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Hoang P, Sturnieks DL, Butler A, Chaplin C, Hicks C, Lo J, Ratanapongleka M, Robinson S, Smith N, Turner J, Krishnan AV, Barnett M, Gandevia S, Lord SR, Menant JC. A custom-built step exergame training programme to prevent falls in people with multiple sclerosis: A multicentre randomised controlled trial. Mult Scler 2024; 30:571-584. [PMID: 38362861 DOI: 10.1177/13524585241229360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Cognitive-motor step training can improve stepping, balance and mobility in people with multiple sclerosis (MS), but effectiveness in preventing falls has not been demonstrated. OBJECTIVES This multisite randomised controlled trial aimed to determine whether 6 months of home-based step exergame training could reduce falls and improve associated risk factors compared with usual care in people with MS. METHODS In total, 461 people with MS aged 22-81 years were randomly allocated to usual care (control) or unsupervised home-based step exergame training (120 minutes/week) for 6 months. The primary outcome was rate of falls over 6 months from randomisation. Secondary outcomes included physical, cognitive and psychosocial function at 6 months and falls over 12 months. RESULTS Mean (standard deviation (SD)) weekly training duration was 70 (51) minutes over 6 months. Fall rates did not differ between intervention and control groups (incidence rates (95% confidence interval (CI)): 2.13 (1.57-2.69) versus 2.24 (1.35-3.13), respectively, incidence rate ratio: 0.96 (95% CI: 0.69-1.34, p = 0.816)). Intervention participants performed faster in tests of choice-stepping reaction time at 6 months. No serious training-related adverse events were reported. CONCLUSION The step exergame training programme did not reduce falls among people with MS. However, it significantly improved choice-stepping reaction time which is critical to ambulate safely in daily life environment.
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Affiliation(s)
- Phu Hoang
- Neuroscience Research Australia, Randwick, NSW, Australia/School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- Multiple Sclerosis Plus, Lidcombe, NSW Australia
| | - Daina L Sturnieks
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
| | - Anna Butler
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Cameron Hicks
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Randwick, NSW, Australia
| | | | | | - Natassia Smith
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Jessica Turner
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Arun V Krishnan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Michael Barnett
- Sydney Neurology MS Clinic, The Brain and Mind Centre, Camperdown, NSW, Australia
| | - Simon Gandevia
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, Randwick, NSW, Australia
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
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Sturnieks DL, Hicks C, Smith N, Ratanapongleka M, Menant J, Turner J, Lo J, Chaplin C, Garcia J, Valenzuela MJ, Delbaere K, Herbert RD, Sherrington C, Toson B, Lord SR. Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial. Nat Med 2024; 30:98-105. [PMID: 38228913 DOI: 10.1038/s41591-023-02739-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024]
Abstract
Exergame training, in which video games are used to promote exercise, can be tailored to address cognitive and physical risk factors for falls and is a promising method for fall prevention in older people. Here, we performed a randomized clinical trial using the smart±step gaming system to examine the effectiveness of two home-based computer game interventions, seated cognitive training and step exergame training, for fall prevention in community-dwelling older people, as compared with a minimal-intervention control group. Participants aged 65 years or older (n = 769, 71% female) living independently in the community were randomized to one of three arms: (1) cognitive training using a computerized touchpad while seated, (2) exergame step training on a computerized mat or (3) control (provided with an education booklet on healthy ageing and fall prevention). The rate of falls reported monthly over 12 months-the primary outcome of the trial-was significantly reduced in the exergame training group compared with the control group (incidence rate ratio = 0.74, 95% confidence interval = 0.56-0.98), but was not statistically different between the cognitive training and control groups (incidence rate ratio = 0.86, 95% confidence interval = 0.65-1.12). No beneficial effects of the interventions were found for secondary outcomes of physical and cognitive function, and no serious intervention-related adverse events were reported. The results of this trial support the use of exergame step training for preventing falls in community-dwelling older people. As this intervention can be conducted at home and requires only minimal equipment, it has the potential for scalability as a public health intervention to address the increasing problem of falls and fall-related injuries. Australian and New Zealand Clinical Trial Registry identifier: ACTRN12616001325493 .
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Affiliation(s)
- Daina L Sturnieks
- Neuroscience Research Australia, Randwick, New South Wales, Australia.
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia.
| | - Cameron Hicks
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natassia Smith
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | | | - Jasmine Menant
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica Turner
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Jaime Garcia
- UTS Games Studio, Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Michael J Valenzuela
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Skin2Neuron Pty Ltd, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert D Herbert
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Sydney School of Public Health, Sydney Local Health District, University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Toson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- UNSW Ageing Futures Institute, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Herold F, Theobald P, Gronwald T, Kaushal N, Zou L, de Bruin ED, Bherer L, Müller NG. Alexa, let's train now! - A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:30-46. [PMID: 36736727 PMCID: PMC10818117 DOI: 10.1016/j.jshs.2023.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/07/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance. METHODS In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale). RESULTS Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group. CONCLUSION The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.
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Affiliation(s)
- Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China.
| | - Paula Theobald
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg 20457, Germany
| | - Navin Kaushal
- Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN 46202, USA
| | - Liye Zou
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich 8093, Switzerland; Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Stockholm 17177, Sweden; Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen 9001, Switzerland
| | - Louis Bherer
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada; Department of Medicine, Universite de Montreal, Montreal, QC H3T 1J4, Canada; Centre de Recherche de l'Institut Universitaire de Geriatrie de Montreal, Montreal, QC H3W 1W5, Canada
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany; Body-Brain-Mind Laboratory, Shenzhen University, Shenzhen 518060, China
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Tung C, Lord SR, Pelicioni PHS, Sturnieks DL, Menant JCC. Prefrontal and Motor Planning Cortical Activity during Stepping Tasks Is Related to Task Complexity but Not Concern about Falling in Older People: A fNIRS Study. Brain Sci 2023; 13:1675. [PMID: 38137123 PMCID: PMC10742256 DOI: 10.3390/brainsci13121675] [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: 09/29/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
This study investigated the effect of concern about falling on neural efficiency during stepping in older people. Community-dwellers aged >65 years were categorised as having low (n = 71) and high (n = 28) concerns about falling based on the Iconographical Falls Efficacy Scale (IconFES 10-item, scores <19 and ≥19, respectively). Participants performed a choice stepping reaction time test (CSRT), an inhibitory CSRT (iCSRT), and a Stroop stepping test (SST)) on a computerised step mat. Cortical activity was recorded using functional near-infrared spectroscopy. There were no significant differences in stepping response times or cortical activity in the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and premotor cortex (PMC) between those with and without concern about falling. However, stepping response times and cortical activity in the PFC, SMA, and PMC were significantly higher in the SST compared with the CSRT in the whole sample. PMC activity was also higher in the SST compared to the iCSRT. These findings demonstrate that cortical activity is higher in cognitively demanding stepping tasks that require selective attention and inhibition in healthy older people. The lack of association between concern about falling and neural efficiency during stepping in this older sample may reflect their only moderate scores on the IconFES.
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Affiliation(s)
- Carmen Tung
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
| | - Stephen Ronald Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Paulo Henrique Silva Pelicioni
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Daina Louise Sturnieks
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
- Ageing Future Institute, University of New South Wales, Kensington, NSW 2052, Australia
| | - Jasmine Charlotte Christiane Menant
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW 2031, Australia; (C.T.); (S.R.L.); (P.H.S.P.); (D.L.S.)
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2052, Australia
- Ageing Future Institute, University of New South Wales, Kensington, NSW 2052, Australia
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Pelicioni PHS, Lord SR, Menant JC, Chaplin C, Canning C, Brodie MA, Sturnieks DL, Okubo Y. Combined Reactive and Volitional Step Training Improves Balance Recovery and Stepping Reaction Time in People With Parkinson's Disease: A Randomised Controlled Trial. Neurorehabil Neural Repair 2023; 37:694-704. [PMID: 37864439 PMCID: PMC10666522 DOI: 10.1177/15459683231206743] [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] [Indexed: 10/22/2023]
Abstract
BACKGROUND Falls are frequent and devastating events for people with Parkinson's disease (PD). Here, we investigated whether laboratory-based reactive step training combined with home-based volitional step training was effective in improving balance recovery and stepping ability in people with PD. METHODS Forty-four people with idiopathic PD were randomized into intervention or control groups. Intervention participants performed unsupervised volitional step training using home-based exergames (80+ minutes/week) for 12 weeks and attended reactive step training sessions in which they were exposed to slip and trip perturbations at 4 and 8 weeks. Control participants continued their usual activities. Primary outcomes were balance recovery following an induced-trip/slip and choice stepping reaction time (CSRT) at the 12-week reassessment. Secondary outcomes comprised sensorimotor, balance, cognitive, psychological, complex stepping (inhibitory CSRT and Stroop Stepping Test [SST]), gait measures, and falls experienced in everyday life. RESULTS At reassessment, the intervention group had significantly fewer total laboratory-induced falls and faster CSRT compared to the control group (P < .05). The intervention group also had significantly faster inhibitory CSRT and SST movement times and made fewer mistakes in the SST (P < .05). There were no significant differences in the rate of every day falls or other secondary outcome measures between the groups. CONCLUSION Combined volitional and reactive step training improved balance recovery from an induced-perturbation, voluntary stepping time, and stepping accuracy in cognitively challenging tests in people with PD. Further research is required to determine whether such combined step training can prevent daily-life falls in this population.
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Affiliation(s)
- Paulo H. S. Pelicioni
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
- School of Health Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
| | - Jasmine C. Menant
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
| | - Carly Chaplin
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Collen Canning
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Matthew A. Brodie
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Randwick, NSW, Australia
| | - Daina L. Sturnieks
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Biomedical Sciences, University of New South Wales, Randwick, NSW, Australia
| | - Yoshiro Okubo
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
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Wang D, Zhou J, Huang Y, Yu H. Identifying the changes in the cortical activity of various brain regions for different balance tasks: A review. NeuroRehabilitation 2023:NRE220285. [PMID: 37125575 DOI: 10.3233/nre-220285] [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: 05/02/2023]
Abstract
BACKGROUND Balance support is critical to a person's overall function and health. Previous neuroimaging studies have shown that cortical structures play an essential role in postural control. OBJECTIVE This review aims to identify differences in the pattern of neural activity induced by balance tasks with different balance control requirements. METHODS Seventy-four articles were selected from the field of balance training and were examined based on four brain function detection technologies. RESULTS In general, most studies focused on the activity changes of various cortical areas during training at different difficulty levels, but more and more attention has also begun to focus on the functional changes of other cortical and deep subcortical structures. Our analysis also revealed the neglect of certain task types. CONCLUSION Based on these results, we identify and discuss future research directions that may contribute to a clear understanding of neural functional plasticity under different tasks.
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Affiliation(s)
- Duojin Wang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Jiankang Zhou
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Yanping Huang
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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Chu NCW, Sturnieks DL, Lord SR, Menant JC. Visuospatial working memory and obstacle crossing in young and older people. Exp Brain Res 2022; 240:2871-2883. [PMID: 36112172 PMCID: PMC9587940 DOI: 10.1007/s00221-022-06458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/02/2022] [Indexed: 12/05/2022]
Abstract
Obstacle crossing requires visuospatial working memory to guide the trailing leg trajectory when vision in unavailable. Visuospatial working memory, as assessed with neuropsychological tests, declines with age, however, this remains to be investigated functionally in obstacle crossing. There is also evidence that visuospatial encoding during a secondary task interferes with balance control during stepping and walking in older people. Here, we studied the interaction effects of age by delay (study 1) and age by secondary visuospatial task (study 2) conditions on obstacle clearance in a visuospatial working memory -guided obstacle crossing task. Healthy young adults aged 19 to 36 years (n = 20 in study 1 and n = 17 in study 2) and healthy older adults aged 66 to 83 years (n = 29 in study 1 and n = 21 in study 2) were instructed to step over an obstacle with their leading leg and straddle it for a delay period before completing the crossing with their trailing leg. In study 1, two obstacle height conditions (12 cm, 18 cm) and two delay durations (20 s, 60 s) were presented in random order. In study 2, participants were required to attend to either no secondary task (control), a visuospatial secondary (star movement) task, or a nonspatial secondary (arithmetic) task, while straddling the obstacle for a delay duration of 20 s, at obstacle heights of 12 cm and 18 cm, randomly presented. Trailing leg kinematics (mean and variability of maximum toe clearance over the obstacle) were determined via motion capture. There were no statistically significant age by delay or age by secondary task interactions. In study 1, toe clearance variability was significantly greater in young adults and increased with increasing delay duration in both groups. In study 2, compared with the control condition, toe clearance variability was significantly greater in the non-spatial secondary task condition but not in the visuospatial condition. Contrary to our hypotheses, these findings suggest that young and older adults alike can store an obstacle representation via visuospatial working memory for durations of at least 60 s and use this information to safely scale their trailing leg over an obstacle. However, the increase in trailing leg toe clearance variability with delay duration suggests that obstacle representation starts to deteriorate even within the first 20 s regardless of age. The finding that undertaking a concurrent arithmetic task impaired visuospatial working memory-guided obstacle clearance suggests a potential increased risk of tripping during obstacle crossing while dual-tasking in both young and older people.
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Affiliation(s)
- N C W Chu
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - D L Sturnieks
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - S R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - J C Menant
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.
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Spanò B, Lombardi MG, De Tollis M, Szczepanska MA, Ricci C, Manzo A, Giuli S, Polidori L, Griffini IA, Adriano F, Caltagirone C, Annicchiarico R. Effect of Dual-Task Motor-Cognitive Training in Preventing Falls in Vulnerable Elderly Cerebrovascular Patients: A Pilot Study. Brain Sci 2022; 12:168. [PMID: 35203932 PMCID: PMC8869774 DOI: 10.3390/brainsci12020168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
Falling is a frequent and major clinical problem among older adults, as well as in patients with chronic cerebrovascular diseases (CVD). At present, sequential (mixed) and simultaneously (dual-task) motor-cognitive trainings are the best approaches to affording patients more autonomy in their everyday motor independence while reducing fall risks and consequences. The objective of this study was to evaluate the efficacy of an advanced and innovative dual-task motor-cognitive rehabilitation program on fall risks in vulnerable older persons with chronic CVD. To this purpose, 26 consecutive older fallers with chronic CVD were recruited, and completed a mixed motor-cognitive or a dual-task motor-cognitive training program. Each patient also underwent two test evaluations to assess balance, gait, fear of falling, and walking performance at pre-and post-intervention. We found that our experimental motor-cognitive dual-task rehabilitation program could be an effective method to improve walking balance, gait, walking speed, and fear of falling, while reducing the risk of falls in older people with chronic CVD. Furthermore, results show that the simultaneous motor-cognitive training is more effective than the sequential motor-cognitive training. Therefore, our study brings innovative data, which can contribute positively to the management of this population.
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Affiliation(s)
- Barbara Spanò
- Technology and Training Methods for Disability Care Laboratory, Department of Clinical and Behavioral Neurology, Santa Lucia Foundation IRCCS, 00179 Rome, Italy; (M.G.L.); (M.D.T.); (M.A.S.); (C.R.); (A.M.); (S.G.); (L.P.); (I.A.G.); (F.A.); (C.C.); (R.A.)
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Pelicioni PHS, Lord SR, Sturnieks DL, Halmy B, Menant JC. Cognitive and Motor Cortical Activity During Cognitively Demanding Stepping Tasks in Older People at Low and High Risk of Falling. Front Med (Lausanne) 2021; 8:554231. [PMID: 34322496 PMCID: PMC8310929 DOI: 10.3389/fmed.2021.554231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Choice stepping reaction time tasks are underpinned by neuropsychological, sensorimotor, and balance systems and therefore offer good indices of fall risk and physical and cognitive frailty. However, little is known of the neural mechanisms for impaired stepping and associated fall risk in older people. We investigated cognitive and motor cortical activity during cognitively demanding stepping reaction time tasks using functional near-infrared spectroscopy (fNIRS) in older people at low and high fall risk. Methods: Ninety-five older adults [mean (SD) 71.4 (4.9) years, 23 men] were categorized as low or high fall risk [based on 12-month fall history (≥2 falls) and/or Physiological Profile Assessment fall risk score ≥1]. Participants performed a choice stepping reaction time test and a more cognitively demanding Stroop stepping task on a computerized step mat. Cortical activity in cognitive [dorsolateral prefrontal cortex (DLPFC)] and motor (supplementary motor area and premotor cortex) regions was recorded using fNIRS. Stepping performance and cortical activity were contrasted between the groups and between the choice and Stroop stepping conditions. Results: Compared with the low fall risk group (n = 71), the high fall risk group (n = 24) exhibited significantly greater DLPFC activity and increased intra-individual variability in stepping response time during the Stroop stepping task. The high fall risk group DLPFC activity was greater during the performance of Stroop stepping task in comparison with choice stepping reaction time. Regardless of group, the Stroop stepping task elicited increased cortical activity in the supplementary motor area and premotor cortex together with increased mean and intra-individual variability of stepping response times. Conclusions: Older people at high fall risk exhibited increased DLPFC activity and stepping response time variability when completing a cognitively demanding stepping test compared with those at low fall risk and to a simpler choice-stepping reaction time test. This increased hemodynamic response might comprise a compensatory process for postural control deficits and/or reflect a degree of DLPFC neural inefficiency in people with increased fall risk.
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Affiliation(s)
- Paulo H S Pelicioni
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.,School of Population Health, University of New South Wales, Sydney, NSW, Australia.,School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.,School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Daina L Sturnieks
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.,School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Bethany Halmy
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia.,School of Population Health, University of New South Wales, Sydney, NSW, Australia
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10
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St George RJ, Hinder MR, Puri R, Walker E, Callisaya ML. Functional Near-infrared Spectroscopy Reveals the Compensatory Potential of Pre-frontal Cortical Activity for Standing Balance in Young and Older Adults. Neuroscience 2020; 452:208-218. [PMID: 33197501 DOI: 10.1016/j.neuroscience.2020.10.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
Recent evidence suggests increased activity of the pre-frontal cortex (PFC) is associated with sensorimotor disturbances of standing balance. Here we manipulate sensorimotor inputs and concurrently load cognitive resources in order to investigate the functional role of PFC activity during standing balance, and how this changes with healthy ageing. Healthy younger (n = 24; mean age = 20.8 years) and older (n = 25; mean age = 70.6 years) adults maintained balance while sensorimotor inputs were manipulated by removing vision, reducing the base of support, and reducing proprioceptive feedback. To load cognitive resources, each balance condition was undertaken alone or simultaneously with a cognitive task (dual-task). Functional near infrared spectroscopy (fNIRS) measured PFC activity and a force-plate measured postural sway. When comparing dual-tasks relative to single balance tasks (dual-task effect), at lower levels of balance task demand, the older adults exhibited increased PFC activity and similar levels of postural sway. However, at higher levels of balance task demand, a limit to PFC activity was observed and postural sway became more unstable in older adults. In contrast, for younger adults at higher levels of balance task demand, the dual-task effect resulted in an increase in PFC activity and postural sway was not unduly affected. These results suggest that PFC activity is compensating for sensorimotor deficits to maintain stability, and that a cognitive resource limit is reached for easier balance tasks in older people compared to younger people. These results suggest that increasing cortical capacity in older people may improve their balance.
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Affiliation(s)
- Rebecca J St George
- Sensorimotor Neuroscience and Ageing Research Group, School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart 7001, Australia.
| | - Mark R Hinder
- Sensorimotor Neuroscience and Ageing Research Group, School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart 7001, Australia.
| | - Rohan Puri
- Sensorimotor Neuroscience and Ageing Research Group, School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart 7001, Australia.
| | - Eliza Walker
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart 7001, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart 7001, Australia; Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston 3199, Australia.
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11
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Pelicioni PHS, Lord SR, Okubo Y, Sturnieks DL, Menant JC. People With Parkinson’s Disease Exhibit Reduced Cognitive and Motor Cortical Activity When Undertaking Complex Stepping Tasks Requiring Inhibitory Control. Neurorehabil Neural Repair 2020; 34:1088-1098. [DOI: 10.1177/1545968320969943] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background People with Parkinson’s disease (PD) have difficulties generating quick and accurate steps in anticipation of and/or in response to environmental hazards. However, neural mechanisms underlying performance in cognitively demanding stepping tasks are unclear. Objective This study compared activation patterns in cognitive and motor cortical regions using functional near-infrared spectroscopy (fNIRS) between people with PD and age-matched healthy older adults (HOA) during stepping tasks. Methods Fifty-two people with PD and 95 HOA performed a simple choice stepping reaction time test (CSRT) and 2 cognitively demanding stepping tests (inhibitory CSRT [iCSRT] and Stroop stepping test [SST]) on a computerized step mat. Cortical activation in the dorsolateral prefrontal cortex (DLPFC), Broca’s area, supplementary motor area (SMA), and premotor cortex (PMC) were recorded using fNIRS. Stepping performance and cortical activity were contrasted between groups and between the CSRT and the iCSRT and SST. Results The PD group performed worse than the HOA in all 3 stepping tests. A consistent pattern of interactions indicated differential hemodynamic responses between the groups. Compared with the CSRT, the PD group exhibited reduced DLPFC activity in the iCSRT and reduced SMA and PMC activity in the SST. The HOA exhibited increased DLPFC, SMA, and PMC activity when performing the SST in comparison with the CSRT task. Conclusions In contrast to the HOA, the PD group demonstrated reduced cortical activity in the DLPFC, SMA, and PMC during the more complex stepping tasks requiring inhibitory control. This may reflect subcortical and/or multiple pathway damage with subsequent deficient use of cognitive and motor resources.
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Affiliation(s)
- Paulo H. S. Pelicioni
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia
- School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia
- School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia
| | - Yoshiro Okubo
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia
- School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia
| | - Daina L. Sturnieks
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, New South Wales, Australia
| | - Jasmine C. Menant
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia
- School of Public Health and Community and Medicine, University of New South Wales, New South Wales, Australia
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