Determination of Body Composition in Community-Dwelling Older Adults With and Without Sarcopenia Using Data From Practical Measures

Adequate body composition is essential for health, function, and independence in older adults. However, standard body composition assessments require complex and costly modalities, limiting their use for early detection of body composition changes and periodic follow-up. This study explored the ability of three practical measures-handgrip strength, five times sit-to-stand test, and upper limb loading during seated push-up test (ULL-SPUT)-to determine body composition in 109 older adults with and without sarcopenia. Participants (average age 76 years) were cross-sectionally measured for outcomes of the study. The ULL-SPUT and handgrip strength, but not the five times sit-to-stand test, significantly correlated with body composition (rs, r = .297-.827, p < .01). The ULL-SPUT, in combination with demographic data, could determine body composition up to 82%. Therefore, the ULL-SPUT may be a practical preliminary measure to identify older adults for whom standard body composition assessments and follow-up would prove timely and beneficial.

The determination of sarcopenia in older adults using a practical measure

BACKGROUND

Many older adults are at risk of sarcopenia, a gradual loss of muscle mass affecting muscle strength and physical function, which can lead to adverse health consequences deteriorating their independence. However, the detection could be delayed due to the requirement of many measures, including a complex imaging modality. Thus, an exploration for a practical community- or home-based measure would be helpful to identify at-risk older adults and begin the timely management.

OBJECTIVE

To explore the ability of the upper limb loading during a seated push-up test (ULL-SPUT) to determine the presence of sarcopenia in community-dwelling older adults.

METHODS

Older adults (n= 110; 62 females, average age approximately 77 years) were cross-sectionally assessed for sarcopenia using standard measures (handgrip strength, appendicular skeletal muscle mass, and walking speed) and the ULL-SPUT.

RESULTS

Data from standard measures indicated that 44 participants had sarcopenia. The ULL-SPUT index of < 16.9 kg/m2 for females (sensitivity = 86%, specificity = 78%, area under the receiver operating characteristic curve [AUC] = 0.85) and < 19.7 kg/m2 for males (sensitivity = 73%, specificity = 69%, AUC = 0.83) could optimally identify participants with sarcopenia.

CONCLUSION

The ULL-SPUT index could be used to screen and monitor older adults with sarcopenia in various clinical, community, and home settings. This practical measure may be accomplished using a digital bathroom scale on a hard, even surface. Outcomes would identify an adult who should undergo further confirmation of sarcopenia through standard measures or the initiation of timely management to promote treatment effectiveness.

Effects of four-week lower limb loading training with and without augmented feedback on mobility, walking device use, and falls among ambulatory individuals with spinal cord injury: a randomized controlled trial

PURPOSE

To compare the effects of lower limb loading training (LLLT) with or without augmented loading feedback during stepping activity on mobility, walking device use, and falls among ambulatory individuals with chronic spinal cord injury (SCI).

STUDY DESIGN

Randomized controlled trial (assessor-blinded) with prospective fall data follow-up, clinical trial registration (NCT03254797).

METHODS

Forty-four ambulatory participants (22 participants/group) were prospectively monitored for their baseline fall data over six months, with baseline assessments for their mobility and walking device used after six months. Then participants involved in the LLLT programs with or without loading feedback according to their groups for 30 min/day, 5 days/week, over 4 weeks. Mobility outcomes were re-assessed at week two and week four, with prospective fall data monitoring over six months, and mobility measured thereafter.

RESULTS

Mobility outcomes of the participants were significantly improved from their baseline ability, especially in those who were trained using augmented feedback (the difference in main outcome, timed up and go, between the groups was 1.8 s; 95% confidence interval = 1.0-3.5s).

CONCLUSIONS

LLLT during stepping activity, especially with augmented loading feedback, could be applied effectively to promote mobility and safety of ambulatory individuals with chronic SCI (post-injury time of approximately four years).

The Use of Practical Measures to Determine Body Composition of Older People

Background

Older adults frequently experience body composition changes-decreased lean body mass (LBM) and bone mineral content (BMC), along with increased body fat mass (FM)-which affect their health and independence. However, the need for standard complex and costly imaging modalities could delay the detection of these changes and retard treatment effectiveness. Thus, this study explored the ability of practical measures, including simple muscle strength tests and demographic data, to determine the body composition of older adults.

Methods

Participants (n = 111, with an average age of 77 years old) were cross-sectionally assessed for the outcomes of the study, including upper limb loading during a seated push-up test (ULL-SPUT), hand grip (HG) strength test and body composition.

Results

The ULL-SPUT significantly correlated with body composition (r or rs, = 0.370-0.781; P < 0.05), particularly for female participants and was higher than that found for the HG strength test (rs = 0.340-0.614; P < 0.05). The ULL-SPUT and HG strength test, along with gender and body mass index (BMI), could accurately determine the LBM and BMC of the participants up to 82%.

Conclusion

The ULL-SPUT along with gender and BMI can be used as a practical strategy to detect the LBM and BMC of older adults in various settings. Such a strategy would facilitate timely managements (i.e. standard confirmation or appropriate interventions) in various settings.

Walking speed to determine walking performance of people with mobility limitations from a developing country

BACKGROUND

The criteria to determine walking performance of people with mobility limitations from developed countries have been already reported. However, these criteria may not be suitable to be applied for people with mobility limitations from developing countries due to the differences in sociodemographic characteristics and environmental conditions.

OBJECTIVE

To explore cutoff points of walking speed to determine walking performance of individuals with mobility limitations from a developing country.

METHODS

Individuals with mobility limitations from a developing country (n = 136) were cross-sectionally interviewed and assessed for their demographics and walking performance. Then they were assessed for their walking speed using the 10-meter walk test.

RESULTS

Walking speeds of ≥0.30 m/s, ≥ 0.40 m/s, and ≥0.65 m/s could optimally indicate the ability of outside-home walking, limited-community walking, and full-community walking, respectively (sensitivity = 78%-84%, specificity = 81%-93%, and area under the receiver operating characteristic curve [AUC] > 0.90). Moreover, a walking speed of ≥0.35 m/s could suggest the ability of functional walking (sensitivity = 78%; specificity = 83%; and AUC = 0.89).

CONCLUSIONS

With the need of standard practical measure for early screening and monitoring of functional alteration over time, the present walking speed cutoff points may be clinically applied to suggest walking performance in daily living specifically for individuals with mobility limitations from a developing country.

Seated push-up tests: Reliable and valid measures for older individuals when used by primary healthcare providers

BACKGROUND

Body composition decline, lower limb impairments, and mobility deficits affect independence of older people. The exploration for a practical measure involving upper extremities may offer an alternative tool to be used by primary healthcare (PHC) providers for these individuals.

OBJECTIVE

To explore reliability and validity of seated push-up tests (SPUTs) among older participants when used by PHC providers.

METHODS

Older participants (n= 146) with an average age of > 70 years were cross-sectionally assessed using various demanding forms of SPUTs and standard measures to assess validity of the SPUTs. Reliability of the SPUTs were assessed in nine PHC raters, including an expert, health professionals, village health volunteers, and care givers.

RESULTS

The SPUTs demonstrated very good agreement, with excellent rater and test-retest reliability (kappa values > 0.87 and ICCs > 0.93, p< 0.001). Moreover, the SPUT outcomes significantly correlated with lean body mass, bone mineral contents, muscle strength and mobility of older participants (r, rp⁢b=-0.270 to 0.758, p< 0.05).

CONCLUSION

SPUTs are reliable and valid for older adults when used by PHC members. The incorporation of such practical measures is particularly important during this COVID-19 pandemic with limited people's hospital access.

Effects of modified long stick exercise on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis

BACKGROUND

Hyperkyphosis is a condition often seen in older women. This condition causes muscle imbalance in the upper back of the body and impacts balance control. Long stick exercise (LSE) is an exercise programme for the elderly that improves muscle strength and balance control.

OBJECTIVE

This research was designed to investigate the effects of a modified LSE on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis.

METHODS

Twenty-eight elderly women with hyperkyphosis were divided into experimental and control groups. The experimental group was assigned to practice the modified LSE programme 30-40 minutes/day, 3 days/week, for 12 weeks. Hyperkyphosis, pectoralis minor length, muscle strength, functional reach test (FRT) and timed up and go test (TUG) were obtained at baseline, after 6 weeks and after 12 weeks of exercise.

RESULTS

The experimental group demonstrated improved hyperkyphosis, pectoralis minor length, muscle strength, FRT, and TUG after 12 weeks of training. Moreover, the experimental group exhibited significantly greater improvements in all outcomes than the control group (p< 0.05).

CONCLUSION

The modified LSE programme is an alternative exercise that is easy and low-impact for improving hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis.

Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury

OBJECTIVE

To establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI).

DESIGN

A cross-sectional study.

SETTING

Tertiary rehabilitation center and communities.

PARTICIPANTS

A total of 309 (168 WU and 141 AM) participants with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

SCIM III scores.

RESULTS

Participants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99).

CONCLUSIONS

The present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients' ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.

Knee Extensor Muscle Strength to Measure the Ability of Five Times Sit to Stand Independently in Patients with Incomplete Spinal Cord Injury

Background: Patients with incomplete spinal cord injury (iSCI) and lower extremity muscle weakness often fall while standing up from a chair. The sit-to-stand (STS) task primarily uses the strength of the knee extensor muscles. The five times sit-to-stand test (FTSST) is often applied to determine lower limb function and the results are related to lower extremity muscle strength. This study explored the cut-off point for knee extensor muscle strength in patients with iSCI to independently determine their FTSST results and the correlation between knee extensor muscle strength and FTSST results. Methods: Forty-four participants were assessed for knee extensor muscle strength using a hand-held dynamometer (HHD) and the FTSST. Results: The data indicated that knee extensor muscle strength ≥ 53.06 Newton was the best independent predictor of the FTSST results (sensitivity 72.7%, specificity 72.7%). Moreover, knee extensor muscle strength was significant and correlated with the FTSST results (r = ─0.45, P = 0.035). Conclusion: The findings offer a cut-off point for the knee extensor muscle strength measured while standing up from a chair that may help medical professionals set rehabilitation goals for patients with iSCI.

The 7th cervical vertebra wall distance (C7WD) identifies balance control, functional mobility and the risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis

BACKGROUND

Thoracic hyperkyphosis is common in the elderly, especially in women, and results in impaired balance control, impaired functional mobility and an increased risk of multiple falls. The 7th cervical vertebra wall distance (C7WD) is a practical method for evaluating thoracic hyperkyphosis.

OBJECTIVE

This study calculated C7WD cut-off scores that may identify impaired balance control, impaired functional mobility and an increased risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis. This study also explored the correlation between C7WD, balance control and functional mobility.

METHODS

Sixty participants were assessed for thoracic hyperkyphosis using the C7WD, balance control using the functional reach test (FRT), functional mobility using the timed up-and-go test (TUG) and a history of falls using their personal information.

RESULTS

The data indicated that a C7WD of at least 7.95 cm, 8.1 cm and 8.8 cm had a good to excellent capability of identifying impaired balance control, impaired functional mobility and an increased risk of multiple falls, respectively. The C7WD results were significant and correlated with balance control (rs=-0.68) and functional mobility (rs= 0.41).

CONCLUSIONS

The C7WD may be utilised as a screening tool for these three impairments in this population.

Responsiveness and minimal clinically important difference of the five times sit-to-stand test in ambulatory individuals with spinal cord injury: A six-month prospective cohort study

OBJECTIVES

To explore the responsiveness and minimal clinically important differences of the five times sit-to-stand test in ambulatory individuals with spinal cord injury.

METHODS

This six-month prospective cohort study was conducted in 109 individuals with spinal cord injury who could walk with or without a walking device for at least 10 meters. Participants were assessed for the five times sit-to-stand test in the four arm-placement conditions and standard measures to determine responsiveness of the test, at baseline, and one, three, and six months. At six months, participants were also interviewed for the global rating of change to estimate the minimal clinically important differences of the five times sit-to-stand test.

RESULTS

The five times sit-to-stand test showed large internal responsiveness (standardized response means>0.83), with moderate external responsiveness as compared to the 10-meter walk test (ρ = -0.28 to -0.48, p < 0.005). The changes in the outcomes >2.27 and >2 s could be used to indicate a level of minimal clinically important change for participants who executed the test with and without hands, respectively.

CONCLUSION

The five times sit-to-stand test is a responsiveness measure for ambulatory individuals with spinal cord injury. The levels of minimal clinically important differences found in this study (>2.27 and >2 s) can be applied as a useful benchmark for the decision of clinically relevant changes over time for these individuals.

Ability to detect history of falls among individuals with spinal cord injury using upper limb loading during a seated push-up test

BACKGROUND

A history of falls is an important risk factor for future falls, including for individuals with spinal cord injury (SCI) who often experience falls and subsequent injuries. This may be even more pronounced during the current COVID-19 pandemic because of the extreme shortage of hospital admission and restricted access to important services. Therefore, the ability of detecting a history of falls that can be applied to wheelchair users and ambulatory individuals with SCI in various settings are essential.

AIM

To investigate the discriminative ability of three clinical measures-the handgrip (HG) test, Spinal Cord Independence Measure (SCIM) III and Upper Limb Loading During a Seated Push-Up Test (ULL-SPUT)-in discriminating individuals with SCI with and without a history of falls over the past six months.

DESIGN

A 6-month retrospective observational cohort study.

SETTING

Inpatient tertiary rehabilitation center.

POPULATION

One hundred and fourteen wheelchair users and ambulatory individuals with SCI.

METHODS

The participants were interviewed and assessed for their demographics, SCI characteristics and fall data over the past six months, with data confirmation from related events, their caregivers and medical records. Subsequently, they were assessed using the HG test, SCIM III, and ULL-SPUT.

RESULTS

In total, 29 participants (25%) fell during the past six months (with the number of falls ranging from 1-20, with minor consequences after the falls). Among the three clinical measures assessed in this study, the ULL-SPUT data of faller participants were significantly higher than those of non-fallers (P<0.05).

CONCLUSIONS

The limited rehabilitation length and increased staying home and social isolation prompted by the COVID-19 pandemic may have reduced the fall rates of the participants. The findings suggest a higher likelihood of falls among wheelchair users and ambulatory individuals with SCI who have good mobility as determined using ULL-SPUT data.

CLINICAL REHABILITATION IMPACT

Apart from being an important rehabilitation strategy, the present findings suggest an additional benefit of ULL-SPUT to identify individuals with SCI with a likelihood of future falls. The measurement can be done easily using digital bathroom scales placing over a flat and smooth surface. Therefore, it would enable the timely initiation of fall prevention strategies in various clinical, community, home and research settings; particularly in this COVID-19 pandemic of limited beds and hospital services for these individuals.

Outcomes of the five times sittostand test could determine lower limb functions of ambulatory people with spinal cord injury only when assessed without hands

Context/Objectives: Various clinical application of the five times sit-to-stand test (FTSST), with or without hands, may confound the outcomes to determine the lower limb functions and mobility of individuals with spinal cord injury (SCI). This study assessed the concurrent validity of the FTSST in ambulatory individuals with SCI who completed the test with or without hands as verified using standard measures for lower extremity motor scores (LEMS) and functional mobility necessary for independence and safety of these individuals.Design: Cross-sectional study.Setting: Tertiary rehabilitation centers and community hospitals.Participants: Fifty-six ambulatory individuals with motor incomplete SCI who were able to walk independently with or without a walking device over at least 10 m.Outcome Measures: Time to complete the FTSST with or without hands according to individuals' abilities, LEMS, and functional mobility.Results: Time to complete the FTSST showed moderate-to-strong correlation with the LEMS scores and all functional mobility tests (ρ = -0.38 to -0.71, P < 0.05), but only in those who performed the test without hands. By contrast, data of those who completed the FTSST with hands were significantly correlated only with the ankle muscle strength and the functional mobility measures that allow upper limb contribution in the tests (ρ = -0.40 to 0.52, P < 0.05).Conclusion: Upper limb involvement could confound the outcomes of the FTSST. The present findings suggest the use of FTSST without hands to determine the lower limb functions of ambulatory individuals with SCI.

Reliability and concurrent validity of the Spinal Cord Independence Measure III among rehabilitation professionals

Study design

A cross-sectional design.

Objectives

To investigate rater reliability of the Spinal Cord Independence Measure or SCIM III among rehabilitation professionals, along with the concurrent validity of the tool as compared to standard measures covering wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI).

Setting

A tertiary rehabilitation center and communities.

Methods

Eighty-two participants with SCI (39 WU and 43 AM individuals) were assessed using SCIM III items. The data of first 30 participants were video recorded for rater reliability assessments by seven rehabilitation professionals, including nurses, occupational therapists, and physical therapists (one novice and one experienced rater for each professional). All participants were also assessed using standard measures to verify concurrent validity of SCIM III by an experienced rater.

Results

The SCIM III showed excellent intra-rater and inter-rater reliability among rehabilitation professionals when analyzed for overall items (intraclass correlation coefficient (ICC) >0.90) and separately for each subscale (kappa values >0.80). The total SCIM III of WU and the mobility scores of AM participants showed significant correlation with standard measures for muscle strength, limit of stability, balance control, functional endurance, and walking ability (r_s = 0.343–0.779; p < 0.05).

Conclusions

The present findings extend clinical benefit and confirm the use of SCIM III interchangeably among rehabilitation professionals after they have been adequately trained. The findings are important for community-based rehabilitation and home healthcare services, especially during the coronavirus (COVID-19) pandemic, when hospital beds and in-patient services are limited for individuals with SCI.

External Devices Among Individuals With Spinal Cord Injury From a Developing Country

OBJECTIVE

The aim of this study was to explore the proportion, number, and type of external devices (including mobility devices, ambulatory aides, and orthotics) possessed and used by individuals with spinal cord injury (SCI) from a developing country.

DESIGN

This was a cross-sectional study.

PARTICIPANTS

A total of 163 participants with SCI from several rural communities in a developing country participated in the study from June 2018 to August 2019.

METHODS

The participants were interviewed and assessed for their SCI characteristics and the external devices (i.e., mobility devices, ambulatory aides, and orthotics) they possessed and used in their daily living.

RESULTS

Most participants (85%), who lived in rural communities with a family income of less than $3167 per year, possessed external devices (one to five types), and 80% of all participants actually used the devices (one to three types) in their daily living. Most participants with motor-complete SCI used a single device, especially a manual wheelchair, whereas those with mild lesion severity used multiple devices for their daily activities, particularly a standard walker.

CONCLUSION

Owing to budget and environmental constraints, the external devices used by individuals with SCI from a developing country are different from those reported in a developed country. The findings provide particular insights into the management of external devices for these individuals of a developing country.

Validity and reliability of the block method for measuring thoracic hyperkyphosis

OBJECTIVE

This study aimed to investigate the concurrent validity of the block method as compared with the gold standard (Cobb's method). An additional aim was to examine the intra- and inter-rater reliability of expert and novice assessors using the block method.

METHODS

In a cross-sectional study, we enrolled 62 participants with hyperkyphosis aged ≥10 years, with hyperkyphosis defined as one or more blocks. The participants were stratified by age (<60 years and ≥60 years). To determine concurrent validity, and kyphosis was assessed in all the participants using the block method and Cobb's method. Finally, 15 participants were included in a reliability study. To determine intra- and inter-rater reliability, each participant was assessed twice, 7 days apart, by one expert and one novice using the block method.

RESULTS

The concurrent validity of the block method and gold standard method showed moderate correlation (r_s = 0.53, P < .001). However, after stratifying the participants by age (<60 years and ≥60 years), there was small to moderate correlation (r_s = 0.42, P = .006, and r_s = 0.64, P = .002, respectively). The intra- and inter-rater reliability of the expert and novice assessors was excellent (ICC_3,1 = 0.82-0.97, P < .001).

CONCLUSIONS

The findings showed small correlation in those <60 and moderate correlation in those ≥60 years, and reported excellent reliability. The block method can be used by novices with strong reliability. This method is a practical technique for early screening hyperkyphosis in the elderly.

The use of simple muscle strength tests to reflect body compositions among individuals with spinal cord injury

STUDY DESIGN

A cross-sectional study.

OBJECTIVES

To investigate the correlation between simple muscle strength tests (including handgrip test and upper limb loading during a seated push-up test [ULL-SPUT]) and body compositions among individuals with spinal cord injury (SCI).

SETTING

A tertiary rehabilitation center.

METHODS

Twenty-four participants with SCI (average age of 40 years) were cross-sectionally assessed using handgrip test, ULL-SPUT, and body compositions (including skeletal muscle mass, bone mineral content, and fat mass) using dual-energy X-ray absorptiometry scan.

RESULTS

The handgrip data had low-to-moderate correlation to body compositions of the arms (r_s = 0.474-0.515, p < 0.05), while the ULL-SPUT data were low-to-excellently correlated to all body compositions of the arms, legs, and trunk (r_s, r = 0.467-0.921, p < 0.05).

CONCLUSIONS

The findings extend clinical benefit of a SPUT apart from being a rehabilitation strategy to promote mobility of individuals with SCI. Simple measurement of the ULL-SPUT, which can be done using digital bathroom scales placed on a hard and even surface, appears to be strongly correlated with body compositions in a small sample of predominantly middle age, normal weight, men with paraplegia. More research is required to understand whether this test can be used clinically to assess body compositions in a more diverse SCI population, and whether it is responsive to changes in body compositions over time.

The utility of upper limb loading device in determining optimal walking ability in ambulatory individuals with spinal cord injury

Background:

Walking devices are frequently prescribed for many individuals, including those with spinal cord injury (SCI), to promote their independence. However, without proper screening and follow-up care, the individuals may continue using the same device when their conditions have progressed, that may possibly worsen their walking ability.

Objective:

This study developed an upper limb loading device (ULLD), and assessed the possibility of using the tool to determine the optimal walking ability of ambulatory participants with SCI who used a walking device daily (n=49).

Methods:

All participants were assessed for their optimal walking ability, i.e., the ability of walking with the least support device or no device as they could do safely and confidently. The participants were also assessed for their amount of weight-bearing on the upper limbs or upper limb loading while walking, amount of weight-bearing on the lower limbs or lower limb loading while stepping of the other leg, and walking performance.

Results:

The findings indicated that approximately one third of the participants (31%) could progress their walking ability from their current ability, whereby four participants could even walk without a walking device. The amount of upper limb loading while walking, lower limb loading ability, and walking performance were significantly different among the groups of optimal walking ability (p<0.05). Furthermore, the amount of upper limb loading showed negative correlation to the amount of lower limb loading and walking performance (ρ=−0.351 to −0.493, p<0.05).

Conclusion:

The findings suggest the potential benefit of using the upper limb loading device and the amount of upper limb loading for walking device prescription, and monitoring the change of walking ability among ambulatory individuals with SCI.

Effects of Exercises on a Hard, Soft, and Sand Surface on Functional Outcomes of Community-Dwelling Older Individuals: A Randomized Controlled Trial

This single-blind, randomized controlled trial compared the effects of Thai dance exercise training on hard, soft, and sand surfaces on the functional outcomes of 120 community-dwelling older adults (40 subjects/group). The subjects were involved in a Thai dance exercise program on each surface, according to their groups, for 50 min/day, 3 days/week, for 6 weeks. The functional outcomes were assessed prior to training, at Week 3, and Week 6 after training. Subjects showed a significant improvement in all functional tests at 3 and 6 weeks after training, particularly in those who were trained on a sand surface and a soft surface (7-30% improvement, p < .05). The improvement was especially demonstrated in the complex and demanding motor activities after exercise on a soft and sand surface. Aside from attempting to modify training programs on a hard surface, the current findings suggest an alternative and cost-effective program to promote the levels of independence and safety that can be applied easily in clinical, home-based, and community settings.

Various Surfaces Benefited Functional Outcomes and Fall Incidence in Individuals With Spinal Cord Injury: A Randomized Controlled Trial With Prospective Data Follow-up

OBJECTIVES

To compare effects of walking training on a walking track with different surfaces (WTDS), including artificial grass, soft, and pebbles, as compared to overground walking training on the functional ability necessary for independence and incidence of falls of ambulatory individuals with spinal cord injury (SCI).

DESIGN

A randomized controlled trial (single-blinded design) with 6-month prospective fall data follow-up.

SETTING

Tertiary rehabilitation centers and several communities.

PARTICIPANTS

Independent ambulatory individuals (N=54) with SCI who walked with or without a walking device.

INTERVENTION

Participants were randomly arranged into a control group (overground walking training, n=26) or experimental group (walking training over a WTDS, n=28) for 30 min/d, 5 d/wk over 4 weeks.

MAIN OUTCOME MEASURES

The 10-m walk test, timed Up and Go test, five times sit-to-stand test, and 6-minute walk test were repeatedly measured 4 times, including before training, and after 2 and 4 weeks, and 6 months. In addition, participants were prospectively monitored for the fall data over 6 months.

RESULTS

Participants who walked with an average speed of 0.52 m/s and postinjury time >7 years could safely walk over a WTDS. They demonstrated significant improvement at 2 and 4 weeks after experimental training (P<.001), but not after control training. During the 6-month follow-up, participants in the experimental group also had the number of those who fell (n=5, 18%) fewer than those in the control group (n=12, 46%).

CONCLUSIONS

Being at a chronic SCI with ability of independent walking, participants needed a challenging task to promote their functional outcomes and minimize fall risk. The findings suggest the use of various surfaces as an alternative rehabilitation strategy for these individuals.

The use of lower limb loading ability as an indicator for independence and safety in ambulatory individuals with spinal cord injury

BACKGROUND

Data relating to weight-bearing or lower limb loading ability (LLLA) have been reported wildly in several individuals, mostly with unilateral impairments, but not in ambulatory individuals with spinal cord injury (SCI) who have bilateral sensorimotor deterioration.

AIM

To assess the LLLA of ambulatory individuals with SCI who walk independently with and without a walking device, and explore the optimal threshold of the LLLA to determine the independence and safety of these individuals.

DESIGN

Cross-sectional study.

SETTING

Tertiary rehabilitation centers and communities.

POPULATION

Ninety ambulatory participants with SCI.

METHODS

Participants were assessed for their LLLA during stepping of the contralateral leg using a digital load cell. In addition, they were assessed using functional mobility tests and interviewed for fall data over the past six months.

RESULTS

Participants who walked independently with or without a walking device had an average LLLA of at least 79% of their bodyweight. In addition, the amount of LLLA at least 94-95% of the bodyweight had moderate diagnostic properties to indicate the independence and safety of these individuals (sensitivity =68-77%, specificity =66-81%, and AUC=0.73-0.80).

CONCLUSIONS

The clear and objective data relating to LLLA can be used as a critical indicator for the safe and steady mobility, specifically for ambulatory individuals with SCI. These data can be used as an optimal threshold in rehabilitation training, screening and monitoring of their functional alteration over time in clinical, community, and home-based settings.

CLINICAL REHABILITATION IMPACT

The LLLA of at least 79% of the bodyweight could determine the ability of independent walking with a walking device, while an LLLA of at least 94-95% of the bodyweight could indicate the ability of walking without a walking device and no multiple falls. These data can be used as an optimal target in rehabilitation training, screening and monitoring of functional alteration over time in various clinical and home-based settings, specifically for ambulatory individuals with SCI.

Thai dance exercises benefited functional mobility and fall rates among community-dwelling older individuals

Background

With dramatic increase in the number of older individuals, special efforts have been made to promote the levels of independence and reduce fall rates among these individuals.

Objective

To investigate the effects of Thai dance exercises over 6 weeks on functional mobility and fall rates in community-dwelling older individuals.

Methods

Sixty-one community-dwelling older adults were interviewed and assessed for their demographics and fall data during 6 months prior to participation in the study. Then they completed the quasi-experimental Thai dance exercise program for 50 minutes/day, 3 days/week over 6 weeks. Their functional mobility relating to levels of independence and safety were assessed prior to training, at 3-week and 6-week training. After completing the program at 6 weeks, participants were prospectively monitored for fall data over 6 months.

Results

Participants improved their functional mobility significantly after 3- and 6-week training ( p < 0.01 ) . The number of faller individuals obviously decreased from 35% ( n = 21 ) prior to training to only 8% ( n = 5 ) after training ( p < 0.01 ) .

Conclusion

The current findings further extend benefits of Thai dance as an alternative musical exercise program to promote levels of independence and safety among community-dwelling older adults.

Dual-Task Obstacle Crossing Training Could Immediately Improve Ability to Control a Complex Motor Task and Cognitive Activity in Chronic Ambulatory Individuals With Spinal Cord Injury

Background: The effectiveness of dual-task training has been reported in individuals with cognitive impairments. To date, there is no clear evidence on the incorporation of dual-task training in ambulatory individuals with spinal cord injury (SCI) who have intact cognitive functions but have various degrees of sensorimotor dysfunction. Objectives: To compare the immediate effects of dual-task obstacle crossing (DTOC) and single-task obstacle crossing (STOC) training on functional and cognitive abilities in chronic ambulatory participants with SCI. Methods: This is a randomized 2 × 2 crossover design with blinded assessors. Twenty-two participants were randomly trained using a 30-minute DTOC and STOC training program with a 2-day washout period. Outcomes, including 10-Meter Walk Tests (single- and dual-task tests), percent of Stroop Color and Word Test task errors, Timed Up and Go Test (TUG), and five times sit-to-stand test, were measured immediately before and after each training program. Results: Participants showed significant improvement in all outcomes following both training programs (p < .05), except percent of Stroop Color and Word Test task errors after STOC training. Obvious differences between the training programs were found for the percent of Stroop task errors and TUG (ps = .014 and .06). Conclusion: Obstacle crossing is a demanding task, thus the obvious improvement was found immediately after both training programs in participants with long post-injury time (approximately 5 years). However, the findings primarily suggest the superior effects of DTOC over STOC on a complex motor task and cognitive activity. A further randomized control trial incorporating a complex dual-task test is needed to strengthen evidence for the benefit of DTOC for these individuals.

The use of functional performance tests by primary health-care providers to determine walking ability with and without awalking device in community-dwelling elderly

Background: Primary health-care (PHC) providers are important for community involvement in health promotion and prevention efforts, particularly today that the number of elderly is increasing dramatically. The use of a standard practical measure would help in promoting the effectiveness of referral and monitoring processes. Objectives: To investigate the use of functional performance tests in terms of the appropriate cutoff point to determine walking ability with and without a walking device in community-dwelling elderly, and reliability of the tests when used by PHC providers. Methods: Community-dwelling people aged 65 years or older who walked with or without a walking device (n = 309) were interviewed and assessed for information related to the use of a walking device in daily living. Then, they were randomly assessed for their functional ability using the Timed Up and Go Test (TUG), Five Times Sit-to-Stand Test (FTSST), and the 10-Meter Walk Test (10MWT). PHC providers, including a physical therapist, village health volunteer, and a caregiver, assessed 30 participants' functional performances, to address rater reliability of the tests. Results: The findings suggested that outcomes of the tests (TUG < 12 s, FTSST < 15 s, and 10MWT > 0.8 m/s) can indicate the ability of walking without a walking device of the participants. These tests could be used by PHC providers, except for the FTSST by a caregiver. Conclusions: The findings offer a clear cutoff point for promoting the involvement of PHC providers and the standardization of a screening, monitoring, and referral process among many clinical and community settings.

Increased Lower Limb Loading During Sit-to-Stand is Important for the Potential for Walking Progression in Ambulatory Individuals with Spinal Cord Injury

Background

Decreased rehabilitation time may increase the need for walking devices at the time of discharge to promote levels of independence among ambulatory individuals with spinal cord injury (SCI). However, using walking devices could create adverse effects on patients. This study explores the proportion of walking devices used, potential for walking progression, and associated factors among ambulatory individuals with SCI.

Methods

Fifty-seven participants were assessed for their demographics and functional ability relating to the requirement for walking devices, including the Timed Up and Go Test (TUGT) and lower limb loading during sit-to-stand (LLL-STS).

Results

Thirty-five participants (61%) used a walking device, particularly a standard walker, for daily walking. More than half of them (n = 23, 66%) had potential of walking progression (i.e., safely walk with a less-support device than the usual one). The ability of walking progression was significantly associated with a mild severity of injury, increased lower-limb muscle strength, decreased time to complete the TUGT, and, in particular, increased LLL-STS.

Conclusion

A large proportion of ambulatory individuals with SCI have the potential for walking progression, which may increase their level of independence and minimise the appearance of disability. Strategies to promote LLL-STS are important for this progression.

Failures in dual-task obstacle crossing could predict risk of future fall in independent ambulatory individuals with spinal cord injury

OBJECTIVE:

To determine whether cognitive-motor interference using ability of dual-task obstacle crossing could predict a risk of fall in 90 ambulatory individuals with spinal cord injury.

DESIGN:

Six-month prospective study.

SETTING:

A rehabilitation center and community hospitals.

SUBJECTS:

Independent ambulatory individuals with spinal cord injury.

MAIN OUTCOME MEASURES:

Subjects were interviewed and evaluated for personal characteristics, dual-task obstacle crossing ability, and functional ability using the 10 Meter Walk Test, Timed Up and Go Test, and Five Times Sit-to-Stand Test. Then they were prospectively monitored for fall data every month for six months in total.

RESULTS:

A total of 90 chronic ambulatory individuals with spinal cord injury with an average age of 52.51 ± 13.43 years, who mostly had mild lesion severity ( n = 71, 79%) and walked with a walking device ( n = 54, 60%) completed in the study. More than one-third of the subjects ( n = 32, 36%) failed in dual-task obstacle crossing. The failures were obviously associated with the fall (unadjusted odds ratio = 7.07, P < 0.002, power = 1.000).

CONCLUSION:

Cognitive-motor interference is important for ambulatory individuals with spinal cord injury, as it could detect those with low functional ability and risk of future falls.

Hyperkyphotic measures using distance from the wall: validity, reliability, and distance from the wall to indicate the risk for thoracic hyperkyphosis and vertebral fracture

C7WD is a practical, valid, and reliable measure that could clearly indicate a risk of hyperkyphosis and vertebral fracture in the elderly. The findings might be particularly of use in regions difficult to access radiology or for the determination of those who need further invasive radiologic examination and therapy.

PURPOSE

To investigate psychometric properties of the 7th cervical vertebra wall distance (C7WD) to determine the risk of thoracic hyperkyphosis and spinal fracture, as compared to a standard radiologic Cobb's method.

METHODS

Community-dwelling elderly (n = 104), aged at least 60 years with occiput-wall distance > 0 cm, were assessed for their C7WD using rulers and a specially developed tool for an accurate perpendicular distance from C7 to the wall: infrared-gun kyphosis wall distance tool (IG-KypDisT). The first 15 participants were also involved in the reliability tests by a healthcare professional, village health volunteer, and caregiver. Within 7 days, all participants were at a hospital to complete a lateral plain radiograph (Cobb's method).

RESULTS

Outcomes of C7WD had excellent correlation to the Cobb angles (r = 0.87 for rulers and r = 0.92 for IG-KypDisT), with excellent reliability when used by all three raters (ICC_3,3 = 0.85-0.99). The C7WD of at least 7.5 and 9.5 cm had the best diagnostic properties to determine the risk of thoracic hyperkyphosis and vertebral fracture, respectively.

CONCLUSION

C7WD is valid and reliable with good diagnostic properties for thoracic hyperkyphosis and vertebral fracture. The findings confirm the use of C7WD using traditional ruler-based method as a practical tool to screen and monitor severity of thoracic hyperkyphosis in clinics and communities. In addition, the measurement using the IG-KypDisT provided accurate data that can be saved for further analysis; it is therefore suggested for research settings. The findings would promote the standardization of hyperkyphosis measurements in various settings.

Effects of dual- and complex-task on walking ability of ambulatory individuals with spinal cord injury

BACKGROUND

Attempting to perform dual- and complex-tasks obviously reduces the walking ability of individuals with impaired cognitive functions. However, there is no clear evidence describing the effects of dual- and complex-tasks on the walking ability of ambulatory individuals with a spinal cord injury (SCI) who have intact cognitive functions, but suffer from various degrees of sensorimotor deterioration.

AIM

To primarily investigate the effects of dual- and complex-task on the walking ability of ambulatory subjects with SCI as compared to healthy individuals. In addition, the study secondarily compared the effects in subgroups of subjects with SCI, including different age groups, lesion severity and level of ability.

DESIGN

Cross-sectional design.

SETTING

A major tertiary referral and community hospitals in Thailand.

POPULATION

Thirty-seven ambulatory individuals with SCI and 13 healthy subjects.

METHODS

All subjects were evaluated for outcomes while they walked under four conditions, including single-task overground walking (ST-OG), dual-task overground walking (DT-OG) using a color word Stroop task, single-task obstacle crossing (ST-OC) and dual-task obstacle crossing (DT-OC). The outcomes were compared among the conditions and between the groups of subjects in terms of walking time, obstacle crossing ability and percent of Stroop task errors.

RESULTS

With the increasing complexity of the tasks, both SCI and healthy subjects walked significantly slower (P<0.001 for those with SCI and P<0.05 for healthy subjects), but not when compared between the ST-OC and DT-OG conditions (P>0.05). Subjects also showed a greater percentage of cognitive task errors when they encountered a dual- and complex-task, particularly those with SCI who were over 50 years old, had mild lesion severity or walked with a walking device (P<0.001).

CONCLUSIONS

The incorporation of dual- and complex-task challenged cognitive-motor interference of ambulatory individuals with SCI.

CLINICAL REHABILITATION IMPACT

The application of such tasks may benefit rehabilitation outcomes in a real-world situation for patients, especially for those who are older than 50, have mild lesion severity or use a walking device.

Importance of independent sit-to-stand ability in ambulatory patients with spinal cord injury

BACKGROUND

Sit-to-stand (STS) is an important and basic activity for daily living. However, a few studies have reported information relating to STS ability in ambulatory patients with spinal cord injury (SCI).

AIM

To investigate factors associated with the ability of independent sit-to-stand (iSTS) among ambulatory patients with SCI.

DESIGN

Cross-sectional cohort study.

SETTING

Inpatient tertiary rehabilitation center and communities.

POPULATION

Ambulatory patients with SCI.

METHODS

Sixty-nine independent ambulatory individuals with SCI who walked with or without a walking device were cross-sectionally interviewed and assessed for their demographics, SCI characteristics, iSTS ability (pass or fail), types of walking device used, balance ability, and lower limb support capability during STS.

RESULTS

Forty-six subjects (67%) successfully performed iSTS ability (pass). The ability of iSTS was significantly associated with lower extremity muscle strength, lower limb support ability, balance control, and ability of walking with a single cane and without a walking device (P<0.01).

CONCLUSIONS

The ability of iSTS is important for ambulatory patients with SCI as it related to ability of walking with minimal use of the upper extremities. Other significant associated factors provided important clue to promote ability of iSTS.

CLINICAL REHABILITATION IMPACT

The findings imply the use of iSTS ability as a simple and practical screening or monitoring tool for the ability of walking at least with a single cane. The improvement of lower extremity muscle strength, lower limb support ability, and balance control could improve iSTS ability of these individuals.

Is walking symmetry important for ambulatory patients with spinal cord injury?

PURPOSE

To assess and compare the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI) who had different degrees of lesion severity, levels of walking ability, and fall history. In addition, the study explored the relationship between the levels of walking symmetry and variables related to the ability of well-controlled walking of the participants.

STUDY DESIGN

Cross-sectional study.

METHODS

Sixty-six eligible participants were assessed and interviewed for levels of walking symmetry, walking speed, functional endurance, symmetrical lower limb support ability, balance control, and fall history over the last 6 months.

RESULTS

Participants walked asymmetrically (85%) similar to those with unilateral impairments (i.e., patients with stroke and amputee, 79-93%). The levels of walking symmetry were significantly correlated to walking speed, functional endurance and balance ability of the participants (p < 0.05). The problem and correlation were particularly apparent in those with the history of multiple falls (79%, r = 0.613-0.765, p < 0.005) Conclusions: The findings confirm problems of asymmetrical walking and the importance of walking symmetry for the ability of well-controlled walking and a risk of multiple falls in ambulatory participants with SCI. Therefore, apart from the levels of independence, the improvement of walking symmetry is crucial for these individuals. Implications for Rehabilitation: Ambulatory individuals with spinal cord injury walked asymmetrically at the same level as those with unilateral impairments such as patients with stroke and amputee. Their levels of walking symmetry were significantly related to the ability of well-controlled walking, particularly in those with the history of multiple falls. The finding confirmed the importance of walking symmetry as a crucial parameter to detect walking improvement and fall risk reduction. Apart from the levels of independence, rehabilitation professionals also need to emphasize on the improvement of symmetrical walking for these patients.

Validity and reliability of a thoracic kyphotic assessment tool measuring distance of the seventh cervical vertebra from the wall

Background

In primary healthcare (PHC) service, community residents, village health volunteers (VHVs), and healthcare professionals need to work in partnership to facilitate universal and equitable healthcare services. However, these partnerships may need an appropriate tool helping them to execute an effective health-related activity.

Objectives

To investigate the reliability and validity of a simple kyphosis measure using a perpendicular distance from the seventh cervical vertebra (C7) to the wall (C₇WD).

Methods

Elderly people with different degrees of kyphosis (n = 179) were cross-sectionally investigated for the intra- and interrater reliability of the measurement by a physical therapist (PT), VHV, and caregiver. The validity was assessed in terms of concurrent validity as compared with the Flexicurve, and discriminative validity for functional deterioration in participants with mild, moderate, and severe kyphosis.

Results

The method showed excellent reliability among PT, VHV, and caregivers (ICC > 0.90, p < 0.001), and excellent correlation to the data from the Flexicurve. Results of the assessment were greater than a level of minimal detectable change and could clearly discriminate functional deterioration in participants with different severity of kyphosis (p < 0.001).

Conclusion

C₇WD is valid and reliable, thus it can be used to promote the standardisation of kyphosis measures among PHC members.

Functional ability and health status of community-dwelling late age elderly people with and without a history of falls

Background:

Obvious functional deterioration is demonstrated in elderly people aged 75 years and older. However, there is only little objective evidence relating to falls in these individuals.

Objective:

This cross-sectional study compared functional abilities and health status in the elderly age at least 75 years with no fall, single fall (1 fall), and multiple falls (≥2 falls) during the past 6 months. Furthermore, the study describes fall information of the participants.

Methods:

Ninety participants (30 individuals/group) were interviewed for their health status and fall history within the past 6 months. Then they were objectively assessed in terms of their functional ability to conduct daily activities independently.

Results:

The findings indicated that the functional abilities of participants with multiple falls were significantly poorer, with the number of those requiring a walking device significantly greater than that in the other groups. These individuals reported loss of balance as a major factor for falls, whereas individuals with a single fall reported an environmental hazard as a common cause of falls.

Conclusion:

Although the cross-sectional findings may be unable to clearly confirm the causal relationship of the outcomes, the data support the influence of intrinsic impairments and can be used to promote functional ability and minimise fall risk in these individuals.