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VanSwearingen JM, Tighe CA, Perera S, Forman DE, Buysse DJ, Brach JS. Association of Sleep Quality with Activity and Participation in Older Adults. Arch Phys Med Rehabil 2025:S0003-9993(25)00716-6. [PMID: 40414548 DOI: 10.1016/j.apmr.2025.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 04/25/2025] [Accepted: 05/20/2025] [Indexed: 05/27/2025]
Abstract
OBJECTIVE To explore the relation of self-reported sleep quality with the International Classification of Functioning domains of activity (e.g., physical functioning) and participation (e.g., disability). DESIGN Descriptive, secondary, cross-sectional data-analysis SETTING: General community PARTICIPANTS: Community-dwelling older adult, volunteers, n=249 INTERVENTIONS: not applicable MAIN OUTCOME MEASURES: . The Pittsburgh Sleep Quality Index (PSQI), self-reported measures of activity and participation by the Late-Life Function and Disability Instrument (LLFDI), the modified Gait Efficacy Scale for confidence in walking, and performance-based measures of physical functioning (gait speed, Six Minute Walk, Figure of 8 Walk and Short Physical Performance Battery, SPPB). Measures of function were regressed on sleep quality adjusted for age, sex, and comorbidities. RESULTS Older adults with good (PSQI≤5) compared to poor (>5) sleep quality reported better function and disability across almost all considered domains (p< 0.05). Effect sizes for self-reported and performance-based measures were comparable and in the small to moderate range. CONCLUSIONS Among older adults with mild to moderate functional limitations and disability, self-reported sleep quality related broadly to activity and participation. Experimental studies are needed to assess the effects of sleep interventions on activity and participation and understand if sleep quality may represent a novel treatment target in future intervention trials to improve function in older adults.
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Affiliation(s)
| | - Caitlan A Tighe
- Department of Psychology, Providence College, Cunningham Square, Providence, Rhode Island
| | - Subashan Perera
- Department of Medicine, Division of Geriatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Daniel E Forman
- Department of Medicine, Divisions of Geriatrics and Cardiology, University of Pittsburgh and Geriatrics, Research, Education, and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Weichmann J, El Barbari JS, Siegwart LC, Hetjens S, Hogan A, Grützner PA, Trinler U. Influence of regional anesthesia on fall risk in adults over 60 years. Clin Biomech (Bristol, Avon) 2025; 121:106383. [PMID: 39580936 DOI: 10.1016/j.clinbiomech.2024.106383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 11/10/2024] [Accepted: 11/14/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Age-related changes can influence gait and contribute to a higher fall risk. Other influencing factors might be certain anesthetic procedures which affect therapeutic decisions. The study's goal was to evaluate whether brachial plexus blockade impacts the postoperative fall risk in adults ≥60 years. METHODS 40 adults ≥60 years without predisposing fall risk factors receiving brachial plexus blockade were included. Gait parameters during single- and dual-task conditions were assessed using the GAITRite® walkway at three measurement points: preoperatively, within 24 h, and two weeks postoperatively. Additionally, a geriatric assessment including Berg Balance Scale, Timed Up and Go test and Montreal Cognitive Assessment was conducted, alongside pain intensity via Numeric Rating Scale. Statistical analysis involved ANOVA with repeated measures. FINDINGS All gait parameters showed a performance reduction within 24 h. Significant changes occurred during single-task in stride length (P = 0.018) and stride width variability (P < 0.01), further during dual-task in stride width (P = 0.015) and velocity (P = 0.039). Notable changes were also observed in the Berg Balance Scale (P < 0.0001), the Timed Up and Go test (P < 0.001), and Montreal Cognitive Assessment (P = 0.037). After two weeks the study parameters returned to the performance prior to surgery. Performance declined with increasing age. Pain intensity remained low. INTERPRETATION While brachial plexus blockade offers various advantages for patients due to its tolerability and controllability an increased gait instability and thus fall risk within the first postoperative day must be considered especially in older adults.
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Affiliation(s)
| | - Jan Siad El Barbari
- Department of Trauma and Orthopedic Surgery, Trauma Center, BG Klinik Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Laura Cosima Siegwart
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Klinik Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics, Biomathematics and Information Processing, Universitätsklinikum Mannheim, 68165 Mannheim, Germany
| | - Aidan Hogan
- Department of Trauma and Orthopedic Surgery, Trauma Center, BG Klinik Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Department of Trauma and Orthopedic Surgery, Trauma Center, BG Klinik Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Ursula Trinler
- Andreas Wentzensen Forschungsinstitut, BG Klinik Ludwigshafen, 67071 Ludwigshafen, Germany
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Yamasaki Y, Arai T, Takaishi S, Takamura H, Maruki H. Increased stride time variability is associated with a higher risk of falls in patients with ataxia after stroke. Physiother Theory Pract 2024; 40:2916-2924. [PMID: 39612266 DOI: 10.1080/09593985.2023.2286334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2024]
Abstract
INTRODUCTION Patients presenting with ataxia are at high risk of falling, however, there are limited studies evaluating fall factors restricted to patients presenting with ataxia due to stroke. PURPOSE This study aimed to examine the characteristics of patients with ataxia after stroke based on their motor function to identify variables associated with fall occurrence. METHODS We divided 33 participants who presented with ataxia after stroke into fall and non-fall groups. Data on motor function, cognitive function, and daily functionality were extracted from their admission records. Walking ability was measured as comfortable walking speed and Stride Time Variability (STV). Independent sample t-tests, Mann - Whitney U tests, and multiple logistic regression analysis were performed. RESULTS There were significant differences between fallers and non-fallers in the STV (p < .001), Mini-Balance Evaluations Systems Test score (p < .014) and Scale for Assessment and Rating of Ataxia score assessment (p < .028). In the multiple logistic regression analysis, only STV was associated with an increased risk of falls (p < .02). The area under the receiver operating characteristic curve was 0.839; the cutoff value of gait cycle variability for falls was 6.345% (sensitivity, 80.0%; specificity, 74.0%). CONCLUSION Increased stride time variability is a useful indicator that sensitively captures fall risk in patients with ataxia after stroke.
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Affiliation(s)
- Yuichiro Yamasaki
- Maruki Memorial Medical and Social Welfare Center Rehabilitation Department, Moroyama-Machi, Saitama, Japan
| | - Tomoyuki Arai
- Department of Physical Therapy, Faculty of Health & Medical Care, Saitama Medical University Graduate School of Medicine, Saitama, Japan
| | - Shinjiro Takaishi
- Maruki Memorial Medical and Social Welfare Center Rehabilitation Department, Moroyama-Machi, Saitama, Japan
| | - Hiroshi Takamura
- Department of Physical Therapy, Health Science University, Fujikawaguchiko Yamanashi, Japan
| | - Hideyuki Maruki
- Maruki Memorial Medical and Social Welfare Center Rehabilitation Department, Moroyama-Machi, Saitama, Japan
- Saitama Medical University orthopaedic surgery, Moroyama-Town, Saitama, Japan
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Commandeur D, Klimstra M, Yoshida K, Hundza S. The Minimum Number of Strides Required for Reliable Gait Measurements in Older Adult Fallers and Non-Fallers. SENSORS (BASEL, SWITZERLAND) 2024; 24:7666. [PMID: 39686203 DOI: 10.3390/s24237666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 11/18/2024] [Accepted: 11/28/2024] [Indexed: 12/18/2024]
Abstract
While the value of walking gait metrics collected using pressure-sensing walkways has shown promise for fall risk assessment, there is no consensus on the minimum number of strides required to obtain reliable metrics. This study aimed to determine the minimum stride count required for reliable single-task (ST), dual-task (DT), and difference score (DS) measurements of the spatio-temporal parameters of gait in older adult fallers and non-fallers. Forty community-dwelling older adults (74.6 ± 3.5 years) performed 10 ST and 10 DT walking passes (~100 strides total) across a GAITRite™ pressure mat. Nine truncated datasets (1-9 passes) were created from the original for each walking condition to assess agreement using two-way random effects, absolute agreement, and single-rater intraclass correlations (ICCs). ICCs demonstrated that a minimum of one pass (~10 strides) is sufficient for reliable mean gait metrics for ST and DT conditions and 10-30 strides for DS, while 10-80 strides are needed for reliable gait variability measures, depending on the metric. This study provides stride count recommendations to ensure reliable gait measurement in older adult populations, highlighting that as few as 10-30 strides are necessary for mean metrics, while variability metrics may require up to 80 strides to ensure reliability.
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Affiliation(s)
- Drew Commandeur
- Motion and Mobility Laboratory, University of Victoria, Victoria, BC V8P 5C2, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8W 3P2, Canada
| | - Marc Klimstra
- Motion and Mobility Laboratory, University of Victoria, Victoria, BC V8P 5C2, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8W 3P2, Canada
- Canadian Sport Institute Pacific, Victoria, BC V9E 2C5, Canada
| | - Kaya Yoshida
- Rehabilitation Sciences, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Centre for Aging SMART and the GF Strong Rehabilitation Centre, Vancouver, BC V5Z 2G9, Canada
| | - Sandra Hundza
- Motion and Mobility Laboratory, University of Victoria, Victoria, BC V8P 5C2, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8W 3P2, Canada
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Shuman V, VanSwearingen JM, Perera S, Mangione KK, Freburger JK, Brach JS. Characteristics associated with gait speed improvements from walking interventions for older adults: A responder analysis. Gait Posture 2024; 114:263-269. [PMID: 39427359 DOI: 10.1016/j.gaitpost.2024.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 09/06/2024] [Accepted: 10/13/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND Some older adults benefit to a great degree from walking interventions and others experience little improvement. Understanding the personal characteristics associated with greater treatment response to different interventions could assist clinicians in providing patients with matched interventions to optimize both outcomes and resource use. RESEARCH QUESTION What personal characteristics are associated with improved gait speed for older adults participating in walking interventions? METHODS This was a secondary analysis of 236 older adults from a trial comparing "Standard" (lower-extremity strength and walking endurance) to "Plus" (additional task-specific training for walking) interventions on gait speed in older adults (≥65 years). Predictors included sociodemographic characteristics, health status, physical performance, and self-reported function. We fitted linear regression models to 12-week change in gait speed. RESULTS Predictors of improved gait speed in Standard group included: younger age (β=-0.015), lower BMI (β=-0.005), slower gait speed (β=-0.015), longer Figure 8 Walk time (β=0.010), and higher Late Life Function and Disability Instrument scores (β=0.003). The parsimonious set of multivariable predictors were never married (β=0.081), not a caregiver (β=0.208), no cancer history (β=-0.052), slower chair rise times (β=0.010), slower gait speed (β=-0.021), and better overall function and disability (β=0.006). Predictors of improved gait speed in Plus group included: lower BMI (β=-0.004), farther Six-Minute Walk distance (β=0.014), and greater modified Gait Efficacy Scale (β=0.002). The parsimonious set of multivariable predictors were increased age (β=0.026), no cardiovascular disease (β=0.137), greater total physical activity counts per day (β=0.003), slower baseline gait speed (β=-0.072), and longer Six-Minute Walk distance (β=0.054). SIGNIFICANCE Those with the combination of suboptimal physical performance and strong self-report of function may benefit from standard strength and conditioning. Individuals may best respond to task-specific training when health status and physical performance are suboptimal and not overtly compromised. Matching interventions with personal characteristics may enhance efficacy of treatments to improve walking in older adults.
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Affiliation(s)
- Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Chang JJ, Chen YC, Yeh SL, Tang PF, Tu CK. Impacts of audiovisual simultaneity perception on single-task and dual-task gaits in middle-aged and older adults. Gait Posture 2024; 113:99-105. [PMID: 38850854 DOI: 10.1016/j.gaitpost.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 05/18/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND While dual-task walking requires the ability to integrate sensory information from multiple ongoing sources, it remains unknown whether dual-task walking is more affected than single-task walking by the multisensory integration ability. RESEARCH QUESTION How does the audiovisual temporal integration ability affect single-task and dual-task gaits in the aging population? METHODS One hundred and thirty healthy middle-aged and older adults (age = 64.7 ± 6.4 years) completed an audiovisual simultaneity judgment (AVSJ) task and underwent single-task, motor dual-task, and cognitive dual-task gait assessments. In the AVSJ task, participants judged whether a flash and an auditory stimulus presented at different stimulus onset asynchronies were simultaneous. The accuracy and precision of the AVSJ performance were assessed using the point of subjective simultaneity (PSS) and the temporal binding window (δ), respectively. A lower absolute PSS and δ indicated better performance. Participants held a cup of water and performed serial-7 subtraction for motor and cognitive dual-task gait assessments, respectively. The spatiotemporal gait parameters and their variability were calculated. The influences of PSS and δ on the gait parameters of the three gaits were examined with multiple hierarchical regressions. RESULTS Only the cognitive dual-task gait was significantly affected by PSS and δ. Greater PSS predicted a longer single support time (β = 0.195, p = 0.024) and its variability (β = 0.224, p = 0.011). Greater δ predicted greater step time variability (β = 0.198, p = 0.022). SIGNIFICANCE Declined perception of audiovisual simultaneity particularly degrades temporal control of cognitive dual-task walking, highlighting the importance of assessing and training this ability after midlife.
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Affiliation(s)
- Jer-Jen Chang
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chuan Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Su-Ling Yeh
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan; Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan
| | - Pei-Fang Tang
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan; Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan; Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan; School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chien-Kuang Tu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Rehabilitation Department, Sin-Wu Branch, Tao-Yuan General Hospital, Ministry of Health and Welfare, Taiwan
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort. THE JOURNAL OF PAIN 2024; 25:104448. [PMID: 38122878 PMCID: PMC11128354 DOI: 10.1016/j.jpain.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60-85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and pain-related psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults. PERSPECTIVE: This article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | | | - Peter C. Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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Chardon M, Barbieri FA, Petit P, Vuillerme N. Reliability of Obstacle-Crossing Parameters during Overground Walking in Young Adults. SENSORS (BASEL, SWITZERLAND) 2024; 24:3387. [PMID: 38894176 PMCID: PMC11174552 DOI: 10.3390/s24113387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024]
Abstract
We aimed to evaluate the intra-session relative and absolute reliability of obstacle-crossing parameters during overground walking in young adults, and to determine the number of trials required to ensure reliable assessment. We analysed data from 43 young male adults who were instructed to walk at a self-selected velocity on a pathway and to step over an obstacle (height = 15 cm; width = 80 cm, thickness = 2 cm) three times. Spatial-temporal gait parameters of the approaching and crossing phases (i.e., before and after the obstacle) and obstacle clearance parameters (i.e., vertical and horizontal distance between the foot and the obstacle during crossing) were computed using a three-dimensional motion analysis system. Intraclass correlation coefficients were used to compute the relative reliability, while standard error of measurement and minimal detectable change were used to assess the absolute reliability for all possible combinations between trials. Results showed that most spatial-temporal gait parameters and obstacle clearance parameters are reliable using the average of three trials. However, the mean of the second and third trials ensures the best relative and absolute reliabilities of most obstacle-crossing parameters. Further works are needed to generalize these results in more realistic conditions and in other populations.
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Affiliation(s)
- Matthias Chardon
- AGEIS (Autonomie, Gérontologie, E-Santé, Imagerie et Société), Université Grenoble Alpes, 38000 Grenoble, France; (M.C.); (P.P.)
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Sao Paulo State University (UNESP), Bauru 17033-360, SP, Brazil
| | - Fabio Augusto Barbieri
- Human Movement Research Laboratory (MOVI-LAB), Department of Physical Education, Sao Paulo State University (UNESP), Bauru 17033-360, SP, Brazil
| | - Pascal Petit
- AGEIS (Autonomie, Gérontologie, E-Santé, Imagerie et Société), Université Grenoble Alpes, 38000 Grenoble, France; (M.C.); (P.P.)
| | - Nicolas Vuillerme
- AGEIS (Autonomie, Gérontologie, E-Santé, Imagerie et Société), Université Grenoble Alpes, 38000 Grenoble, France; (M.C.); (P.P.)
- Institut Universitaire de France, 75005 Paris, France
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Özateş ME, Yaman A, Salami F, Campos S, Wolf SI, Schneider U. Identification and interpretation of gait analysis features and foot conditions by explainable AI. Sci Rep 2024; 14:5998. [PMID: 38472287 PMCID: PMC10933258 DOI: 10.1038/s41598-024-56656-4] [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] [Received: 05/19/2023] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
Clinical gait analysis is a crucial step for identifying foot disorders and planning surgery. Automating this process is essential for efficiently assessing the substantial amount of gait data. In this study, we explored the potential of state-of-the-art machine learning (ML) and explainable artificial intelligence (XAI) algorithms to automate all various steps involved in gait analysis for six specific foot conditions. To address the complexity of gait data, we manually created new features, followed by recursive feature elimination using Support Vector Machines (SVM) and Random Forests (RF) to eliminate low-variance features. SVM, RF, K-nearest Neighbor (KNN), and Logistic Regression (LREGR) were compared for classification, with a Majority Voting (MV) model combining trained models. KNN and MV achieved mean balanced accuracy, recall, precision, and F1 score of 0.87. All models were interpreted using Local Interpretable Model-agnostic Explanation (LIME) method and the five most relevant features were identified for each foot condition. High success scores indicate a strong relationship between selected features and foot conditions, potentially indicating clinical relevance. The proposed ML pipeline, adaptable for other foot conditions, showcases its potential in aiding experts in foot condition identification and planning surgeries.
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Affiliation(s)
| | - Alper Yaman
- Fraunhofer IPA, Nobelstrasse 12, Stuttgart, Germany.
| | - Firooz Salami
- Clinic for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sarah Campos
- Clinic for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Sebastian I Wolf
- Clinic for Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Suri A, Hubbard ZL, VanSwearingen J, Torres-Oviedo G, Brach JS, Redfern MS, Sejdic E, Rosso AL. Fear of falling in community-dwelling older adults: What their gait acceleration pattern reveals. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:108001. [PMID: 38199138 PMCID: PMC11411449 DOI: 10.1016/j.cmpb.2023.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/08/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Fear of Falling (FOF) is common among community-dwelling older adults and is associated with increased fall-risk, reduced activity, and gait modifications. OBJECTIVE In this cross-sectional study, we examined the relationships between FOF and gait quality. METHODS Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC. RESULTS Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s2), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF. CONCLUSION Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zachary L Hubbard
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gelsy Torres-Oviedo
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada; North York General Hospital, Toronto, Ontario, Canada
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Suri A, VanSwearingen J, Baillargeon EM, Crane BM, Moored KD, Carlson MC, Dunlap PM, Donahue PT, Redfern MS, Brach JS, Sejdic E, Rosso AL. Association of Gait Quality With Daily-Life Mobility: An Actigraphy and Global Positioning System Based Analysis in Older Adults. IEEE Trans Biomed Eng 2024; 71:130-138. [PMID: 37428666 PMCID: PMC10792545 DOI: 10.1109/tbme.2023.3293752] [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: 07/12/2023]
Abstract
OBJECTIVE Walking is a key component of daily-life mobility. We examined associations between laboratory-measured gait quality and daily-life mobility through Actigraphy and Global Positioning System (GPS). We also assessed the relationship between two modalities of daily-life mobility i.e., Actigraphy and GPS. METHODS In community-dwelling older adults (N = 121, age = 77±5 years, 70% female, 90% white), we obtained gait quality from a 4-m instrumented walkway (gait speed, walk-ratio, variability) and accelerometry during 6-Minute Walk (adaptability, similarity, smoothness, power, and regularity). Physical activity measures of step-count and intensity were captured from an Actigraph. Time out-of-home, vehicular time, activity-space, and circularity were quantified using GPS. Partial Spearman correlations between laboratory gait quality and daily-life mobility were calculated. Linear regression was used to model step-count as a function of gait quality. ANCOVA and Tukey analysis compared GPS measures across activity groups [high, medium, low] based on step-count. Age, BMI, and sex were used as covariates. RESULTS Greater gait speed, adaptability, smoothness, power, and lower regularity were associated with higher step-counts (0.20<|ρp| < 0.26, p < .05). Age(β = -0.37), BMI(β = -0.30), speed(β = 0.14), adaptability(β = 0.20), and power(β = 0.18), explained 41.2% variance in step-count. Gait characteristics were not related to GPS measures. Participants with high (>4800 steps) compared to low activity (steps<3100) spent more time out-of-home (23 vs 15%), more vehicular travel (66 vs 38 minutes), and larger activity-space (5.18 vs 1.88 km2), all p < .05. CONCLUSIONS Gait quality beyond speed contributes to physical activity. Physical activity and GPS-derived measures capture distinct aspects of daily-life mobility. Wearable-derived measures should be considered in gait and mobility-related interventions.
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Dunlap PM, Crane BM, Perera S, Moored KD, Carlson MC, Brach JS, Klatt BN, Rosso AL. Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial. Phys Ther 2023; 103:pzad071. [PMID: 37364044 PMCID: PMC10471202 DOI: 10.1093/ptj/pzad071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/22/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial. METHODS Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis. RESULTS There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same. CONCLUSION There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation. IMPACT The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Breanna M Crane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Subashan Perera
- Division of Geriatric Medicine and Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Sathyan S, Ayers E, Adhikari D, Gao T, Milman S, Barzilai N, Verghese J. Biological Age Acceleration and Motoric Cognitive Risk Syndrome. Ann Neurol 2023; 93:1187-1197. [PMID: 36843279 PMCID: PMC10865507 DOI: 10.1002/ana.26624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/21/2023] [Accepted: 02/13/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and subjective cognitive concerns, is associated with multiple age-related risk factors. We hypothesized that MCR is associated with biological age acceleration. We examined the associations of biological age acceleration with MCR, and mortality risk in MCR cases. METHODS Biological age was determined using proteomic and epigenetic clocks in participants aged 65 years and older in the LonGenity study (N = 700, females = 57.9%) and Health and Retirement Study (HRS; N = 1,043, females = 57.1%) cohorts. Age acceleration (AgeAccel) was operationally defined as the residual from regressing predicted biological age (from both clocks separately) on chronological age. Association of AgeAccel with incident MCR in the overall sample as well as with mortality risk in MCR cases was examined using Cox models and reported as hazard ratios (HRs). RESULTS AgeAccel scores derived from a proteomic clock were associated with prevalent MCR (odds ratio adjusted for age, gender, education years, and chronic illnesses [aOR] = 1.36, 95% confidence interval [CI] = 1.09-1.71) as well as predicted incident MCR (HR = 1.19, 95% CI = 1.00-1.41) in the LonGenity cohort. In HRS, the association of AgeAccel using an epigenetic clock with prevalent MCR was confirmed (aOR = 1.47, 95% CI = 1.16-1.85). Participants with MCR and accelerated aging (positive AgeAccel score) were at the highest risk for mortality in both LonGenity (HR = 3.38, 95% CI = 2.01-5.69) and HRS (HR = 2.47, 95% CI = 1.20-5.10). INTERPRETATION Accelerated aging predicts risk for MCR, and is associated with higher mortality in MCR patients. ANN NEUROL 2023;93:1187-1197.
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Affiliation(s)
- Sanish Sathyan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dristi Adhikari
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tina Gao
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies. THE JOURNAL OF PAIN 2023; 24:980-990. [PMID: 36706887 PMCID: PMC10257757 DOI: 10.1016/j.jpain.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/20/2022] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP. PERSPECTIVE: This article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, North Carolina
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware; Biostatistics Core, University of Delaware, Newark, Delaware
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, Delaware.
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Lee HJ, Park JS, Yang HW, Shin JW, Han JW, Kim KW. A normative study of the gait features measured by a wearable inertia sensor in a healthy old population. Gait Posture 2023; 103:32-36. [PMID: 37084626 DOI: 10.1016/j.gaitpost.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Gait function impairments are associated with the risk of various medical conditions in older adults. As gait function declines with advancing age, normative data are required for proper interpretation of gait function in older adults. RESEARCH PURPOSE This study aimed to construct age-stratified normative data of non-dimensionally normalized temporal and spatial gait features in healthy older adults. METHODS We recruited 320 community-dwelling healthy adults aged 65 years or older from two prospective cohort studies. We stratified them into four age groups (65-69, 70-74, 75-79, and 80-84 years). Each age group comprised 40 men and 40 women. We obtained six gait features (cadence, step time, step time variability, step time asymmetry, gait speed, and step length) using a wearable inertia measurement unit attached on the skin overlying L3-L4 on the back. To mitigate the influence of body shape, we non-dimensionally normalized the gait features into unitless values using height and gravity. RESULT The effect of age group was significant in all raw gait features (p < 0.001 for step time variability, speed and step length; p < 0.05 for cadence, step time and step time asymmetry), and that of sex was significant in the five raw gait features, except for step time asymmetry(p < 0.001 for cadence, step time, speed, and step length; p < 0.05 for step time asymmetry). When gait features were normalized, the effect of age group remained (p < 0.001 for all gait features), whereas that of sex disappeared (p > 0.05 for all gait features). SIGNIFICANCE Our dimensionless normative data on gait features may be useful in comparative studies of gait function between sexes or ethnicities with different body shapes.
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Affiliation(s)
- Hyang Jun Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republiuc of Korea
| | - Ji Sun Park
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republiuc of Korea
| | - Hee Won Yang
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republiuc of Korea
| | - Jeong Wook Shin
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republiuc of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republiuc of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republiuc of Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republiuc of Korea; Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Republiuc of Korea.
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Boripuntakul S, Kamnardsiri T, Lord SR, Maiarin S, Worakul P, Sungkarat S. Gait variability during abrupt slow and fast speed transitions in older adults with mild cognitive impairment. PLoS One 2022; 17:e0276658. [PMID: 36269750 PMCID: PMC9586342 DOI: 10.1371/journal.pone.0276658] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Gait speed modulation, including abruptly decreasing or increasing gait speed, is a challenging task and prerequisite for safe mobility in the community. Older adults with Mild Cognitive Impairment (MCI) exhibit gait deficits under challenging walking conditions which may increase their risk of falls. The purpose of this study was to investigate spatiotemporal variability during slow and fast speed transitions in older adults with and without MCI. Twenty-five older adults with MCI (mean age = 68.56 ± 3.79 years) and 25 cognitively intact controls (mean age = 68.72 ± 4.67 years) participated. Gait performance during gait speed transitions was measured in two walking conditions: 1) a slow to fast speed transition in response to a randomly presented cue, and 2) a fast to slow speed condition in response to a randomly presented cue. Means and variability of spatiotemporal parameters during the transitions were measured and mixed model repeated measures ANOVAs were used to assess interaction and main effects. The older adults with MCI exhibited greater variability of step length (MCI = 13.93 ± 5.38, Control = 11.12 ± 3.15, p = 0.03) and swing time (MCI = 13.35 ± 6.01, Control = 10.43 ± 2.87, p = 0.03) than the controls during the fast to slow speed transitions. No other between-group differences were evident for the gait parameters across the two walking conditions. The findings suggest that older adults with MCI have reduced ability to adapt their gait during transitions from fast to slow walking speeds. This impairment may indicate a decline in automated regular rhythmic gait control and explain in part why this group is at increased risk of falls. Slow speed transition task might be incorporated as a fall risk screening in older adults with MCI.
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Affiliation(s)
- Sirinun Boripuntakul
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
- Research Group of Modern Management and Information Technology, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Teerawat Kamnardsiri
- Research Group of Modern Management and Information Technology, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
- Department of Digital Game, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Stephen Ronald Lord
- Neuroscience Research Australia, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Surinthorn Maiarin
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
| | - Puangsoi Worakul
- Clinical Psychology Program, Faculty of Education, Prince of Songkla University, Pattani Campus, Pattani, Thailand
| | - Somporn Sungkarat
- Faculty of Associated Medical Sciences, Department of Physical Therapy, Chiang Mai University, Chiang Mai, Thailand
- Research Group of Modern Management and Information Technology, College of Arts, Media and Technology, Chiang Mai University, Chiang Mai, Thailand
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Hasui N, Mizuta N, Matsunaga A, Taguchi J, Nakatani T. Effects of rhythmic auditory cueing on gait variability and voluntary control of walking -a cross-sectional study. Hum Mov Sci 2022; 85:102995. [PMID: 36087408 DOI: 10.1016/j.humov.2022.102995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
Temporal gait variability is strongly associated with motor function and falls in the context of numerous diseases. Rhythmic auditory cueing (RAC) can influence stride-to-stride time, although its effects on temporal gait variability remain unclear. Therefore, the aim of the present cross-disease study was to examine the effects of RAC on stride time variability (STV), as well as the factors affecting changes in STV during walking with RAC. Participants with post-stroke (n = 12) and orthopedic disease (n = 23) performed a random block design under four conditions: comfortable walking speed (CWS) and walking with RAC (RAC 0%, RAC +10%, RAC -10%). STV was measured along with co-contraction and inter-muscular coherence of the shank muscles during walking for each condition. The contributions of the muscle activity pattern and voluntary control to the change in STV between the CWS and RAC 0% conditions were examined using hierarchical multiple regression analysis. STV was significantly lower in the RAC 0% condition than in the CWS condition (p = 0.03). Hierarchical multiple regression analysis revealed that the change in STV was explained by STV in the CWS condition (β = -0.36) and by changes in co-contraction (β = 0.43) and inter-muscular coherence (β = 0.38) during the stance phase between the CWS and RAC 0% conditions (R2 = 0.56, p < 0.001). These findings indicate that walking training with RAC is effective in reducing gait variability and immediately improves muscle activity patterns and excessive corticospinal activity.
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Affiliation(s)
- Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 tsuru-no-so, Takarazuka-shi, Hyogo 665-0833, Japan.
| | - Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-cho, Handa, Aichi 475-0012, Japan; Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara 635-0832, Japan
| | - Ayaka Matsunaga
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 tsuru-no-so, Takarazuka-shi, Hyogo 665-0833, Japan
| | - Junji Taguchi
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 tsuru-no-so, Takarazuka-shi, Hyogo 665-0833, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, Medical Corporation SHOWAKAI, 22-2 tsuru-no-so, Takarazuka-shi, Hyogo 665-0833, Japan
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Harris R, Brach JS, Moye J, Ogawa E, Ward R, Halasz I, Bean J. The Live Long Walk Strong Rehabilitation Program Study: Design and Methods. Arch Rehabil Res Clin Transl 2022; 4:100205. [PMID: 36123980 PMCID: PMC9482036 DOI: 10.1016/j.arrct.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify attributes targeted by rehabilitative treatment within which improvements lead to short- and long-term changes in mobility. Maintaining independence in mobility is important to many older adults and is associated with critical outcomes such as aging in place, morbidity, and mortality. Design The Live Long Walk Strong rehabilitation study is a phase 2 single-blind, randomized controlled trial. Setting Veterans Affairs Boston Healthcare System, outpatient physical therapy. Participants 198 community-dwelling middle- and older-aged veterans (aged 50 years and older) will be recruited from primary care practices (N=198). Interventions Comparing a moderate-vigorous intensity physical therapy program of 10 sessions with a waitlist control group. Main Outcome Measure The primary outcome measure is gait speed. Secondary outcomes include leg strength and power, trunk muscle endurance, gait smoothness, and exercise self-efficacy. Results Outcomes will be assessed within 2 weeks of intervention completion, at 8 weeks postintervention, and at 16 weeks postintervention. Two-sample t tests will compare mean change in gait speed and target attributes (leg power, trunk muscle endurance, gait smoothness, and exercise self-efficacy) between treatment and control groups. Paired t tests will examine within-person change at subsequent follow-up visits. Multivariable regression analyses will evaluate relationships between dependent and independent variables and potential mediation adjusting for relevant covariates. Conclusions Results of this study are expected to advance and refine the design of Live Long Walk Strong rehabilitative care and demonstrate its proof of concept and efficacy.
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Affiliation(s)
- Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Moye
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Cambridge, MA
| | - Elisa Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Rachel Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
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Hemmati F, Karimi MT, Hosseini SI, Mardani MA, Fadayevatan R. The effect of toe-only rocker sole shoes on gait variability of the elderly. Med Biol Eng Comput 2022; 60:2493-2498. [DOI: 10.1007/s11517-022-02605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
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Embon-Magal S, Krasovsky T, Doron I, Asraf K, Haimov I, Gil E, Agmon M. The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study. BMC Geriatr 2022; 22:720. [PMID: 36045345 PMCID: PMC9429752 DOI: 10.1186/s12877-022-03403-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in Motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive impairment. Methods Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome. Results CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. Conclusions The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements. Trial registration ACTRN12616001543471. Date: 08/11/2016.
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Dapp U, Vinyard D, Golgert S, Krumpoch S, Freiberger E. Reference values of gait characteristics in community-dwelling older persons with different physical functional levels. BMC Geriatr 2022; 22:713. [PMID: 36038832 PMCID: PMC9422159 DOI: 10.1186/s12877-022-03373-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mobility is one major component of healthy ageing of older persons. It includes gait speed, nowadays valued as the sixth vital sign of ageing. Quantitative gait analysis can support clinical diagnostics, monitor progression of diseases and provide information about the efficacy of interventions. Fast gait speed is an additional marker in the area of functional ability. Our aim was to contribute reference values of gait parameters of older persons based on their functional ability. Methods We visualised and combined three different established frameworks that assess gait characteristics into a new framework based approach that comprises eight gait parameters: gait speed, stride length, walk ratio, single and double support time, step width, step width CV (coefficient of variance), stride length CV. Gait parameters were stratified by two instruments that indicate levels of functional ability: First, the LUCAS Functional Ability Index (FAI), a self-administered screening tool easy to apply to a public-health orientated approach and second the Short Physical Performance Battery (SPPB), an established performance test widely used in comprehensive geriatric assessments (CGA). Gait parameters of older community-dwelling persons were measured with an objective Gait system (GAITRite) across differing functional ability ranging from robust to transient (postrobust and prefrail) to frail physical status. Results Of 642 community-dwelling participants (age 78.5 ± 4.8; n = 233 male, n = 409 female) categorisations by SPPB were 27.1% for robust (11–12 points), 44.2% for transient (8–10 points), 28.7% for frail (0–7 points), and 16.2, 50.3, 33.5% for robust, transient, frail by LUCAS FAI. Overall, our results showed that distinction by functional level only uncovers a wide spectrum of functional decline for all investigated gait parameters. Stratification by functional ability (biological age) revealed a greater range of differentiation than chronological age. Conclusions Gait parameters, carefully selected by literature, showed clinically meaningful differences between the functional featuring a gradient declining from robust over transient to frail in most gait parameters. We found discriminative power of stratifications by SPPB to be the highest, closely followed by LUCAS FAI, age groups and dichotomous age making the application of the LUCAS FAI more cost and time effective than conducting SPPB. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03373-0.
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Affiliation(s)
- Ulrike Dapp
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany.
| | - Dominic Vinyard
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany
| | - Stefan Golgert
- Scientific Department at the University of Hamburg, Albertinen-Haus Geriatrics Center, Sellhopsweg 18-22, 22459, Hamburg, Germany
| | - Sebastian Krumpoch
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nürnberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nürnberg, Germany.
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22
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Parati M, Ambrosini E, DE Maria B, Gallotta M, Dalla Vecchia LA, Ferriero G, Ferrante S. The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:363-377. [PMID: 34985239 PMCID: PMC9987464 DOI: 10.23736/s1973-9087.22.07037-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups. EVIDENCE ACQUISITION A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the Consensus-Based Standards for the Selection of Health Measurement Instruments Checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values. EVIDENCE SYNTHESIS A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in single-and cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction). CONCLUSIONS Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy -
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Brach JS, Perera S, Shuman V, Gil AB, Kriska A, Nadkarni NK, Rockette-Wagner B, Cham R, VanSwearingen JM. Effect of Timing and Coordination Training on Mobility and Physical Activity Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2212921. [PMID: 35604689 PMCID: PMC9127558 DOI: 10.1001/jamanetworkopen.2022.12921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Importance Standard exercise interventions targeting underlying physiologic system impairments have limited success in improving walking. Augmenting standard interventions with timing and coordination training, which incorporates the principles of motor learning and integrates multiple systems, may be more successful. Objective To determine whether a standard strength and endurance program incorporating timing and coordination training (standard-plus) improves gait speed more than strength and endurance training alone. Design, Setting, and Participants The Program to Improve Mobility in Aging (PRIMA) study was an assessor-blinded, randomized, 2-group intervention trial that included a 12-week intervention and 24-week follow-up period. The trial was conducted at a university research clinic from 2016 to 2020. Participants included 249 community-dwelling older adults (aged ≥65 years) with gait speed between 0.60 and 1.20 m/s. Statistical analysis was performed from December 2020 to March 2021. Interventions Participants were randomized to standard strength and endurance (n = 125) or standard-plus, including timing and coordination training (n = 124), 50 to 60 minutes, twice a week for 12 weeks. Main Outcomes and Measures Primary outcome of gait speed and secondary outcomes representing components of the intervention (leg strength and power, 6-minute walk test, chair sit-and-reach test, and figure of 8 walk test) and activity and participation (Late Life Function and Disability Instrument and daily physical activity measured by accelerometry) were measured at 12, 24, and 36 weeks. Results Among 249 randomized participants, 163 (65.5%) were female, 22 (8.8%) were Black, 219 (88.0%) were White; mean (SD) age was 77.4 (6.6) years; mean (SD) gait speed was 1.07 (0.16) m/s; and 244 (98.0%) completed the intervention. The 2 groups did not have significantly different improvements in gait speed or secondary outcomes representing the components of the intervention at any time point. For gait speed, individuals in the standard-plus group had a mean (SD) improvement of 0.079 (0.135) m/s over 12 weeks, 0.065 m/s (0.141) over 24 weeks, and 0.059 (0.150) m/s over 36 weeks; individuals in the standard group improved gait speed by 0.081 (0.124) m/s over 12 weeks, 0.051 (0.129) m/s over 24 weeks, and 0.065 (0.148) m/s over 36 weeks. Conclusions and Relevance This randomized clinical trial found no difference in gait speed change between the standard and standard-plus intervention groups, and both groups showed sustained improvements in mobility 24 weeks after the intervention. Trial Registration ClinicalTrials.gov Identifier: NCT02663778.
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Affiliation(s)
- Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexandra B. Gil
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea Kriska
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neelesh K. Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Rakie Cham
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Reliability of IMU-Derived Temporal Gait Parameters in Neurological Diseases. SENSORS 2022; 22:s22062304. [PMID: 35336475 PMCID: PMC8955629 DOI: 10.3390/s22062304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/25/2022]
Abstract
Evaluating gait is part of every neurological movement disorder assessment. Generally, the physician assesses the patient based on their experience, but nowadays inertial measurement units (IMUs) are also often integrated in the assessment. Instrumented gait analysis has a longstanding tradition and temporal parameters are used to compare patient groups or trace disease progression over time. However, the day-to-day variability needs to be considered especially in specific patient cohorts. The aim of the study was to examine day-to-day variability of temporal gait parameters of two experimental conditions in a cohort of neurogeriatric patients using data extracted from a lower back-worn IMU. We recruited 49 participants (24 women (age: 78 years ± 6 years, BMI = 25.1 kg/m2 and 25 men (age: 77 years ± 6 years, BMI = 26.5 kg/m2)) from the neurogeriatric ward. Two gait distances (4 m and 20 m) were performed during the first session and repeated the following day. To evaluate reliability, the Intraclass Correlation Coefficient (ICC2,k) and minimal detectable change (MDC) were calculated for the number of steps, step time, stride time, stance time, swing time, double limb support time, double limb support time variability, stride time variability and stride time asymmetry. The temporal gait parameters showed poor to moderate reliability with mean ICC and mean MDC95% values of 0.57 ± 0.18 and 52% ± 53%, respectively. Overall, only four out of the nine computed temporal gait parameters showed high relative reliability and good absolute reliability values. The reliability increased with walking distance. When only investigating steady-state walking during the 20 m walking condition, the relative and absolute reliability improved again. The most reliable parameters were swing time, stride time, step time and stance time. Study results demonstrate that reliability is an important factor to consider when working with IMU derived gait parameters in specific patient cohorts. This advocates for a careful parameter selection as not all parameters seem to be suitable when assessing gait in neurogeriatric patients.
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Lindh-Rengifo M, Jonasson SB, Ullén S, Stomrud E, Palmqvist S, Mattsson-Carlgren N, Hansson O, Nilsson MH. Components of gait in people with and without mild cognitive impairment. Gait Posture 2022; 93:83-89. [PMID: 35101749 DOI: 10.1016/j.gaitpost.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several objective gait parameters are associated with cognitive impairment, but there is limited knowledge of gait models in people with mild cognitive impairment (MCI). RESEARCH QUESTION How can 18 objective gait characteristics be used to define different components of gait in people with MCI (with suspected incipient neurocognitive disorder) and cognitively unimpaired people (CU), respectively? METHODS Spatiotemporal gait data were collected by using an electronic walkway (GAITRite®), i.e. assessments in comfortable gait speed. Using cross-sectional gait data, two principal component analyses (PCA) were performed (varimax rotation) to define different components of gait in people with MCI (n = 114) and CU (n = 219), respectively, from the BioFINDER-2 study. RESULTS Both PCAs produced four components, here called Variability, Pace/Stability, Rhythm and Asymmetry. Total variance explained was 81.0% (MCI) versus 80.3% (CU). The Variability component explained the largest amount of variance (about 25%) in both groups. The highest loading gait parameter was the same for both groups in three out of four components, i.e. step velocity variability (Variability), mean step length (Pace/Stability) and mean step time (Rhythm). In the asymmetry component, stance time asymmetry (MCI) and swing time asymmetry (CU) loaded the highest. SIGNIFICANCE The gait components seem similar in people with and without MCI, although there were some differences. This study may aid the identification of gait variables that represent different components of gait. Gait parameters such as step velocity variability, mean step length, mean step time as well as swing and stance time asymmetry could serve as interesting core variables of different gait components in future research in people with MCI (with suspected incipient neurocognitive disorder) and CU. However, the selection of gait variables depends on the purpose. It needs to be noted that assessment of variability measures requires more advanced technology than is usually used in the clinic.
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Affiliation(s)
- Magnus Lindh-Rengifo
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | | | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden
| | - Erik Stomrud
- Memory Clinic, Skåne University Hospital, Malmö, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sebastian Palmqvist
- Memory Clinic, Skåne University Hospital, Malmö, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Niklas Mattsson-Carlgren
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Lund, Sweden; Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Oskar Hansson
- Memory Clinic, Skåne University Hospital, Malmö, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Maria H Nilsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Memory Clinic, Skåne University Hospital, Malmö, Sweden; Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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26
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Knox PJ, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Aberrant Lumbopelvic Movements Predict Prospective Functional Decline in Older Adults with Chronic Low Back Pain. Arch Phys Med Rehabil 2022; 103:473-480.e1. [PMID: 34547273 PMCID: PMC8901446 DOI: 10.1016/j.apmr.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate if clinically observable aberrant lumbopelvic movements are associated with physical function at 12-month follow-up in older adults with chronic low back pain (CLBP), both directly and indirectly through baseline physical function. DESIGN Secondary analysis of a yearlong prospective cohort study. SETTING Clinical Research Laboratory. PARTICIPANTS Community-dwelling older adults with CLBP (N=250). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data from 239 participants were analyzed. Participants were screened at baseline for aberrant lumbopelvic movements during active trunk flexion; total observable aberrant movements were recorded and summed (range 0-4). Latent constructs of physical function were developed from an array of perception-based and performance-based outcome measures at baseline and 12 months, respectively. Structural Equation Modeling was used to assess the direct effect of baseline aberrant movement score on the latent construct of 12-month physical function, and its indirect effect through baseline physical function. RESULTS Aberrant movements were present in most participants (64.7%) and had a significant negative total effect on 12-month physical function (γ= -0.278, P<.001). Aberrant movement score's direct effect and indirect effect, through baseline functioning, were significantly negatively associated with physical function at 12-months, after adjusting for covariates (γ=-0.068, P=.038; γ= -0.210, P<.001, respectively). CONCLUSIONS Aberrant lumbopelvic movements are associated with decreased physical function at 12-month follow-up in older adults with CLBP, independent of baseline physical function and covariates. Future studies should evaluate if screening for aberrant movements may inform prognostic and interventional efforts in this patient population.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE.,Biostatistics Core, University of Delaware, Newark, DE
| | | | - Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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27
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Gait characteristics in community-dwelling older persons with low skeletal muscle mass and low physical performance. Aging Clin Exp Res 2022; 34:1563-1571. [PMID: 35133611 PMCID: PMC9246787 DOI: 10.1007/s40520-021-02061-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022]
Abstract
Background Demographic changes in the western world entail new clinical approaches and challenges in older persons. Low skeletal muscle mass and low physical performance in older persons are both predisposing conditions for disability and obtaining knowledge in this cohort is essential. Aim The primary aim of the study was to analyze a broader spectrum of gait characteristics within this specific population and differentiate them across different test conditions. Methods Two centers participating at the SPRINTT project with hi-tech gait analysis available conducted a cross-sectional descriptive study on N = 115 community-dwelling older persons with low muscle mass and physical performance. Reference values of 13 gait parameters were collected across different conditions: usual gait speed, fast gait speed, and usual gait speed while simultaneously naming animals. Results and discussion This study shows the first spatio-temporal reference values in a community-dwelling older population composed of individuals with low skeletal muscle mass and low physical performance. In comparison to the normative spatio-temporal gait parameters in older persons reported in the literature, this population showed some differences. The mean gait speed was lower than 1 m/s, considered as a cutoff for vulnerable community-dwelling individuals, which corresponds to a greater risk of falls, hospitalization, and mortality. The stride length variability was higher, exposing to a greater risk of falling, and was also associated with a higher risk of developing cognitive decline. Conclusion This study represents the first step in the development of quantitative reference values in community-dwelling older persons with low physical performance and low skeletal muscle mass.
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Hicks GE, Pohlig RT, Coyle PC, Sions JM, Weiner DK, Pugliese JM, Velasco TO, O’Brien VA. Classification of Geriatric Low Back Pain Based on Hip Characteristics With a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings From Delaware Spine Studies. Phys Ther 2021; 101:6374826. [PMID: 34636887 PMCID: PMC8801002 DOI: 10.1093/ptj/pzab227] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/03/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study is to identify geriatric chronic low back pain (LBP) subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time. METHODS Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and 6-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models. RESULTS Regarding LVMM, a model with 3 classes/subgroup fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic, subgroup 2 = weak and nonsymptomatic, and subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared with the WS subgroup, whereas the strong and nonsymptomatic subgroup had better mobility function than the 2 "weak" subgroups. CONCLUSION These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup given their consistently poor LBP and mobility function outcomes. IMPACT Among older adults with chronic low back pain, there are 3 hip subgroups: "strong and nonsymptomatic," "weak and nonsymptomatic," and "weak and symptomatic." People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, because their outcomes are consistently poorer than those in the other subgroups.
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Affiliation(s)
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, Delaware, USA,Biostatistics Core, University of Delaware, Newark, Delaware, USA
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - J Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Debra K Weiner
- Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Dunlap PM, Rosso AL, Zhu X, Klatt BN, Brach JS. The Association of Mobility Determinants and Life Space Among Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:2320-2328. [PMID: 34529773 DOI: 10.1093/gerona/glab268] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is important to understand the factors associated with life space mobility so that mobility disability can be prevented/treated. The purpose of this study was to identify the association between mobility determinants and life space among older adults. METHODS This study was a cross-sectional analysis of 249 community-dwelling older adults (mean age=77.4 years, 65.5% female, 88% white) who were recruited for a randomized, controlled, clinical intervention trial. Associations between cognitive, physical, psychosocial, financial, and environmental mobility determinants and the Life Space Assessment (LSA) at baseline were determined using Spearman's correlation coefficients and one-way analysis of variance. Multivariate analysis was performed using multivariable linear regression models. RESULTS The mean LSA score for the sample was 75.3 (SD=17.8). Personal factors (age, gender, education, comorbidities), cognitive (Trail Making Test A and B), physical (gait speed, lower extremity power, Six Minute Walk Test, Figure of 8 Walk Test, tandem stance, energy cost of walking, and Late Life Function and Disability Function Scale), psychosocial (Modified Gait Efficacy Scale), and financial (neighborhood socio-economic status) domains of mobility were significantly associated with LSA score. In the final regression model, age (β=-0.43), lower extremity power (β=0.03), gait efficacy (β=0.19), and energy cost of walking (β=-57.41) were associated with life space (R 2=0.238). CONCLUSIONS Younger age, greater lower extremity power, more confidence in walking, and lower energy cost of walking were associated with greater life space. Clinicians treating individuals with mobility disability should consider personal, physical, and psychosocial factors assessing barriers to life space mobility.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaonan Zhu
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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30
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Coyle PC, Knox PJ, Pohlig RT, Pugliese JM, Sions JM, Hicks GE. Hip Range of Motion and Strength Predict 12-Month Physical Function Outcomes in Older Adults With Chronic Low Back Pain: The Delaware Spine Studies. ACR Open Rheumatol 2021; 3:850-859. [PMID: 34524738 PMCID: PMC8672177 DOI: 10.1002/acr2.11342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study was to investigate whether poor hip range of motion (ROM) and strength predict 12‐month physical function decline among older adults with chronic low back pain (LBP) and whether hip osteoarthritis modifies those relationships. Methods At baseline, passive ROM and strength measurements were taken for hip flexion, extension, abduction, adduction, internal rotation, and external rotation; ultrasound images and self‐reported symptoms were used to evaluate hip osteoarthritis presence (eg, osteophytes and hip pain). At baseline and 12 months, performance‐based (repeated chair rise, self‐selected gait speed, 6‐minute walk test [6MWT]) and self‐reported (Quebec LBP Disability Questionnaire, Late‐Life Function & Disability Instrument [LLFDI] basic and advanced lower extremity scales) physical function outcomes were assessed. Regression models were constructed for each outcome predicted by baseline hip ROM and strength measures, with adjustment for potential covariates. To avoid collinearity, hip ROM and strength measures with the strongest unadjusted correlations were included in final models. The hip osteoarthritis presence by hip ROM/strength interaction was also explored. Results Hip abduction strength predicted repeated chair rise (β = −0.297, P < 0.001), gait speed (β = 0.160, P = 0.003), 6MWT (β = 0.159, P ≤ 0.001), Quebec LBP Disability Questionnaire (β = −0.152, P = 0.003), and LLFDI basic lower extremity scale (β = 0.171, P = 0.005) outcomes. Regarding hip ROM, extension predicted repeated chair rise (β = −0.110, P = 0.043) and LLFDI advanced lower extremity scale (β = 0.090, P = 0.007) outcomes, external rotation predicted gait speed (β = 0.122, P = 0.004) outcomes, and abduction predicted LLFDI basic lower extremity scale (β = 0.114, P = 0.026) outcomes. The hip osteoarthritis interaction was not significant for any model. Conclusion Reduced hip strength and ROM predict physical function decline; hip osteoarthritis presence may not modify these relationships.
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Lau LK, Wee SL, Mallya JU, Yap PLK, Pang WJB, Chen KK, Abdul Jabbar K, Seah WT, Ng TP. Physiological and cognitive determinants of gait in middle-aged, older-aged and oldest-aged Asian adults – The Yishun study. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Suri A, Rosso AL, VanSwearingen J, Coffman LM, Redfern MS, Brach JS, Sejdić E. Mobility of Older Adults: Gait Quality Measures are associated with Life-Space Assessment Scores. J Gerontol A Biol Sci Med Sci 2021; 76:e299-e306. [PMID: 34038537 DOI: 10.1093/gerona/glab151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relation of gait quality to real-life mobility among older adults is poorly understood. This study examined the association between gait quality, consisting of step variability, smoothness, regularity, symmetry and gait speed with the Life-Space Assessment (LSA). METHODS In community-dwelling older adults (N=232, age 77.5±6.6, 65% females), gait quality was derived from: a) an instrumented walkway: gait speed, variability and walk-ratio; and b) accelerometer: signal variability, smoothness, regularity, symmetry, and time-frequency spatiotemporal variables during 6-minute walk. In addition to collecting LSA scores, cognitive functioning, walking-confidence, and falls were recorded. Spearman correlations (speed as covariate) and Random Forest Regression were used to assess associations between gait quality and LSA, and Gaussian-mixture modeling (GMM) was used to cluster participants. RESULTS Spearman correlations of ρp=0.11 (signal amplitude variability ML), ρp=0.15, ρp=-0.13 (symmetry AP-V, ML-AP), ρp=0.16 (power V) and ρ=0.26 (speed), all p<0.05 and marginally related, ρp=-0.12 (regularity V), ρp=0.11 (smoothness AP) and ρp=-0.11 (step-time variability), p<0.1 were obtained. The cross-validated Random Forest model indicated good fit LSA prediction error of 17.77; gait and cognition were greater contributors than age and gender. GMM indicated two clusters. Group-1(N=189) had better gait quality than Group-2(N=43): greater smoothness AP (2.94±0.75 vs 2.30±0.71); greater similarity AP-V (0.58±0.13 vs 0.40±0.19); lower regularity V (0.83±0.08 vs 0.87±0.10); greater power V (1.86±0.18 vs 0.97±1.84); greater speed (1.09±0.16 vs 1.00±0.16 m/s); lower step time CoV (3.70±1.09 vs 5.09±2.37) and better LSA (76±18 vs 67±18), padjusted<0.004. CONCLUSIONS Gait quality measures taken in the clinic are associated with real-life mobility in the community.
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Affiliation(s)
- Anisha Suri
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh
| | - Jessie VanSwearingen
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Leslie M Coffman
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh
| | - Jennifer S Brach
- Department of Physical Therapy, School of Rehabilitation Sciences, University of Pittsburgh, Pittsburgh
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh
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Spatio-temporal gait parameters obtained from foot-worn inertial sensors are reliable in healthy adults in single- and dual-task conditions. Sci Rep 2021; 11:10229. [PMID: 33986307 PMCID: PMC8119721 DOI: 10.1038/s41598-021-88794-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Inertial measurement units (IMUs) are increasingly popular and may be usable in clinical routine to assess gait. However, assessing their intra-session reliability is crucial and has not been tested with foot-worn sensors in healthy participants. The aim of this study was to assess the intra-session reliability of foot-worn IMUs for measuring gait parameters in healthy adults. Twenty healthy participants were enrolled in the study and performed the 10-m walk test in single- and dual-task ('carrying a full cup of water') conditions, three trials per condition. IMUs were used to assess spatiotemporal gait parameters, gait symmetry parameters (symmetry index (SI) and symmetry ratio (SR)), and dual task effects parameters. The relative and the absolute reliability were calculated for each gait parameter. Results showed that spatiotemporal gait parameters measured with foot-worn inertial sensors were reliable; symmetry gait parameters relative reliability was low, and SR showed better absolute reliability than SI; dual task effects were poorly reliable, and taking the mean of the second and the third trials was the most reliable. Foot-worn IMUs are reliable to assess spatiotemporal and symmetry ratio gait parameters but symmetry index and DTE gait parameters reliabilities were low and need to be interpreted with cautious by clinicians and researchers.
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Lau LK, Mallya JU, Pang WJB, Chen KK, Abdul Jabbar KB, Seah WT, Yap PLK, Ng TP, Wee SL. Physiological and Cognitive Determinants of Dual-Task Costs for Gait Parameters: The Yishun Study. Gerontology 2021; 67:457-466. [PMID: 33752216 DOI: 10.1159/000514171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies indicate that physiological and cognitive aging are causally related and functionally interdependent. However, the relative contribution of physiological factors and cognition to dual-task costs (DTC) of gait parameters has not been well studied. In this cross-sectional study, we examined the trajectory of DTC of gait parameters across the adult age spectrum for both sexes and identified the contributions of physical and cognitive performance to DTC of gait. METHODS A total of 492 community-dwelling adults, aged 21-90 years, were randomly recruited into the study. Participants were divided into 7 age groups, with 10-year age range for each group. Demographic data, height, body mass, education level, and information on comorbidities were recorded. Cognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status. Physical performance included visual contrast sensitivity, postural sway, hand reaction time, handgrip strength, knee extensor strength, and single-task and dual-task gait assessments. Stepwise multivariable regression was used to examine the association between physical and cognitive performance with DTC of gait parameters. RESULTS Women were found to have significantly higher DTC of gait speed (p = 0.01), cadence (p < 0.01), and double support time (p < 0.01) than men. However, significant aging effect on DTC of gait speed (p = 0.01), step length (p = 0.01), and double support time (p = 0.01) was observed in men but not in women. Immediate memory was the primary determinant for the DTC of gait speed (β = -0.25, p < 0.01), step length (β = -0.22, p < 0.01), and cadence (β = -0.15, p = 0.03) in men. Besides immediate memory, postural sway (β = -0.13, p = 0.03) and hand reaction (β = 0.14, p = 0.02) were also significantly associated with DTC of step length and cadence, respectively, in women. CONCLUSION There were sex differences in the amplitude and trajectories of DTC of gait parameters. The DTC increased with age in men but not in women. Immediate memory was the primary determinant of DTC of gait parameters in men while immediate memory, postural sway, and reaction time were associated with DTC of gait in women. Future studies should investigate the clinical implications of the sex differences in the DTC with fall risks.
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Affiliation(s)
- Lay Khoon Lau
- Geriatric Education and Research Institute (GERI), Singapore, Singapore,
| | - Jagadish Ullal Mallya
- Geriatric Education and Research Institute (GERI), Singapore, Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | | | | | - Wei Ting Seah
- Geriatric Education and Research Institute (GERI), Singapore, Singapore
| | - Philip Lin Kiat Yap
- Geriatric Education and Research Institute (GERI), Singapore, Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute (GERI), Singapore, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute (GERI), Singapore, Singapore.,Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
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Ogawa EF, Harris R, DeGutis JM, Ward RE, Brach JS, Halasz I, Travison TG, Bean JF. Evaluating the Feasibility and Effects of a Short-Term Task Specific Power Training With and Without Cognitive Training Among Older Adults With Slow Gait Speed: A Pilot Study. Arch Rehabil Res Clin Transl 2021; 3:100118. [PMID: 34179754 PMCID: PMC8211979 DOI: 10.1016/j.arrct.2021.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the feasibility and efficacy of short-term functional power training and further examine whether the addition of cognitive training targeting sustained attention and inhibitory control would augment the effect on the outcomes. Design: Randomized pilot study. Setting: Clinical research facility. Participants: Community-dwelling primary care patients (N=25) aged >65 years with mobility limitation within the VA Boston Healthcare System. Interventions: Participants were randomly assigned to either functional power training (n=14) or functional power+cognitive training (n=11), offered 3 times a week for 6 weeks. Session durations were either 70 minutes (functional power+cognitive training) or 40 minutes (functional power training). Main Outcome Measures: We evaluated feasibility (dropouts, attendance), mobility performance (Short Physical Performance Battery [SPPB]), leg power [stair climb test]), dynamic balance [figure-of-8], and gait characteristics [gait speed, stance time, step width, swing time, step length, variabilities under single-task and dual-task conditions]). Nonparametric analyses were used to compare overall pre-post changes and between-group differences. Results: Of the 39 veterans screened, 25 were randomized and enrolled. Twenty-one men with a mean age 76±7 years completed the study; 86% were white. Participants had a mean SPPB score of 8.3±1.6 out of 12. For those completing the study, overall attendance was 79%. Among all participants, clinically relevant and/or statistically significant median change in mobility performance (∆1 point), leg power (∆25.0W), dynamic balance (∆-1.1s), and gait characteristics (gait speed [∆0.08s, ∆0.09s], step length [∆1.9cm, ∆3.8cm], and stance time [∆-0.02s, ∆-0.05s] under single- and dual-task, respectively) were observed after 6 weeks of training. There were no statistically significant group differences in dropouts, attendance rate, or any of the outcomes based on cognitive training status. Conclusions: Short-term functional power training with or without a cognitive training led to clinically meaningful improvements in mobility performance, leg power, dynamic balance, and gait characteristics. These findings add to the body of evidence supporting the benefits of functional power training on clinically relevant outcomes. Additional cognitive training did not have an added effect on the study outcomes from our study. Further research is needed.
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Affiliation(s)
- Elisa F Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Joseph M DeGutis
- Department of Psychiatry, Harvard Medical School, Boston, MA.,Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA
| | - Rachel E Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Cambridge, MA.,Spaulding Rehabilitation Hospital, Boston, MA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Thomas G Travison
- Harvard Medical School, Cambridge, MA.,Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Cambridge, MA.,Spaulding Rehabilitation Hospital, Boston, MA
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The Influence of Diabetes on Multisensory Integration and Mobility in Aging. Brain Sci 2021; 11:brainsci11030285. [PMID: 33668979 PMCID: PMC7996615 DOI: 10.3390/brainsci11030285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/08/2021] [Accepted: 02/20/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: one out of every four adults over the age of 65 are living with diabetes, and this alarming rate continues to increase with age. Diabetes in older adults is associated with many adverse health outcomes, including sensory and motor impairments. The objective of this exploratory study was to determine whether diabetes influences the interplay between multisensory integration processes and mobility in aging. (2) Methods: in this cross-sectional observational study, we recruited 339 non-demented older adults (76.59 ± 6.21 years; 52% female, 18% with diabetes). Participants completed a simple reaction time test in response to visual, somatosensory, and combined visual-somatosensory stimulation. Magnitude of visual-somatosensory integration was computed and served as the independent variable. (3) Results: logistic regression revealed that presence of diabetes was inversely associated with the magnitude of visual-somatosensory integration (β = −3.21; p < 0.01). Further, mediation models revealed that presence of diabetes negatively influenced the relationship of visual–somatosensory integration magnitude with balance (95% CI −0.16, −0.01) and gait (95% CI −0.09, −0.01). Participants with diabetes and taking insulin (n = 14) failed to integrate sensory information entirely; (4) conclusions: taken together, results from this exploration provide compelling evidence to support the adverse effect of diabetes on both multisensory and motor functioning in older adults.
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Chow MR, Ayiotis AI, Schoo DP, Gimmon Y, Lane KE, Morris BJ, Rahman MA, Valentin NS, Boutros PJ, Bowditch SP, Ward BK, Sun DQ, Treviño Guajardo C, Schubert MC, Carey JP, Della Santina CC. Posture, Gait, Quality of Life, and Hearing with a Vestibular Implant. N Engl J Med 2021; 384:521-532. [PMID: 33567192 PMCID: PMC8477665 DOI: 10.1056/nejmoa2020457] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bilateral vestibular hypofunction is associated with chronic disequilibrium, postural instability, and unsteady gait owing to failure of vestibular reflexes that stabilize the eyes, head, and body. A vestibular implant may be effective in alleviating symptoms. METHODS Persons who had had ototoxic (7 participants) or idiopathic (1 participant) bilateral vestibular hypofunction for 2 to 23 years underwent unilateral implantation of a prosthesis that electrically stimulates the three semicircular canal branches of the vestibular nerve. Clinical outcomes included the score on the Bruininks-Oseretsky Test of Motor Proficiency balance subtest (range, 0 to 36, with higher scores indicating better balance), time to failure on the modified Romberg test (range, 0 to 30 seconds), score on the Dynamic Gait Index (range, 0 to 24, with higher scores indicating better gait performance), time needed to complete the Timed Up and Go test, gait speed, pure-tone auditory detection thresholds, speech discrimination scores, and quality of life. We compared participants' results at baseline (before implantation) with those at 6 months (8 participants) and at 1 year (6 participants) with the device set in its usual treatment mode (varying stimulus pulse rate and amplitude to represent rotational head motion) and in a placebo mode (holding pulse rate and amplitude constant). RESULTS The median scores at baseline and at 6 months on the Bruininks-Oseretsky test were 17.5 and 21.0, respectively (median within-participant difference, 5.5 points; 95% confidence interval [CI], 0 to 10.0); the median times on the modified Romberg test were 3.6 seconds and 8.3 seconds (difference, 5.1; 95% CI, 1.5 to 27.6); the median scores on the Dynamic Gait Index were 12.5 and 22.5 (difference, 10.5 points; 95% CI, 1.5 to 12.0); the median times on the Timed Up and Go test were 11.0 seconds and 8.7 seconds (difference, 2.3; 95% CI, -1.7 to 5.0); and the median speeds on the gait-speed test were 1.03 m per second and 1.10 m per second (difference, 0.13; 95% CI, -0.25 to 0.30). Placebo-mode testing confirmed that improvements were due to treatment-mode stimulation. Among the 6 participants who were also assessed at 1 year, the median within-participant changes from baseline to 1 year were generally consistent with results at 6 months. Implantation caused ipsilateral hearing loss, with the air-conducted pure-tone average detection threshold at 6 months increasing by 3 to 16 dB in 5 participants and by 74 to 104 dB in 3 participants. Changes in participant-reported disability and quality of life paralleled changes in posture and gait. CONCLUSIONS Six months and 1 year after unilateral implantation of a vestibular prosthesis for bilateral vestibular hypofunction, measures of posture, gait, and quality of life were generally in the direction of improvement from baseline, but hearing was reduced in the ear with the implant in all but 1 participant. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02725463.).
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Affiliation(s)
- Margaret R Chow
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Andrianna I Ayiotis
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Desi P Schoo
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Yoav Gimmon
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Kelly E Lane
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Brian J Morris
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Mehdi A Rahman
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Nicolas S Valentin
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Peter J Boutros
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Stephen P Bowditch
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Bryan K Ward
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Daniel Q Sun
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Carolina Treviño Guajardo
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Michael C Schubert
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - John P Carey
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Charles C Della Santina
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
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Delval A, Betrouni N, Tard C, Devos D, Dujardin K, Defebvre L, Labidi J, Moreau C. Do kinematic gait parameters help to discriminate between fallers and non-fallers with Parkinson's disease? Clin Neurophysiol 2021; 132:536-541. [PMID: 33450575 DOI: 10.1016/j.clinph.2020.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although a number of clinical factors have been linked to falls in Parkinson's disease (PD), the diagnostic value of gait parameters remains subject to debate. The objective of this retrospective study was to determine to what extent the combination of gait parameters with clinical characteristics can distinguish between fallers and non-fallers. METHODS Using a video motion system, we recorded gait in 174 patients with PD. The patients' clinical characteristics (including motor status, cognitive status, disease duration, dopaminergic treatment and any history of falls or freezing of gait) were noted. The considered kinematic gait parameters included indices of gait bradykinesia and hypokinesia, asymmetry, variability, and foot clearance. After a parameters selection using an ANCOVA analysis, support vector machine algorithm was used to build classification models for distinguishing between fallers and non-fallers. Two models were built, the first included clinical data only while the second incorporated the selected gait parameters. RESULTS The "clinical-only" model had an accuracy of 94% for distinguishing between fallers and non-fallers. The model incorporating additional gait parameters including stride time and foot clearance performed even better, with an accuracy of up to 97%. CONCLUSION Although fallers differed significantly from non-fallers with regard to disease duration, motor impairment or dopaminergic treatment, the addition of gait parameters such as foot clearance or stride time to clinical variables increased the model's discriminant power. SIGNIFICANCE This predictive model now needs to be validated in prospective cohorts.
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Affiliation(s)
- Arnaud Delval
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Clinical Neurophysiology Department, Lille University Medical Center, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France.
| | - Nacim Betrouni
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France
| | - Céline Tard
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France
| | - David Devos
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France
| | - Luc Defebvre
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France
| | - Jordan Labidi
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France
| | - Caroline Moreau
- Univ. Lille, Inserm, U1172 - Lille Neuroscience and Cognition, F-59000 Lille, France; Neurology and Movement Disorders Department, Lille University Medical Center, F-59000 Lille, France; Lille Center of Excellence for Neurodegenerative Diseases, LiCEND, France
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Mayhew AJ, Phillips SM, Sohel N, Thabane L, McNicholas PD, de Souza RJ, Parise G, Raina P. The impact of different diagnostic criteria on the association of sarcopenia with injurious falls in the CLSA. J Cachexia Sarcopenia Muscle 2020; 11:1603-1613. [PMID: 32940016 PMCID: PMC7749560 DOI: 10.1002/jcsm.12622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/26/2020] [Accepted: 08/23/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Sarcopenia definitions recommend different combinations of variables (lean mass, strength, and physical function) and different methods of adjusting lean mass. The purpose of this paper was to address the gaps in the literature regarding how differences in the operationalization of sarcopenia impact the association between sarcopenia and injurious falls. METHODS Participants included 9936 individuals from the Canadian Longitudinal Study on Aging aged ≥65 years at baseline (2012-2015), with complete data for sarcopenia-related variables, injurious falls, and covariates. Sarcopenia was defined using all combinations of muscle variables (lean mass, grip strength, chair rise test, and gait speed) and methods of adjusting lean mass (height2 , weight, body mass index (BMI), and regressing on height and fat mass) recommended by the expert group sarcopenia definitions. Multiple cut off values for the measures were explored. The association between sarcopenia and injurious falls (0, 1, or 2+ falls) measured 18 months after baseline data collection were assessed using proportional odds regression models. RESULTS In men (n = 5162, 72.9 ± 5.6 years), the odds of having a higher level of injurious falls was between 1.43 and 2.14 greater when sarcopenia was defined as (i) lean mass adjusted for weight only; (ii) grip strength (<30 or <26 kg) only; (iii) lean mass adjusted for weight and grip strength (<30 or <26 kg); (iv) lean mass adjusted for BMI and grip strength (<26 kg); and (v) lean mass adjusted using the regression technique and grip strength (<30 or <26 kg). In women (n = 4774, 72.8 ± 5.6 years), only the combination of lean mass adjusted using regression with gait speed (<0.8 m/s) was associated with a significantly higher odds (1.46, 95% confidence interval: 1.01-2.10, P = 0.04) of having a higher level of injurious falls. CONCLUSIONS Sarcopenia definitions based on different combinations of muscle variables and methods of adjusting lean mass are not equally associated with injurious falls. In men, definitions including grip strength but not gait speed or the chair rise test, and adjusting lean mass for weight, BMI, or using the residual technique but not height2 , tended to be associated with injurious falls. In women, sarcopenia was generally not associated with injurious falls regardless of the definition used.
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Affiliation(s)
- Alexandra J. Mayhew
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Labarge Centre for Mobility in AgingMcMaster UniversityHamiltonOntarioCanada
- McMaster Institute for Research on AgingMcMaster UniversityHamiltonOntarioCanada
| | | | - Nazmul Sohel
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Labarge Centre for Mobility in AgingMcMaster UniversityHamiltonOntarioCanada
- McMaster Institute for Research on AgingMcMaster UniversityHamiltonOntarioCanada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics Unit, Research Institute at St JoesSt. Joseph's Healthcare HamiltonHamiltonOntarioL8N 4A6Canada
| | - Paul D. McNicholas
- Department of Mathematics & StatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Population Genomics Program, Chanchlani Research CentreMcMaster UniversityHamiltonOntarioCanada
| | - Gianni Parise
- Department of KinesiologyMcMaster UniversityHamiltonOntarioCanada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Labarge Centre for Mobility in AgingMcMaster UniversityHamiltonOntarioCanada
- McMaster Institute for Research on AgingMcMaster UniversityHamiltonOntarioCanada
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Coyle PC, Perera S, Shuman V, VanSwearingen J, Brach JS. Development and Validation of Person-Centered Cut-Points for the Figure-of-8-Walk Test of Mobility in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2020; 75:2404-2411. [PMID: 32006022 DOI: 10.1093/gerona/glaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Figure-of-8-Walk test (F8WT) is a performance measure of the motor skill of walking. Unlike walking speed over a straight path, it captures curved path walking, which is essential to real-world activity, but meaningful cut-points have yet to be developed for the F8WT. METHODS A secondary analysis of 421 community-dwelling older adults (mean age 80.7 ± 7.8), who participated in a community-based exercise clinical trial, was performed. Area under receiver operating characteristic curves (AUROCC) were calculated using baseline data, with F8WT performance discriminating different self-reported global mobility and balance dichotomies. Cut-points for the F8WT were chosen to optimize sensitivity and specificity. For validation, F8WT cut-points were applied to postintervention F8WT data. Participants were called monthly for 12 months after intervention completion to record self-reported incident falls, emergency department visits, and hospitalizations; risks of the outcomes were compared between those who performed well and poorly on the F8WT. RESULTS F8WT performance times of ≤9.09 seconds and ≤9.27 seconds can discriminate those with excellent (sensitivity = 0.647; specificity = 0.654) and excellent/very good global mobility (sensitivity = 0.649; specificity = 0.648), respectively. A total number of steps ≤17 on the F8WT can discriminate those with excellent/very good/good global balance (sensitivity = 0.646; specificity = 0.608). Compared to those who performed poorly, those who performed well had a lower incidence of negative outcomes: F8WT time ≤9.09 seconds = 46%-59% lower; F8WT time ≤9.27 seconds = 46%-56% lower; F8WT steps ≤17 = 44%-50% lower. CONCLUSIONS Clinicians may consider these preliminary cut-points to aid in their clinical decision making, but further study is needed for definitive recommendations.
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Affiliation(s)
- Peter C Coyle
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Physical Therapy, University of Delaware, Newark
| | - Subashan Perera
- Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pennsylvania
| | - Valerie Shuman
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
| | | | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania
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Soulard J, Vaillant J, Balaguier R, Baillet A, Gaudin P, Vuillerme N. Foot-Worn Inertial Sensors Are Reliable to Assess Spatiotemporal Gait Parameters in Axial Spondyloarthritis under Single and Dual Task Walking in Axial Spondyloarthritis. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6453. [PMID: 33198119 PMCID: PMC7697708 DOI: 10.3390/s20226453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was (1) to evaluate the relative and absolute reliability of gait parameters during walking in single- and dual-task conditions in patients with axial spondyloarthritis (axSpA), (2) to evaluate the absolute and relative reliability of dual task effects (DTE) parameters, and (3) to determine the number of trials required to ensure reliable gait assessment, in patients with axSpA. Twenty patients with axSpa performed a 10-m walk test in single- and dual-task conditions, three times for each condition. Spatiotemporal, symmetry, and DTE gait parameters were calculated from foot-worn inertial sensors. The relative reliability (intraclass correlation coefficients-ICC) and absolute reliability (standard error of measurement-SEM and minimum detectable change-MDC) were calculated for these parameters in each condition. Spatiotemporal gait parameters showed good to excellent reliability in both conditions (0.59 < ICC < 0.90). The reliability of symmetry and DTE parameters was low. ICC, SEM, and MDC were better when using the mean of the second and the third trials. Spatiotemporal gait parameters obtained from foot-worn inertial sensors assessed in patients with axSpA in single- and dual-task conditions are reliable. However, symmetry and DTE parameters seem less reliable and need to be interpreted with caution. Finally, better reliability of gait parameters was found when using the mean of the 2nd and the 3rd trials.
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Affiliation(s)
- Julie Soulard
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
- CHU Grenoble Alpes, 38000 Grenoble, France
| | - Jacques Vaillant
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
| | - Romain Balaguier
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
| | - Athan Baillet
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG UMR5525, 38000 Grenoble, France; (A.B.); (P.G.)
| | - Philippe Gaudin
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG UMR5525, 38000 Grenoble, France; (A.B.); (P.G.)
| | - Nicolas Vuillerme
- University Grenoble Alpes, AGEIS, 38000 Grenoble, France; (J.V.); (R.B.); (N.V.)
- Institut Universitaire de France, 75000 Paris, France
- LabCom Telecom4Health, University Grenoble Alpes & Orange Labs, 38000 Grenoble, France
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Sathyan S, Ayers E, Gao T, Milman S, Barzilai N, Rockwood K, Verghese J. Frailty and Risk of Incident Motoric Cognitive Risk Syndrome. J Alzheimers Dis 2020; 71:S85-S93. [PMID: 31450502 DOI: 10.3233/jad-190517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frailty is highly prevalent among older adults, and associated with cognitive decline. Relationship between frailty and motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by the presence of subjective cognitive complaints and slow gait, is yet to be elucidated. OBJECTIVE To examine whether frailty increases the risk of developing incident MCR. METHODS We analyzed 641 adults, aged 65 and above, participating in the LonGenity study. Frailty was defined using a 41-point cumulative deficit frailty index (FI). MCR was diagnosed at baseline and annual follow-up visits using established criteria. Cox proportional hazard models were used to study the association of baseline frailty with incident MCR, and reported as hazard ratio (HR) with 95% confidence intervals (CI) adjusted for age, sex, and education. RESULTS At baseline, 70 participants (10·9%) had prevalent MCR. Of the remaining 571 non-MCR participants (mean age 75.0, 57.3% women), 70 developed incident MCR (median follow-up 2.6 years). Higher frailty scores at baseline were associated with an increased risk of incident MCR (HR for each 0.01 increase in the FI: 1.07; 95% CI 1.03-1.11; p = 0.0002). The result was unchanged even after excluding mobility related or chronic illnesses items from the FI as well as accounting for reverse causation, competing risk of death, baseline cognitive status, social vulnerability, and excluding participants with mild cognitive impairment syndrome. CONCLUSIONS Higher levels of frailty increase risk for developing MCR and suggest shared mechanisms. This association merits further study to identify strategies to prevent cognitive decline.
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Affiliation(s)
- Sanish Sathyan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tina Gao
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kenneth Rockwood
- Divisions of Geriatric Medicine & Neurology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Lau LK, Wee SL, Pang WJB, Chen KK, Abdul Jabbar K, Yap PLK, Mallya JU, Ng DHM, Tan QLL, Seah WT, Ng TP. Reference Values of Gait Speed and Gait Spatiotemporal Parameters for a South East Asian Population: The Yishun Study. Clin Interv Aging 2020; 15:1753-1765. [PMID: 33061327 PMCID: PMC7522423 DOI: 10.2147/cia.s270407] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Age-related slowing of gait has been reported to start as early as the fifth decade and accelerate beyond the seventh decade of life. A single cut-off for slow gait may not be appropriate for men and women of different ages. We aimed to report reference values for gait speed and spatiotemporal gait parameters of adult age groups in a South East Asian population. Methods A total of 507 community-dwelling adults, aged 21-90 years were recruited into the study through random sampling, filling quotas of 20-40 participants in each sex and age group (10-year age groups between 21 and 60 years; 5-year age groups beyond age 60 years). Demographic data, height, weight and information on comorbidities were recorded. Habitual gait speed and spatiotemporal parameters were measured, and the average of three trials was recorded using the GAITRite system. Results Gait speed peaked in their 40s for both men and women, but the trajectories differed slightly across age groups. Although similar for men in their 50s and 60s, gait speed was significantly slower among those aged 71 years and older. For women beyond 50 years old, gait slowed with age. After adjusting for height, women were found to walk significantly faster and with a longer step length than men. Women also walked with a significantly narrower stride width and less external rotation of the feet. The lowest quintile for gait speed in our study cohort was 0.9m/s, below the recommended cut-off of 1.0m/s. Conclusion We established the reference values as well as the quintiles for gait speed and spatiotemporal gait parameters across adult age groups in a multi-ethnic Asian population. This contributes to a valuable database for gait assessment and evaluation of preventive or rehabilitative programs.
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Affiliation(s)
- Lay Khoon Lau
- Geriatric Education and Research Institute (GERI), Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute (GERI), Singapore.,Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore
| | | | | | | | - Philip Lin Kiat Yap
- Geriatric Education and Research Institute (GERI), Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Jagadish Ullal Mallya
- Geriatric Education and Research Institute (GERI), Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | | | | | - Wei Ting Seah
- Geriatric Education and Research Institute (GERI), Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute (GERI), Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore
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Osaba MY, Martelli D, Prado A, Agrawal SK, Lalwani AK. Age-related differences in gait adaptations during overground walking with and without visual perturbations using a virtual reality headset. Sci Rep 2020; 10:15376. [PMID: 32958807 PMCID: PMC7505838 DOI: 10.1038/s41598-020-72408-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/07/2020] [Indexed: 11/20/2022] Open
Abstract
Older adults have difficulty adapting to new visual information, posing a challenge to maintain balance during walking. Virtual reality can be used to study gait adaptability in response to discordant sensorimotor stimulations. This study aimed to investigate age-related modifications and propensity for visuomotor adaptations due to continuous visual perturbations during overground walking in a virtual reality headset. Twenty old and twelve young subjects walked on an instrumented walkway in real and virtual environments while reacting to antero-posterior and medio-lateral oscillations of the visual field. Mean and variability of spatiotemporal gait parameters were calculated during the first and fifth minutes of walking. A 3-way mixed-design ANOVA was performed to determine the main and interaction effects of group, condition and time. Both groups modified gait similarly, but older adults walked with shorter and slower strides and did not reduce stride velocity or increase stride width variability during medio-lateral perturbations. This may be related to a more conservative and anticipatory strategy as well as a reduced perception of the optic flow. Over time, participants adapted similarly to the perturbations but only younger participants reduced their stride velocity variability. Results provide novel evidence of age- and context-dependent visuomotor adaptations in response to visual perturbations during overground walking and may help to establish new methods for early identification and remediation of gait deficits.
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Affiliation(s)
- Muyinat Y Osaba
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Dario Martelli
- Department of Mechanical Engineering, University of Alabama, Tuscaloosa, AL, USA
| | - Antonio Prado
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Anil K Lalwani
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, 180 Fort Washington Avenue, Harkness Pavilion, 8th Floor, New York, NY, 10032, USA. .,New York Presbyterian Hospital, New York, NY, USA.
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Mayhew AJ, Phillips SM, Sohel N, Thabane L, McNicholas PD, de Souza RJ, Parise G, Raina P. Do Different Ascertainment Techniques Identify the Same Individuals as Sarcopenic in the Canadian Longitudinal Study on Aging? J Am Geriatr Soc 2020; 69:164-172. [PMID: 32936468 DOI: 10.1111/jgs.16823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Sarcopenia is associated with poor health outcomes such as disability, institutionalization, and mortality. Efforts to manage sarcopenia clinically have been hindered by challenges in determining how to ascertain sarcopenia status correctly. The objective of this project was to assess the agreement between the different methods of ascertaining sarcopenia recommended by expert groups. DESIGN Cross-sectional study of baseline data (2011-2015) from the Canadian Longitudinal Study on Aging. SETTING Population-based multicenter study of community-dwelling participants. PARTICIPANTS Eligible participants (n = 12,646) aged 65 to 85 living within 25 to 50 km of 11 data collection sites in Canada. The analyses included 10,820 participants with the data required to diagnose sarcopenia. MEASUREMENTS Sarcopenia was operationalized as appendicular lean mass (ALM), ALM and grip strength, ALM and gait speed, and grip strength and gait speed. Within each combination, ALM was adjusted for height squared, weight, body mass index, and the residual of regressing lean mass on height and fat mass. The lowest 20th sex-specific percentile values were used as the cutoffs for low ALM. Low grip strength cutoffs of 35.5 kg for men and 20 kg for women and a gait speed cutoff of .8 m/s were used. RESULTS The mean age was 73.0 ± 5.6 years, and 51.9% of the sample was male. The agreement (Cohen's κ) between the different combinations of variables used to ascertain sarcopenia status was below .50. Agreement for the different lean mass adjustment techniques ranged from .04 to .76. CONCLUSION The combination of variables used to ascertain sarcopenia and many of the ALM adjustment techniques have insufficient agreement to be considered equivalent. This has important clinical implications for the management of sarcopenia because treatments may differ based on how sarcopenia is identified. To improve the clinical utility of sarcopenia, a unified definition of sarcopenia is required.
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Affiliation(s)
- Alexandra J Mayhew
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Ivor Wynne Centre, McMaster University, Hamilton, Ontario, Canada
| | - Nazmul Sohel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, Research Institute at St Joes, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Paul D McNicholas
- Department of Mathematics & Statistics, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Gianni Parise
- Department of Kinesiology, Ivor Wynne Centre, McMaster University, Hamilton, Ontario, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Labarge Centre for Mobility in Aging, Hamilton, Ontario, Canada.,McMaster Institute for Research on Aging, Hamilton, Ontario, Canada
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Werner C, Heldmann P, Hummel S, Bauknecht L, Bauer JM, Hauer K. Concurrent Validity, Test-Retest Reliability, and Sensitivity to Change of a Single Body-Fixed Sensor for Gait Analysis during Rollator-Assisted Walking in Acute Geriatric Patients. SENSORS 2020; 20:s20174866. [PMID: 32872168 PMCID: PMC7506931 DOI: 10.3390/s20174866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022]
Abstract
Body-fixed sensor (BFS) technology offers portable, low-cost and easy-to-use alternatives to laboratory-bound equipment for analyzing an individual's gait. Psychometric properties of single BFS systems for gait analysis in older adults who require a rollator for walking are, however, unknown. The study's aim was to evaluate the concurrent validity, test-retest-reliability, and sensitivity to change of a BFS (DynaPort MoveTest; McRoberts B.V., The Hague, The Netherlands) for measuring gait parameters during rollator-assisted walking. Fifty-eight acutely hospitalized older patients equipped with the BFS at the lower back completed a 10 m walkway using a rollator. Concurrent validity was assessed against the Mobility Lab (APDM Inc.; Portland, OR, USA), test-retest reliability over two trials within a 15 min period, and sensitivity to change in patients with improved, stable and worsened 4 m usual gait speed over hospital stay. Bland-Altman plots and intraclass correlation coefficients (ICC) for gait speed, cadence, step length, step time, and walk ratio indicate good to excellent agreement between the BFS and the Mobility Lab (ICC2,1 = 0.87-0.99) and the repeated trials (ICC2,1 = 0.83-0.92). Moderate to large standardized response means were observed in improved (gait speed, cadence, step length, walk ratio: 0.62-0.99) and worsened patients (gait speed, cadence, step time: -0.52 to -0.85), while those in stable patients were trivial to small (all gait parameters: -0.04-0.40). The BFS appears to be a valid, reliable and sensitive instrument for measuring spatio-temporal gait parameters during rollator-assisted walking in geriatric patients.
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Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Heidelberg University, 69117 Heidelberg, Germany;
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany;
- Correspondence: ; Tel.: +49-6221-319-1760
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, 69117 Heidelberg, Germany;
| | - Saskia Hummel
- Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany; (S.H.); (L.B.)
| | - Laura Bauknecht
- Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany; (S.H.); (L.B.)
| | - Jürgen M. Bauer
- Center for Geriatric Medicine, Heidelberg University, 69117 Heidelberg, Germany;
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany;
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany;
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Lowry K, Woods T, Malone A, Krajek A, Smiley A, Van Swearingen J. The Figure-of-8 Walk Test used to detect the loss of motor skill in walking among persons with Parkinson's disease. Physiother Theory Pract 2020; 38:552-560. [PMID: 32543340 DOI: 10.1080/09593985.2020.1774948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Figure-of-8 Walk Test (F8W) is a valid measure of walking skill in older adults with a mobility disability. Use of the F8W in assessing walking skill in persons with Parkinson's disease (PWP) is unknown. PURPOSE We examined the validity of the F8W by associations with mobility, and cognitive and physical function, and determined the ability of the F8W to discriminate the motor skill of walking in PWP from that of older adults (OA). METHODS Participants, PWP (n = 60) and OA (n = 34) performed the F8W, usual straight path walking, the Montreal Cognitive Assessment (MoCA), and the Late-Life Function and Disability Instrument (LLFDI). RESULTS Among PWP, F8W time and steps related to: usual gait speed (r = -0.660, -0.650); stride time variability (r = 0.377, 0.438); cognition (r = -0.293, time only); and physical function (r = -0.532, - 0.619), all p < .05. Area under the curve (AUC) analyses demonstrated greater sensitivity and specificity of F8W performance (0.811, 0.790) compared to usual gait speed (0.729) to recognize the motor skill of walking in PWP from that of OA. CONCLUSION The F8W is a valid indicator of the motor skill of walking in PWP. Use of the F8W may uncover walking difficulties not identified by usual gait speed.
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Affiliation(s)
- Kristin Lowry
- Department of Physical Therapy, Des Moines University, Des Moines, IA, USA
| | - Taylor Woods
- Department of Physical Therapy, Des Moines University, Des Moines, IA, USA
| | - Amanda Malone
- Iowa Clinic Waukee Physical Therapy, Waukee, IA, USA
| | - Alex Krajek
- University of Wisconsin Hospital, Madison, WI, USA
| | - Ann Smiley
- Department of Kinesiology, Iowa State University, Ames, IA, USA
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Kobsar D, Charlton JM, Tse CTF, Esculier JF, Graffos A, Krowchuk NM, Thatcher D, Hunt MA. Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis. J Neuroeng Rehabil 2020; 17:62. [PMID: 32393301 PMCID: PMC7216606 DOI: 10.1186/s12984-020-00685-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults. METHODS Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intraclass correlation coefficients (ICC) for validity and reliability, respectively. Alternatively, qualitative summaries of outcomes were conducted on those that could not be meta-analyzed. RESULTS A total of 82 articles, assessing the validity or reliability of over 100 outcomes, were included in this review. Seventeen biomechanical outcomes, primarily spatiotemporal parameters, were meta-analyzed. The validity and reliability of step and stride times were found to be excellent. Similarly, the validity and reliability of step and stride length, as well as swing and stance time, were found to be good to excellent. Alternatively, spatiotemporal parameter variability and symmetry displayed poor to moderate validity and reliability. IMUs were also found to display moderate reliability for the assessment of local dynamic stability during walking. The remaining biomechanical outcomes were qualitatively summarized to provide a variety of recommendations for future IMU research. CONCLUSIONS The findings of this review demonstrate the excellent validity and reliability of IMUs for mean spatiotemporal parameters during walking, but caution the use of spatiotemporal variability and symmetry metrics without strict protocol. Further, this work tentatively supports the use of IMUs for joint angle measurement and other biomechanical outcomes such as stability, regularity, and segmental accelerations. Unfortunately, the strength of these recommendations are limited based on the lack of high-quality studies for each outcome, with underpowered and/or unjustified sample sizes (sample size median 12; range: 2-95) being the primary limitation.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Francois Esculier
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,The Running Clinic, Lac Beauport, QC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Thatcher
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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Skiadopoulos A, Moore EE, Sayles HR, Schmid KK, Stergiou N. Step width variability as a discriminator of age-related gait changes. J Neuroeng Rehabil 2020; 17:41. [PMID: 32138747 PMCID: PMC7059259 DOI: 10.1186/s12984-020-00671-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is scientific evidence that older adults aged 65 and over walk with increased step width variability which has been associated with risk of falling. However, there are presently no threshold levels that define the optimal reference range of step width variability. Thus, the purpose of our study was to estimate the optimal reference range for identifying older adults with normative and excessive step width variability. METHODS We searched systematically the BMC, Cochrane Library, EBSCO, Frontiers, IEEE, PubMed, Scopus, SpringerLink, Web of Science, Wiley, and PROQUEST databases until September 2018, and included the studies that measured step width variability in both younger and older adults during walking at self-selected speed. Data were pooled in meta-analysis, and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. A single-decision threshold method based on the Youden index, and a two-decision threshold method based on the uncertain interval method were used to identify the optimal threshold levels (PROSPERO registration: CRD42018107079). RESULTS Ten studies were retrieved (older adults = 304; younger adults = 219). Step width variability was higher in older than in younger adults (SMD = 1.15, 95% CI = 0.60; 1.70; t = 4.72, p = 0.001). The single-decision method set the threshold level for excessive step width variability at 2.14 cm. For the two-decision method, step width variability values above the upper threshold level of 2.50 cm were considered excessive, while step width variability values below the lower threshold level of 1.97 cm were considered within the optimal reference range. CONCLUSION Step width variability is higher in older adults than in younger adults, with step width variability values above the upper threshold level of 2.50 cm to be considered as excessive. This information could potentially impact rehabilitation technology design for devices targeting lateral stability during walking.
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Affiliation(s)
- Andreas Skiadopoulos
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Biomechanics Research Building 214, 6160 University Drive South, Omaha, NE, 68182-0860, USA
| | - Emily E Moore
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Biomechanics Research Building 214, 6160 University Drive South, Omaha, NE, 68182-0860, USA
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, USA
| | - Harlan R Sayles
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, USA
| | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, USA
| | - Nicholas Stergiou
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Biomechanics Research Building 214, 6160 University Drive South, Omaha, NE, 68182-0860, USA.
- College of Public Health, University of Nebraska Medical Center, Omaha, USA.
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Alqahtani BA, Sparto PJ, Whitney SL, Greenspan SL, Perera S, Brach JS. Psychometric properties of instrumented postural sway measures recorded in community settings in independent living older adults. BMC Geriatr 2020; 20:82. [PMID: 32111166 PMCID: PMC7048114 DOI: 10.1186/s12877-020-1489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
Background In the last few decades, research related to balance in older adults has been conducted in lab-based settings. The lack of portability and high cost that is associated with the current gold standard methods to quantify body balance limits their application to community settings such as independent living facilities. The purpose of the study was to examine the relative and absolute reliability and the convergent validity of static standing balance performance using an accelerometer device. Methods A total of 131 participants (85% female, mean age 80 ± 8 years) were included for the validity aim, and a subsample of 38 participants were enrolled in the reliability testing (89% female, mean age 76 ± 7 years). The root-mean-square (RMS) and normalized path length (NPL) for sway in antero-posterior (AP) and medio-lateral (ML) directions were calculated for different standing balance conditions. Test-retest reliability was assessed over two testing visits occurring 1 week apart using the intraclass correlation coefficient (ICC) for relative reliability, and the minimal detectable change (MDC) was calculated for the absolute reliability. Spearman’s rank correlation coefficient was used to test convergent validity at baseline between balance measurements and related mobility measures. Results Reliability of balance performance using accelerometers was good to excellent with ICC values ranging from 0.41 to 0.83 for RMS sway and from 0.49 to 0.82 for NPL sway. However, the ICC during semi-tandem stance in A-P direction was 0.35, indicating poor reliability. The MDC of the sway measurements ranged from 2.4 to 9.4 for the RMS and 5.2 to 13.8 for the NPL. Balance measurements were correlated with mobility measurements. Conclusions Using a portable accelerometer to quantify static standing postural control provides reliable measurements in community settings.
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Affiliation(s)
- Bader A Alqahtani
- Department of Health and Rehabilitation sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, 11942, Kingdom of Saudi Arabia.
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 500, Pittsburgh, PA, 15213, USA
| | - Subashan Perera
- Department of Medicine, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Medical Building, Suite 500, Pittsburgh, PA, 15213, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA, 15219, USA
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