Quantitative assessment of bed rise difficulty in young and elderly women

Assessing impaired bed mobility in patients with Parkinson's disease: a scoping review

BACKGROUND

Although most patients with Parkinson's disease (PD) experience difficulties in bed mobility, evidence on the suitability of the methods for assessing impaired bed mobility in PD are lacking.

OBJECTIVES

To identify objective methods for assessing impaired bed mobility in PD and to discuss their clinimetric properties and feasibility for use in clinical practice.

DATA SOURCES

PubMed, Web of Science, and Cochrane Library were searched between 1995 and 2022.

SELECTION CRITERIA

Studies were included if they described an objective assessment method for assessing impaired bed mobility in PD.

DATA EXTRACTION AND DATA SYNTHESIS

Characteristics of the identified measurement methods such as clinimetric properties and feasibility were extracted by two authors. The methodological quality of studies was evaluated using the Appraisal of studies tool.

RESULTS

Twenty-three studies were included and categorised into three assessment methods: sensor-based assessments (48%), rating scales (39%), and timed-tests (13%). The risk of bias was low for all but one study, which was medium.

LIMITATIONS

Despite applying wide selection criteria, a relatively small number of studies were identified in our results.

CONCLUSION

Rating scales may be the most preferred for assessing impaired bed mobility in PD in clinical practice, until clinimetric validity are adequately demonstrated in the other assessment methods. CONTRIBUTION OF PAPER.

Role of raising the upper limb of the non-rising side when performing rising movements from bed

Rising movements from bed comprise an important aspect of recovery from the bedridden state; however, they have not been sufficiently investigated using motion analysis studies. In particular, the effect of using the upper limb of the non-rising side before waist flexion on rising movements remains to be analyzed; this study aimed to clarify this effect. Accordingly, motion analyses were performed on rising movements under two constraint conditions, namely raising the upper limb of the non-rising side (upper limb use-condition) and keeping it in contact with the pelvis (upper limb non-use-condition); subsequently, the kinematics and kinematics parameters were compared. In comparison with the upper limb use-condition, in the upper limb non-use-condition, the distance traveled by the center of mass of the body (CoM trajectory, p < 0.01) increased while switching from the half-side-lying to on-hand postures, horizontal body movement (movement speed (Normalized time/total time), p < 0.01 and weight of center of body mass (CoM momentum in horizontal plane), p < 0.05) during the same period increased, and the half-side-lying time approached the peak value of the waist flexion angular velocity (Time lag between from half-side-lying to waist angler peak velocity, p < 0.05). The compensatory movement that occurred due to the upper limb non-use-condition denoted an increase in body momentum in the horizontal direction, rather than in the sagittal plane. Therefore, the upper limb on the non-rising side contributed to the smooth movement of the body in the horizontal direction. Moreover, this study demonstrated that asymmetrical rising movement in the diagonal direction is a characteristic movement wherein the horizontal movement of the body constitutes the main movement.

Technological evaluation of strategies to get out of bed by people with Parkinson's disease: Insights from multisite wearable sensors

Background

Difficulty getting out of bed is a common night-time and early morning manifestation of Parkinson's disease (PD), rated by 40% of the patients as their most concerning motor symptoms. However, current assessment methods are based on clinical interviews, video analysis, and clinical scales as objective outcome measures are not yet available.

Objective

To study the technical feasibility of multisite wearable sensors in the assessment of the supine-to-stand (STS) task as a determinant of the ability to get out of bed in patients with PD and age-matched control subjects, and develop relevant objective outcome measures.

Methods

The STS task was assessed in 32 patients with PD (mean Hoehn and Yahr; HY = 2.5) in the early morning before their first dopaminergic medication, and in 14 control subjects, using multisite wearable sensors (NIGHT-Recorder®; trunk, both wrists, and both ankles) in a sleep laboratory. Objective getting out of bed parameters included duration, onset, velocity and acceleration of truncal rotation, and angle deviation (a°) from the z-axis when subjects rose from the bed at different angles from the x-axis (10°, 15°, 30°, 45°, and 60°) as measures of truncal lateral flexion. Movement patterns were identified from the first body part or parts that moved. Correlation analysis was performed between these objective outcomes and standard clinical rating scales.

Results

Compared to control subjects, the duration of STS was significantly longer in patients with PD (p = 0.012), which is associated with a significantly slower velocity of truncal rotation (p = 0.003). Moderate and significant correlations were observed between the mean STS duration and age, and the Nocturnal Hypokinesia Questionnaire. The velocity of truncal rotation negatively and significantly correlated with HY staging. Any arm and leg moved together as the first movement significantly correlated with UPDRS-Axial and item #28. Several other correlations were also observed.

Conclusion

Our study was able to demonstrate the technical feasibility of using multisite wearable sensors to quantitatively assess early objective outcome measures of the ability of patients with PD to get out of bed, which significantly correlated with axial severity scores, suggesting that axial impairment could be a contributing factor in difficulty getting out of bed. Future studies are needed to refine these outcome measures for use in therapeutic trials related to nocturia or early morning akinesia in PD.

INBED: A Highly Specialized System for Bed-Exit-Detection and Fall Prevention on a Geriatric Ward

OBJECTIVE

In geriatric institutions, the risk of falling of patients is very high and frequently leads to fractures of the femoral neck, which can result in serious consequences and medical costs. With regard to the current numbers of elderly people, the need for smart solutions for the prevention of falls in clinical environments as well as in everyday life has been evolving.

METHODS

Hence, in this paper, we present the Inexpensive Node for bed-exit Detection (INBED), a comprehensive, favourable signaling system for bed-exit detection and fall prevention, to support the clinical efforts in terms of fall reduction. The tough requirements for such a system in clinical environments were gathered in close cooperation with geriatricians.

RESULTS

The conceptional efforts led to a multi-component system with a core wearable device, attached to the patients, to detect several types of movements such as rising, restlessness and-in the worst case-falling. Occurring events are forwarded to the nursing staff immediately by using a modular, self-organizing and dependable wireless infrastructure. Both, the hardware and software of the entire INBED system as well as the particular design process are discussed in detail. Moreover, a trail test of the system is presented.

CONCLUSIONS

The INBED system can help to relieve the nursing staff significantly while the personal freedom of movement and the privacy of patients is increased compared to similar systems.

Timed mobility: description of measurement, performance, and dimensionality among older adults

PURPOSE

To describe the measurement, performance, and dimensionality of five timed mobility activities completed by older adults.

MATERIALS AND METHODS

Cross-sectional observational study using correlational and factor analysis to examine the dimensionality of five timed mobility activities performed by 189 older adults in an outpatient setting.

RESULTS

The times to complete supine-to-sit, five repetition sit-to-stand, 8 m comfortable gait, four step ascent, and four step descent were correlated significantly with one another (r = 0.294-0.827, p < 0.001). The times were also internally consistent (α = 0.71) and loaded highly on a single factor (0.587-0.888).

CONCLUSION

The timed measurements of this study were easily obtained. They can be viewed as unidimensional and representative of a single construct of the international classification of functioning, disability, and health -timed mobility. Implications for rehabilitation For patients who are independent in mobility, timing offers a means of differentiating the performance of individual patients. As the times to complete five mobility activities are interrelated, mobility is supported as a rehabilitation construct and patients who are faster at one activity should be expected to be faster at another.

Analyzing the characteristics of rising from the bed in patients having undergone total hip arthroplasty immediately after surgery

BACKGROUND

Immediately after patients undergo total hip arthroplasty (THA), they are often coached through the process of rising from the bed to prevent dislocation. However, motion analysis of this process, which can guide coaching methods, has not been conducted. The purpose of this study was to clarify whether there is a difference in hip joint angle, rise time, pain, and difficulty based on the method of rising from the bed in postoperative patients, immediately after THA.

METHODS

Twenty patients who underwent THA were enrolled in this study. Seven days after surgery, 3-D motion analysis was performed while subjects rose from the bed using six different methods that include rising from the bed using either the affected or non-affected side either with or without assistance. Hip joint angle, rise time, pain, and difficulty were evaluated.

RESULTS

In all six methods, the maximal hip joint angle of the affected side was in the safe range. The maximal hip adduction angle and adduction angle at maximum flexion of the affected side were significantly lower in patients who rose from the bed using their affected side than in those who rose using their non-affected side. There were no differences in maximal hip flexion angle, internal rotation angle, internal rotation angle at maximum flexion of the affected side, rise time, pain, or difficulty regardless of the direction of rising from the bed or the use of assistance.

SIGNIFICANCE

Coaching patients to rise from the bed is better performed when using the most optimal method that takes into consideration the movement direction and patient's individuality.

Bed-exit alarm effectiveness

This study describes the accuracy of two types of bed-exit alarms to detect bed-exiting body movements: pressure-sensitive and a pressure-sensitive combined with infrared (IR) beam detectors (dual sensor system). We also evaluated the occurrence of nuisance alarms, or alarms that are activated when a participant does not attempt to get out of bed. Fourteen nursing home residents were directly observed for a total of 256 nights or 1636.5h; an average of 18.3+/-22.3 (+/-S.D.) nights/participant for an average of 6.4+/-1.2 h/night. After adjusting for body movements via repeated measures, Poisson regression modeling, the least squares adjusted means (LSM) show a marginally significant difference between the type of alarm groups on the number of true positives (NTP) (mean/S.E.M.=0.086/1.617) for pressure-sensitive versus dual sensor alarm (0.593/1.238; p=0.0599) indicating that the dual sensor alarm may have a higher NTP. While the dual sensor bed-exit alarm was more accurate than the pressure-sensitive alarm in identifying bed-exiting body movements and reducing the incidence of false alarms, false alarms were not eliminated altogether. Alarms are not a substitute for staff; adequate staff availability is still necessary when residents need or wish to exit bed.

Bed and Toilet Height as Potential Environmental Risk Factors

Seat height that is too high (> 120% of lower leg length [LLL]) or too low (< 80% of LLL) can impede safe transfer and result in falls. This study examines the difference between LLL of frail nursing home residents and the height of their toilets and beds in the lowest position, compares the patient or environmental characteristics of those able to transfer from the bed or toilet to those who cannot, and determines the relationship of patient or environmental characteristics to bed-related falls. A retrospective observational design using secondary data from 263 nursing home residents finds that bed height of three fourths of participants was greater than 140% of LLL, whereas toilet height of more than half was 100% to 120% of LLL. Increased fall risk is associated with increased age, shorter length of stay, normal lower extremity range of motion, less cognitive impairment, more behavioral symptoms, and no complaints of pain during exam.

Explosive force and fractionated reaction time in elderly low- and high-active women

PURPOSE

The purpose of this study was to determine whether muscle power, activation time, and neuromuscular stimulation are related to physical activity patterns in older women.

METHODS

Forty women (65-84 yr) were assigned to high-active (HA) and low-active (LA) groups on the basis of a historical activity questionnaire, and then they performed a series of maximal, voluntary, isometric knee extensions in a visually cued RT task. Fractionated RT measures were taken using three landmarks in the data: the presentation of the visual stimulus, the beginning of the EMG burst, and the initiation of force development. The rate and magnitude of neural stimulation were taken from surface EMG.

RESULTS

Peak torque was 15% greater, rate of torque development was 26% greater, motor time was 17% shorter, rate of EMG rise was 25% faster, and onset EMG magnitude was 15% greater in HA than in LA subjects (P<0.05).

CONCLUSION

These results indicate that older women with a history of vigorous activity can generate greater force, power, and motor output in comparison with their less active peers. The lower-body mass index of the HA subjects and 310% greater volume of physical activity are likely to account for the enhanced neuromuscular function seen. It is plausible that in addition to aging, physical inactivity is responsible for a large portion of the loss of neuromuscular function seen in older adults.

Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair

OBJECTIVES

To determine the effect of a 12-week intervention to improve the ability of disabled older adults to rise from a bed and from a chair.

DESIGN

Subjects were randomly allocated to either a 12-week task-specific resistance-training intervention (training in bed- and chair-rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention.

SETTING

Seven congregate housing facilities.

PARTICIPANTS

Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related activities of daily living: transferring, walking, bathing, and toileting.

MEASUREMENTS

At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed- and chair-rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks.

RESULTS

Regarding the maximum total number of bed- and chair-rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed- and chair-rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise-time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance.

CONCLUSIONS

Task-specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed- and chair-rise tasks. The actual rise-time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.

Chair and bed rise performance in ADL-impaired congregate housing residents

OBJECTIVES

To examine the ability of activity of daily living (ADL)-impaired older adults to successfully rise, and, when successful, the time taken to rise, from a bed and chair under varying rise task demands.

SETTING

Seven congregate housing facilities

SUBJECTS

Congregate housing residents (n = 116, mean age 82) who admitted to requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility-related ADLs: transferring, walking, bathing, and toileting.

METHODS

Subjects performed a series of bed and chair rise tasks where the rise task demand varied according to the head of bed (HOB) height, chair seat height, and use of hands. Bed rise tasks included supine to sit-to-edge, sit up in bed with hand use, and sit up in bed without hands, all performed from a bed where the HOB was adjusted to 0, 30, and 45 degrees elevations; roll to side-lying then rise (HOB 0 degrees); and supine to stand (HOB 0 degrees). Chair seat heights were adjusted according to the percent of the distance between the floor and the knee (% FK), and included rises (1) with hands and then without hands at 140, 120, 100, and 80% FK; (2) from a reclining (105 degrees at chair back) and tilting (seat tilted 10 degrees posteriorly) chair (100% FK); and (3) from a 80% FK seat height with a 4-inch cushion added, with and then without hands. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. After log transformation of rise time, a linear effects model was used to compare rise time between tasks.

RESULTS

The median total number of tasks successfully completed was 18 (range, 3-21). Nearly all subjects were able to rise from positions where the starting surface was elevated as long as hand use was unlimited. With the HOB at 30 or 45 degrees essentially all subjects could complete supine to sit-to-edge and sit up with hands. Essentially all subjects could rise from a seat height at 140, 120, and 100% FK as long as hand use was allowed. A small group (8-10%) of subjects was dependent upon hand use to perform the least challenging tasks, such as 140% FK without hands chair rise and 45 degrees sit up without hands. This dependency upon hand use increased significantly as the demand of the task increased, that is, as the HOB or seat height was lowered. Approximately three-quarters of the sample could not rise from a flat (0 degrees HOB elevation) bed or low (80% FK) chair when hand use was not allowed. Similar trends were seen in rise performance time, that is, performance times tended to increase as the HOB or chair seat elevation declined and as hand use was limited. Total self-reported ADL disability, compared to the single ADL transferring item, was a stronger predictor of rise ability and timed rise performance, particularly for chair rise tasks.

CONCLUSIONS

Lowering HOB height and seat height increased bed and chair rise task difficulty, particularly when hand use was restricted. Restricting hand use in low HOB height or lowered seat height conditions may help to identify older adults with declining rise ability. Yet, many of those who could not rise under "without hands" conditions could rise under "with hands" conditions, suggesting that dependency on hand use may be a marker of progressive rise impairment but may not predict day-to-day natural milieu rise performance. Intertask differences in performance time may be statistically significant but are clinically small. Given the relationship between self-reported ADL disability and rise performance, impaired rise performance may be considered a marker for ADL disability. These bed and chair rise tasks can serve as outcomes for an intervention to improve bed and chair rise ability and might also be used in future studies to quantify improvements or declines in function over time, to refine physical therapy protocols, and to examine the effect of bed and chair design modifications on bed and chai

Rising from the floor in older adults

OBJECTIVE

The primary goal was to determine the ability of older adults to rise from the floor. A secondary goal was to explore how rise ability might differ based on initial body positions and with or without the use of an assistive device.

DESIGN

Cross-sectional analysis of young, healthy older, and congregate housing older adults.

SETTING

University-based laboratory and congregate housing facility.

PARTICIPANTS

Young adult controls (12 men and 12 women, mean age 23 years), healthy older adults (12 men and 12 women, mean age 73 years), and congregate housing older adults (32 women and 6 men, mean age 80 years). The healthy older adult women (n = 12, mean age 75 years) and a subset of the congregate housing women (n = 27, mean age 81 years) were identified for further analyses.

INTERVENTION

Videotaping and timing of rising from the floor from controlled initial body positions (supine, on side, prone, all fours, and sitting) and with or without the use of a furniture support.

MAIN OUTCOME MEASURES

Whether subjects were successful in rising, and if they were, the time taken to rise. Subjects also rated their perceived difficulty of the task as compared to the reference task, rising from a supine position.

RESULTS

Older adults have more difficulty rising from the floor than younger adults. The healthy old took twice as long as the young to rise, whereas the congregate old took two to three times as long as the healthy old to rise. Although all young and healthy old rose from every position, a subset of the congregate housing residents was unable to rise from any position, 24% when attempting to rise without a support and 13% when attempting to rise with a support. Congregate old were most likely to be successful when rising from a side-lying position while using the furniture for support. The more able congregate old, as well as the young and healthy old, rose more quickly and admitted to the least difficulty when rising from the all fours position.

CONCLUSIONS

The inability to rise from the floor is relatively common in congregate housing older adults. Based on the differences between groups in time to complete the rise, determining the differences in rise strategies, and the underlying biomechanical requirements of rising from different positions with or without a support would appear to be useful. These data may serve as the foundation for future interventions to improve the ability to rise from the floor.

Healthy young and old women differ in their trunk elevation and hip pivot motions when rising from supine to sitting

OBJECTIVE

To describe the differences between healthy young and older women in regards to trunk elevation and hip pivot motions when rising from a supine to a seated position.

DESIGN

Cross-sectional comparison.

SETTING

University laboratory.

PARTICIPANTS

Two groups of healthy female volunteers: young adult female controls (n = 22, mean age 23.5 years) and community-dwelling older female adults (n = 17, mean age 73.8 years).

MEASUREMENTS

Subjects were videotaped as they performed three controlled bed mobility tasks, starting from a supine position: (1) rising to a seated position at the edge of a firm plinth surface (SS); and rising to a seated position without moving to the edge of the bed while either (2) using hands (SUH) or (3) not using hands (SUNH). A series of movements involving the trunk were identified as subjects performed the SS task.

RESULTS

The older women were more likely to rotate and laterally flex their trunks, particularly in the later phases of the SS task. In addition, during the SS task, the older group was more likely to bear weight on their hip/gluteal area, particularly in the later phases, and more likely to use a broad pivot base, consisting of the hip and the elbow. While all young and old performed the SUH task, less than half of the older group could complete the SUNH task. Moreover, the subgroup of older adults who could not complete the SUNH task may have accounted for much of the differences between the young and the old on the SS task.

CONCLUSION

Healthy young and older women differ in their ability to rise from a supine to sitting position, primarily in the strategies used to elevate the trunk and facilitate a pivot. Trunk flexion ability likely contributes to the age group differences noted in rising. These data provide the basis for a biomechanical analysis of the critical body segment motions and the strengths required to perform bed mobility tasks.