Associations Between Fine Motor Performance in Activities of Daily Living and Cognitive Ability in a Nondemented Sample of Older Adults: Implications for Geriatric Physical Rehabilitation

The Role of Visual Information Quantity in Fine Motor Performance

BACKGROUND/OBJECTIVES

Fine motor movements are essential for daily activities, such as handwriting, and rely heavily on visual information to enhance motor complexity and minimize errors. Tracing tasks provide an ecological method for studying these movements and investigating sensorimotor processes. To date, our understanding of the influence of different quantities of visual information on fine motor control remains incomplete. Our study examined how variations in the amount of visual feedback affect motor performance during handwriting tasks using a graphic pen tablet projecting on a monitor.

METHODS

Thirty-seven right-handed young adults (20 to 35 years) performed dot-to-dot triangle tracing tasks under nine experimental conditions with varying quantities of visual cues. The conditions and triangle shape rotations were randomized to avoid motor training or learning effects. Motor performance metrics, including absolute error, time of execution, speed, smoothness, and pressure, were analyzed.

RESULTS

As visual information increased, absolute error (from 6.64 mm to 2.82 mm), speed (from 99.28 mm/s to 57.19 mm/s), and smoothness (from 4.17 mm2/s6 to 0.80 mm2/s6) decreased, while time of execution increased (from 12.68 s to 20.85 s), reflecting a trade-off between accuracy and speed. Pressure remained constant across conditions (from 70.35 a.u. to 74.39). Spearman correlation analysis demonstrated a moderate to strong correlation between absolute error and time of execution across conditions. The Friedman test showed significant effects of experimental conditions on all motor performance metrics except for pressure, with Kendall's W values indicating a moderate to strong effect size.

CONCLUSION

These findings deepen our understanding of sensorimotor integration processes and could potentially have implications for optimizing motor skills acquisition and training and developing effective rehabilitation strategies.

Stroke rehabilitation: from diagnosis to therapy

Stroke remains a significant global health burden, necessitating comprehensive and innovative approaches in rehabilitation to optimize recovery outcomes. This paper provides a thorough exploration of rehabilitation strategies in stroke management, focusing on diagnostic methods, acute management, and diverse modalities encompassing physical, occupational, speech, and cognitive therapies. Emphasizing the importance of early identification of rehabilitation needs and leveraging technological advancements, including neurostimulation techniques and assistive technologies, this manuscript highlights the challenges and opportunities in stroke rehabilitation. Additionally, it discusses future directions, such as personalized rehabilitation approaches, neuroplasticity concepts, and advancements in assistive technologies, which hold promise in reshaping the landscape of stroke rehabilitation. By delineating these multifaceted aspects, this manuscript aims to provide insights and directions for optimizing stroke rehabilitation practices and enhancing the quality of life for stroke survivors.

Complex decongestive therapy improves finger tapping score in patients with breast cancer-related lymphedema

PURPOSE

Breast cancer-related lymphedema (BCRL) impairs upper limb function and cognitive performance. This study aimed to evaluate the effects of fifteen sessions of complex decongestive therapy (CDT) on fine motor performance and information processing speed in women with BCRL.

METHODS

Thirty-eight women with BCRL (54.97 ± 10.78 years) were recruited in the study. Participants either received five times weekly CDT consisting of manual lymphatic drainage, skin care, compression bandaging, and remedial exercises (n = 19) or served as a wait-list control group (n = 19). We used the Finger Tapping Task to assess fine motor performance and the Digit Symbol Substitution Test to assess information processing speed. ANCOVA was performed to analyze the effect of CDT on the dependent variables, adjusting for covariates and baseline values.

RESULTS

CDT significantly improved finger tapping score (p < 0.001) compared to the wait-list to the control group, whereas information processing speed did not significantly change (p = 0.673).

CONCLUSION

The findings suggest that CDT is an effective conservative therapeutic approach to improve upper extremity fine motor function in women with BCRL. Future studies are needed to investigate the effect of CDT on different cognitive domains.

Social capital and well-being of the elderly 'left-behind' by their migrant children in India

BACKGROUND

The study aims to examine the association between individual forms of social capital and the well-being of the elderly 'left-behind' parents and to determine if there is a gender difference within the possible relationship.

METHODS

This study applied the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18) data. In this study, the respondents were 4,736 older parents 'left-behind' by their migrant adult sons. We employed descriptive statistics and bivariate analysis to assess the study sample's characteristics. The proportion test was performed to examine if there was a significant gender difference among older adults regarding depression, ADL, and IADL impairments. In addition, binary logistic regression was utilized to investigate the associations between social capital and elderly parents' health outcomes.

RESULTS

This study found a significant gender difference in depression (male: 8.26%; female:11.32%; P < 0.001), ADL (male:20.23%; female:25.75%; P = 0.032), and IADL (male: 33.97% female: 54.13%; P < 0.001) limitations. Elderly parents who did not participate in any social activity had a higher odd of ADL (aOR: 2.44; 95%CI: 1.882-3.171; P = < 0.001) and IADL (aOR: 1.22; 95%CI: 1.034-1.766 ; P = < 0.001) limitations. Networking with friends through phone/email conversations has a substantial impact on lowering depression in older parents. Older adults with good personal social capital were less likely to have depression, ADL, and IADL limitations.

CONCLUSION

Personal social capital is closely associated with the well-being of left-behind older parents. More efforts should be in place to increase the stock of social capital in this group with focused gender disparity.

Investigating Subtypes of Motor Skills and Activities of Daily Living among Young Children with Motor Delay

The purpose of this study was to classify preschool children into subtypes based on motor skills and to characterize the activities of daily living for each subtype. The subjects were 45 preschool children whose scores on the Movement Assessment Battery for Children-Second Edition (MABC-2) and the Functional Independence Measure for Children (WeeFIM) were measured. The fine score and gross score were calculated from the MABC-2, and a cluster analysis was performed. The difference between the fine score and the gross score was evaluated for each subtype, and multiple comparisons among subtypes were performed for the fine, gross, and WeeFIM scores. Subtype analysis showed that the fine score was significantly lower than the gross score for subtype I (p < 0.001), and the gross score was significantly lower than the fine score for subtype III (p = 0.018). Subtype II had a significantly lower score than subtype I and subtype III (p < 0.001). Children with subtype II had more difficulty dressing movements and less communication skills than subtype III (p < 0.05). Classification into three subtypes according to motor ability and some of the characteristics of ADLs were identified.

Head posture mediates the association of cognition with hand grip and pinch strength in older adults: an examination using structural equation modeling

BACKGROUND

The association of cognition with hand grip and pinch strength has been well-recognized in older adults. The authors sought to explore: (1) associations among forward head posture (FHP), cognition, and hand grip and pinch strength in older adults; and (2) the mediator role of FHP in these pathways using structural equation modeling (SEM).

METHODS

This cross-sectional study included 88 older adults (70.5% male; mean age = 68.75±3.87 years). Cognition was assessed by the Mini-Mental State Examination (MMSE), head posture by the Craniovertebral Angle (CVA) obtained from photographic analysis, hand grip strength by a handheld dynamometer, and pinch strength by a pinch meter. Using the two SEMs, a potential mediator role of the CVA was investigated. While the MMSE was addressed as an independent variable in both models, hand grip and pinch strength were addressed as dependent variables in model 1 and model 2, respectively.

RESULTS

The correlations between the CVA and MMSE (r = 0.310), hand grip strength (r = 0.370), and pinch strength (r = 0.274 to 0.292) were statistically significant (p < 0.001). In addition, significant associations were found between the MMSE and hand grip and pinch strength, ranging from 0.307 to 0.380 (p < 0.001). The mediation analysis showed that the standardized total (β = 0.41, p < 0.001) and indirect (mediated) effects (β = 0.12, p = 0.008) of the MMSE on hand grip strength were significant in model (1) The results were similar for model (2) The standardized total (β = 0.39, p = 0.001) and indirect effects (β = 0.10, p = 0.026) of the MMSE on pinch strength were significant. As a partial mediator in both models, the CVA explained 29% and 26% of the total effect in models 1 and 2, respectively.

CONCLUSIONS

The CVA was associated with the MMSE, hand grip strength, and pinch strength, and CVA partially mediates the association of the MMSE with grip and pinch strength in older adults, indicating that cognition had an effect on grip and pinch strength through an indirect path via head posture. This finding reveals that evaluating head posture and providing corrective therapeutic interventions as needed may be beneficial in reducing the negative impact of decreased cognition on motor functions in older adults.

Mediation Analysis of the Effect of Visuospatial Memory on Motor Skill Learning in Older Adults

There is high inter-individual variability in motor skill learning among older adults. Identifying the nature of these individual differences remains challenging due to interactions between participant characteristics (e.g., age, cognition) and task-related factors (e.g., nature of task, level of skill pre-training), making it difficult to determine plausibly causal relationships. This study addresses these competing explanations by using mediation analysis to examine plausible causal inference between visuospatial memory and one-month retention of both gross and fine motor components of a functional upper-extremity task following training. Results suggest that better visuospatial memory results in more retention of fine but not gross motor skill, expanding on previous correlational studies in older adults and informing future interventions for maximizing motor learning in geriatric populations.

Is intensive gait training feasible and effective at old age? A retrospective case-control study on the use of Lokomat Free-D in patients with chronic stroke

BACKGROUND

In the last decade, the number of people over 60 has increased, leading to various healthcare problems. The aim of this retrospective study is to evaluate the effects of robotic rehabilitation in elderly patients as well as their perception of usability and adaptation to intensive robotic neurorehabilitation.

METHODS

This is a retrospective case-control study. Eighty elderly stroke patients were included in the analysis using an electronic data retrieval system. The enrolled patients were divided into two groups: the experimental group (EG) underwent rehabilitation training with Lokomat FreeD, equipped with a VR screen, while the control group (CG) performed traditional rehabilitation training. The two groups matched for age, sex, education, brain injury, stroke interval. The rehabilitation protocol included a total of 40 training sessions.

RESULTS

Both types of rehabilitation led to an improvement in the perceived level of disability (FIM) and in the performance in gait and balance (TT), highlighting a significant improvement especially in the EG. However, only in the EG, Lokomat training had induced an increase in the distance covered in 10 min (10 m walk test), and a significant improvement in mood (HRS-D). Moreover, Lokomat-FreeD was well tolerated by patients with high levels of usability.

CONCLUSIONS

Our results suggest that elderly patients may benefit from high-intensity robotic neurorehabilitation using the Lokomat-Pro FreeD.

Age-related differences in functional tool-use are due to changes in movement quality and not simply motor slowing

Age-related declines in fine motor control may impact tool-use and thereby limit functional independence. Most previous research has, however, focused on the effect of aging on gross motor tasks. Few studies have investigated the effects of aging on the strategy or quality of fine motor skills, especially in tool-use, which may better reflect how age impacts complex movement capability. Twenty-two young (ages 19-35) and 18 older adults (ages 58-87) performed a timed upper extremity task using a tool to acquire and transport objects to different locations. Overall task performance was divided into two phases based on 3-D position of the tool: a gross motor phase (object transport) and a fine motor phase (object acquisition). Overall, older adults took longer to complete the task. A linear model indicated that this was due to the duration of the fine motor phase more so than the gross motor phase. To identify age-related differences in the quality of the fine motor phase, we fit three-dimensional ellipsoids to individual data and the calculated the ellipsoid volume. Results demonstrated a significant volume-by-age interaction, whereby increased ellipsoid volume (space the tool occupied) related to increased mean dwell time for the older adult group only; younger adults did not demonstrate this relationship. Additionally, older adults with longer movement times during the fine motor phase also had lower cognitive scores. No age-related differences were observed for the gross motor phase, suggesting that age-related declines in tool-use may be due to changes in fine motor control and cognitive status.

Activities of Daily Living of Home Healthcare Patients

Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during an HHC stay. This was a secondary data analysis of a 5% random sample (n = 105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in seven or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing HHC length of stay, being female, and prior inpatient stay. Clinicians, policy makers, and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement.

Social capital and the health of left-behind older adults in rural China: a cross-sectional study

OBJECTIVE

To examine the association between social capital and the health of male and female left-behind older adults in rural China.

STUDY DESIGN

This cross-sectional study among the left-behind older adults aged 60 and older and with all their children working outside of Hubei, Shaanxi and Guangdong provinces in China was conducted in 2017-2018. A total of 1106 questionnaires were collected (participation rate=100.0%), and questionnaires from 1016 participants were used (effective rate=91.9%).

METHODS

An ordinary least squares model was used to evaluate the association between social capital and health. Social capital included family trust, friend/neighbour trust, stranger trust, social participation, and network size and density. Health outcomes included basic and instrumental activities of daily living (BADL and IADL) and depression.

RESULTS

Elevated family trust, friend/neighbour trust, stranger trust, high-level participation and middle-level network density were associated with reduced depression (b=-3.23, p<0.001; b=-0.41, p<0.001; b=-0.76, p<0.01; b=-1.04, p<0.05; b=-0.74, p<0.05, respectively). High-level participation and network density were also associated with elevated BADL (b=0.16, p<0.05; b=0.24, p<0.05, respectively). Elevated family trust (b=-2.86, p<0.05 in men; b=-3.86, p<0.001 in women), stranger trust (b=-0.68, p<0.05 in men; b=-0.80, p<0.05 in women) and high-level participation (b=-0.92, p<0.05 in men; b=-1.22, p<0.01 in women) were associated with reduced depression in both sexes. By contrast, elevated friend/neighbour trust was associated with reduced depression (b=-0.56, p<0.001) in women, high-level participation was associated with elevated BADL (b=0.19, p<0.05) and IADL (b=0.43, p<0.05) in men, and high-level network density was associated with elevated BADL (b=0.44, p<0.05) and IADL (b=0.57, p<0.05) and reduced depression (b=-1.05, p<0.05) in women.

CONCLUSIONS

Social capital is closely related to left-behind older adults' health in rural China. More attention should be paid to increasing the stock of social capital in this special population, with a particular focus on the sex disparity.

Self-reported physical and mental health and motor functioning in elders with and without Parkinson's disease

Parkinson's Disease (PD) is a neurological disorder characterized by motor symptoms and other clinical conditions, such as cognitive impairment, negative mood, anxiety. The present study explored the impact of PD on self-reported physical and mental health, objective cognition and postural control. The relationship among these variables was examined in order to understand the impact on quality of life. Fifty-four participants, 27 with and 27 without PD, were recruited in Sardinia - an area with an atypical prevalence of PD and psychological characteristics that might mitigate the impact of PD on life quality. Participants completed objective tests of cognitive ability and postural control and self-report measures of physical and mental health. The detrimental effect of PD was evident across all outcomes. Self-reported physical and mental health were both related to postural control. Variance in perceived physical health was explained, not only by PD itself and postural control but also by participation in leisure activities. Self-report outcomes related to life quality are related not only by motor disturbances associated with PD but also with lifestyle activities. In conclusion, social contexts promoting socially-oriented activities, such as that found in Sardinia, may, therefore, mitigate some of the detrimental consequences of PD.