Postural instability in cognitively impaired elderly during forward and backward body leans

Effects of Jaques-Dalcroze eurhythmics program on postural stability in elderly women

Decreased postural stability is observed in older adults. There is an increased risk of falls, which may lead to serious complications and death. Elderly people can maintain and even improve their postural stability through properly selected exercises. This study investigated the effect of exercise using the Emil Jaques–Dalcroze’s Eurhythmics (JDE) method on the postural stability of women over 65 years of age. The study model was based on a randomized controlled trial—parallel group design. Fifty-nine women (69.85 ± 3.29) were divided into two groups: intervention (IG, n = 26) and control (CG, n = 33). The IG subjects participated in a JDE exercise programme for 12 weeks, twice a week for 45 min each. Postural stability was determined using a test on the AMTI AccuSway Plus posturography platform, recording centre of pressure (COP) point displacement. A biofeedback model was used. Accuracy, speed and reaction time of movements were assessed. Two measurement sessions were conducted in both groups: 1 week before starting the exercise programme and immediately afterwards. After 12 weeks of exercise, subjects from IG scored significantly better in the test of accuracy (p < 0.05) and speed (p < 0.05) of movements. Additionally, for parameters determining accuracy of movements, an interaction between allocation to a group and a measurement session was shown (group × time). A 12-week exercise program using the JDE method improves the postural stability of women over 65 years of age by improving the parameters of speed and accuracy of torso movements.

Balance and gait performance in older adults with early-stage cognitive impairment

BACKGROUND

People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks.

AIM

We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer's disease.

DESIGN

Prospective observational study.

SETTING

Outpatient department of neurology or psychology.

POPULATION

Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded.

METHODS

Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale [BBS]) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition.

RESULTS

The BBS (P=0.04), posturography of fall risk index (FR, P=0.01) and sensory integration indices in eyes open and firm surface (EOFIS, P=0.009), eyes open and foam surface (EOFOS, P=0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (P=0.04) and stride length (P=0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups.

CONCLUSIONS

It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems.

CLINICAL REHABILITATION IMPACT

Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.