our understanding of a healthy diet and multidimensional concepts of healthy aging. When a sufficient number of epidemiological studies is available, evidence can be synthesized and clinical trials can be designed to evaluate a healthy diet as a strategy for healthy aging to further our progress in translating evidence to practice and promoting healthy aging.

[MDVI patients - Multiply disabled visually impaired : On the situation of the child, parents and ophthalmologist with MDVI children]

Functional visual perception significantly contributes to the child's development and consists of much more than just visual acuity and the visual field. It includes cognitive interpretation of visual stimuli and runs along the temporal and parietal pathways of visual processing. Central visual impairment (CVI) usually affects otherwise healthy children with often good visual acuity, whereas the multiply disabled visually impaired (MDVI) have visual impairment and multiple disabilities. In MDVI patients an ocular and/or CVI can be present. The examination of MDVI patients poses a great challenge for the ophthalmologist and reflective visual test procedures should also be used. Particular attention should be paid to refraction and accommodation. The main ocular diagnosis in MDVI is optic atrophy and the general diagnoses are dominated by sequelae of premature birth, often in combination with spasticity and epilepsy. Early intervention is essential and is independent of the underlying diagnoses.

Role of vision in static balance in persons with and without visual impairments

BACKGROUND

Vision is one of the elements of the system responsible for maintaining static balance. Any visual impairments or conditions hampering the reception of visual stimuli may affect static balance. It would be interesting to identify to what extent people with different degrees of dysfunction and in different conditions are able to compensate for the inability to receive visual stimuli while maintaining balance.

AIM

The aim of this study was to determine the role of the vision in maintaining static balance. This study sought to assess balance and the degree of compensation when the possibility of receiving visual stimuli is limited in persons without visual impairments and persons with varying degrees of visual impairments.

DESIGN

Controlled observational study.

SETTING

Main University Laboratory.

POPULATION

The study included 122 individuals, 81 of whom were visually impaired. The participants with visual impairments were divided into three groups according to their levels of disability.

METHODS

Subjects performed tests on a stabilographic platform: standing on both feet with eyes open and closed, single right- and left-leg stance with eyes open and closed. The center of pressure path length and the visual inspection indicator were analysed. Significance of differences between the groups regarding the visual inspection indicator and tests performed with eyes open and closed was assessed with the use of the Mann-Whitney U test. The effects and interactions between variables were verified using the ANOVA test for the main effects and factorial designs.

RESULTS

Differences were noted in balance of persons without visual impairments in single-leg stance tests with eyes open and closed as well as when standing on both feet with eyes open and closed. In persons with visual impairment, significant differences were observed in the single left-leg stance test with eyes open and closed only. Testing conditions and disability levels exerted a significant influence on static balance in single-leg tests.

CONCLUSIONS

The findings of the study confirm the role of vision in maintaining balance in the context of factors that may affect it, i.e. conditions (eyes open or closed) and possibilities of receiving visual stimuli (disability level).

CLINICAL REHABILITATION IMPACT

The significance of the visual effect was noted in single-leg tests. More demanding tests detect compensatory mechanisms of balance more accurately.

Postural Control Adaptation and Habituation During Vibratory Proprioceptive Stimulation: An HD-EEG Investigation of Cortical Recruitment and Kinematics

The objective of the present work is to measure postural kinematics and power spectral variation from HD-EEG to assess changes in cortical activity during adaptation and habituation to postural perturbation. To evoke proprioceptive postural perturbation, vibratory stimulation at 85 Hz was applied to the calf muscles of 33 subjects over four 75-second stimulation periods. Stimulation was performed according to a pseudorandom binary sequence. Vibratory impulses were synchronized to high-density electroencephalography (HD-EEG, 256 channels). Changes in absolute spectral power (ASP) were analyzed over four frequency bands ( ∆ : 0.5-3.5 Hz; θ : 3.5-7.5 Hz; α : 7.5-12.5 Hz; β : 12.5-30 Hz). A force platform recorded torque actuated by the feet, and normalized sway path length (SPL) was computed as a construct for postural performance during each period. SPL values indicated improvement in postural performance over the trial periods. Significant variation in absolute power values (ASP) was found in assessing postural adaptation: an increase in θ band ASP in the frontal-central region for closed-eyes trials, an increase in θ and β band ASP in the parietal region for open-eyes trials. In habituation, no significant variations in ASP were observed during closed-eyes trials, whereas an increase in θ , α , and β band ASP was observed with open eyes. Furthermore, open-eyed trials generally yielded a greater number of significant ASP differences across all bands during both adaptation and habituation, suggesting that following cortical activity during postural perturbation may be up-regulated with the availability of visual feedback. These results altogether provide deeper insight into pathological postural control failure by exploring the dynamic changes in both cortical activity and postural kinematics during adaptation and habituation to proprioceptive postural perturbation.

Cumulative Effect of Visual Impairment, Multimorbidity, and Frailty on Intrinsic Capacity in Community-Dwelling Older Adults

Objectives: We aim to determine the prevalence of vision impairment (VI) and its cumulative impact on multimorbidity, frailty, physical and cognitive function, and quality of life. Method: In all, 780 community-dwelling older adults were interviewed for demographic data and a one-off physical activity screening. Covariate measurements include vision via Snellen chart, multimorbidity, five-item FRAIL (Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight) scale and Mini-Mental State Examination (MMSE). Outcome variables taken were Barthel Index, Lawton Instrumental Activities of Daily Living (IADL) scale, grip strength, Timed Up and Go (TUG), and EuroQol 5D (EQ-5D). Results: In all, 426 (54.6%) were female, mean age was 71.3 ± 0.2 years; 240 (30.8%) had VI. The interaction between VI, multimorbidity, and frailty significantly impacts grip strength, TUG, quality of life, and IADL. Discussion: Our study is the first to look at the interaction of VI, multimorbidity, frailty, and its combined impact on key domains of intrinsic capacity. Our results further support vision screening to enable aging in place and highlight importance of screening for frailty and cognition in those with VI.