Lateral Perturbation-Induced and Voluntary Stepping in Fallers and Nonfallers After Stroke

Abstract Objective A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke. Methods This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated. Results Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation. Conclusion A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed. Impact Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk.

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Impact of pain on reactive balance and falls in community-dwelling older adults: a prospective cohort study

Age and Ageing ◽

10.1093/ageing/afaa070 ◽

2020 ◽

Vol 49 (6) ◽

pp. 982-988

Author(s):

Tatsuya Hirase ◽

Yoshiro Okubo ◽

Jasmine Menant ◽

Stephen R Lord ◽

Daina L Sturnieks

Keyword(s):

Older Adults ◽

Neck Pain ◽

Lower Limb ◽

Step Length ◽

Community Dwelling ◽

Limb Pain ◽

Step Initiation ◽

Lower Limb Pain ◽

Postural Perturbations ◽

Reactive Balance

Abstract Background pain is associated with increased postural sway and falls in older adults. However, the impact of pain on reactive balance induced by postural perturbations and how this might predispose older adults to falls is not known. Objective to investigate whether any pain, back/neck pain and lower limb pain are associated with poor reactive balance and prospective fall outcomes in older adults. Design 12-month prospective cohort study. Setting community. Subjects 242 community-dwelling older adults aged 70+ years. Methods participants completed a questionnaire on the presence of pain and underwent force-controlled waist-pull postural perturbations while standing. Force thresholds for stepping, step initiation time, step velocity and step length were quantified. Falls were monitored with monthly falls calendars for 12-months. Results participants with lower limb pain had significantly lower force thresholds for stepping. Those with any pain or pain in the back/neck had longer step initiation time, slower step velocity and shorter step length. The three pain measures (any pain, back/neck pain, lower limb pain) were significantly associated with multiple falls when adjusted for age, sex, body mass index, use of polypharmacy, strength and walking speed. In mediation analyses, there was a significant indirect effect of reactive balance for the relationship between back/neck pain and falls with fractures. Conclusions older people with pain have impaired reactive balance and an increased risk of falls. Reactive balance partially mediated the association between pain and fall-related fractures. Further research is required to confirm the findings of this study.

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Comparison of Lateral Perturbation-Induced Step Training and Hip Muscle Strengthening Exercise on Balance and Falls in Community-Dwelling Older Adults: A Blinded Randomized Controlled Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/glab017 ◽

2021 ◽

Author(s):

Mark W Rogers ◽

Robert A Creath ◽

Vicki Gray ◽

Janice Abarro ◽

Sandy McCombe Waller ◽

...

Keyword(s):

Older Adults ◽

Controlled Trial ◽

Step Length ◽

Community Dwelling ◽

Controlled Study ◽

Balance Performance ◽

Muscle Strengthening ◽

Hip Muscle ◽

Hip Abduction ◽

Community Dwelling Older Adults

Abstract Background This factorial, assessor-blinded, randomized, and controlled study compared the effects of perturbation-induced step training (lateral waist-pulls), hip muscle strengthening, and their combination, on balance performance, muscle strength, and prospective falls among older adults. Methods Community-dwelling older adults were randomized to 4 training groups. Induced step training (IST, n = 25) involved 43 progressive perturbations. Hip abduction strengthening (HST, n = 25) utilized progressive resistance exercises. Combined training (CMB, n = 25) included IST and HST, and the control performed seated flexibility/relaxation exercises (SFR, n = 27). The training involved 36 sessions for a period of 12 weeks. The primary outcomes were the number of recovery steps and first step length, and maximum hip abduction torque. Fall frequency during 12 months after training was determined. Results Overall, the number of recovery steps was reduced by 31% and depended upon the first step type. IST and CMB increased the rate of more stable single lateral steps pre- and post-training than HST and SFR who used more multiple crossover and sequential steps. The improved rate of lateral steps for CMB exceeded the control (CMB/SFR rate ratio 2.68). First step length was unchanged, and HST alone increased hip torque by 25%. Relative to SFR, the fall rate ratios (falls/person/year) [95% confidence interval] were CMB 0.26 [0.07–0.90], IST 0.44 [0.18–1.08], and HST 0.30 (0.10–0.91). Conclusions Balance performance through stepping was best improved by combining perturbation and strength training and not strengthening alone. The interventions reduced future falls by 56%–74% over the control. Lateral balance perturbation training may enhance traditional programs for fall prevention.

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A 1-Year Exercise Program for Older Women: Effects on Falls, Injuries, and Physical Performance

Journal of Aging and Physical Activity ◽

10.1123/japa.2.2.127 ◽

1994 ◽

Vol 2 (2) ◽

pp. 127-142 ◽

Cited By ~ 49

Author(s):

Priscilla Gilliam MacRae ◽

Michael E. Feltner ◽

Sibylle Reinsch

Keyword(s):

Older Women ◽

Exercise Program ◽

Community Dwelling ◽

Medical Attention ◽

Knee Extensors ◽

Post Intervention ◽

Hip Abductor ◽

Gait Abnormalities ◽

Risk Factors For Falls ◽

Low Intensity Exercise

This study examined the effects of a 1-year low intensity exercise program in community dwelling older women on falls, injuries, and risk factors for falls such as poor balance, muscular weakness, and gait abnormalities. Eighty older women were assigned to an exercise (Ex,n= 42) or attention control (Co,n= 38) group. During the 1-year study, 36% of the Ex group experienced a fall compared to 45% of the Co group (χ2= 0.22,p≥ 0.05). None of the 10 fallers in the Ex group suffered an injury that required medical attention, compared with 3 of the 14 fallers (21%) in the Co group. Further analyses indicated that the Co group declined significantly in isometric strength of the knee extensors and ankle dorsiflexors while the Ex group did not change significantly across the 1-year study. On measures of hip abductor strength, balance, and gait, the groups were not significantly different from each other pre- to post intervention.

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Mini-Mental State Exam Status of Community-Dwelling Cognitively Intact Centenarians

International Psychogeriatrics ◽

10.1017/s104161029500216x ◽

1995 ◽

Vol 7 (3) ◽

pp. 417-427 ◽

Cited By ~ 59

Author(s):

Philip A. Holtsberg ◽

Leonard W. Poon ◽

Carol A. Noble ◽

Peter Martin

Keyword(s):

Mental State ◽

Community Dwelling ◽

Group Differences ◽

Performance Deficits ◽

Mini Mental State Exam ◽

Concomitant Variables ◽

Gender Education ◽

And Gender ◽

Cognitively Intact ◽

Significant Covariates

Mini-Mental State Exam (MMSE) scores for 247 community-dwelling, well-functioning individuals in their 60s (n = 88), in their 80s (n = 92), and 100 or older (n = 67) were compared to examine overall and component MMSE differences. The concomitant influences of visual or literacy deficits, gender, education, race, income, and activities of daily living on MMSE performance were analyzed. Mean MMSE scores of 27.8, 27.1, and 24.8, respectively, for the three cohorts were significantly different, even when all concomitant variables were controlled. After the concomitant variables were controlled, results indicated that there were no age group differences on five MMSE items: naming, repeating, listening and obeying, reading and obeying, and writing sentences. Participants with visual or literacy deficits scored 1.5 points lower than other partimcipants, and displayed performance deficits in four items form the Read & Write MMSE division: naming, reading and obeying, writing sentences, and praxis. Education and gender were significant covariates for total and divisional MMSE scores.

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Physical Activity Level Following Resistance Training in Community-Dwelling Older Adults Receiving Home Care: Results from a Cluster-Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136682 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6682

Author(s):

Hilde Bremseth Bårdstu ◽

Vidar Andersen ◽

Marius Steiro Fimland ◽

Lene Aasdahl ◽

Hilde Lohne-Seiler ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Resistance Training ◽

Home Care ◽

Community Dwelling ◽

Activity Level ◽

Group Differences ◽

Control Group ◽

Cluster Randomized ◽

Community Dwelling Older Adults

Older adults’ physical activity (PA) is low. We examined whether eight months of resistance training increased PA level in community-dwelling older adults receiving home care. A two-armed cluster-randomized trial using parallel groups was conducted. The included participants were >70 years and received home care. The resistance training group performed resistance training using body weight, elastic bands, and water canes twice per week for eight months. The control group was informed about the national PA guidelines and received motivational talks. The ActiGraph GT3X+ accelerometer was used to estimate PA. Outcomes included total PA (counts per minute), sedentary behavior (min/day), light PA (min/day), moderate-to-vigorous PA (min/day), and steps (mean/day). Between-group differences were analyzed using multilevel linear mixed models. Twelve clusters were randomized to either resistance training (7 clusters, 60 participants) or the control group (5 clusters, 44 participants). A total of 101 participants (median age 86.0 (interquartile range 80–90) years) had valid accelerometer data and were included in the analysis. There were no statistically significant between-group differences for any of the PA outcomes after four or eight months. This study offers no evidence of increased PA level following resistance training in older adults with home care.

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The Role of Knee Extensor Strength in Balance-Restoring Step Initiation and Execution

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-192961 ◽

2008 ◽

Author(s):

Gregory W. King ◽

Carl W. Luchies

Keyword(s):

Knee Extensor ◽

Step Length ◽

Step Response ◽

Balance Recovery ◽

Step Initiation ◽

Age Related ◽

Knee Extensor Strength ◽

Step Duration ◽

Stepping Response

A stepping response is often used to restore balance following a fall. Using laboratory-induced balance perturbations, various researchers have reported age-related alterations in balance recovery step characteristics including earlier step liftoff time [1; 2], shorter step length [1; 3], and longer step duration [2]. Such age-related changes in the step response may be related to older adults’ reduced strength reserve, which is prominent in the lower extremities [4] and therefore likely plays an important role in balance recovery.

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Effect of Thyroid Hormone Therapy on Fatigability in Older Adults With Subclinical Hypothyroidism: A Nested Study Within a Randomized Placebo-Controlled Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa123 ◽

2020 ◽

Vol 75 (9) ◽

pp. e89-e94

Author(s):

Mirah J Stuber ◽

Elisavet Moutzouri ◽

Martin Feller ◽

Cinzia Del Giovane ◽

Douglas C Bauer ◽

...

Keyword(s):

Older Adults ◽

Subclinical Hypothyroidism ◽

Heart Diseases ◽

Controlled Trial ◽

Community Dwelling ◽

Group Differences ◽

Coronary Heart Diseases ◽

Starting Dose ◽

The Mean ◽

The Impact

Abstract Background Fatigue often triggers screening for and treatment of subclinical hypothyroidism. However, data on the impact of levothyroxine on fatigue is limited and previous studies might not have captured all aspects of fatigue. Method This study is nested within the randomized, placebo-controlled, multicenter TRUST trial, including community-dwelling participants aged ≥65 and older, with persistent subclinical hypothyroidism (TSH 4.60–19.99 mIU/L, normal free thyroxine levels) from Switzerland and Ireland. Interventions consisted of daily levothyroxine starting with 50 μg (25 μg if weight <50 kg or known coronary heart diseases) together with dose adjustments to achieve a normal TSH and mock titration in the placebo group. Main outcome was the change in physical and mental fatigability using the Pittsburgh Fatigability Scale over 1 year, assessed through multivariable linear regression with adjustment for country, sex, and levothyroxine starting dose. Results Among 230 participants, the mean ± standard deviation (SD) TSH was 6.2 ± 1.9 mIU/L at baseline and decreased to 3.1 ± 1.3 with LT4 (n = 119) versus 5.3 ± 2.3 with placebo (n = 111, p < .001) after 1 year. After adjustment we found no between-group difference at 1 year on perceived physical (0.2; 95% CI −1.8 to 2.1; p = .88), or mental fatigability (−1.0; 95% CI −2.8 to 0.8; p = .26). In participants with higher fatigability at baseline (≥15 points for the physical score [n = 88] or ≥13 points for the mental score [n = 41]), the adjusted between-group differences at 1 year were 0.4 (95% CI −3.6 to 2.8, p = .79) and −2.2 (95% CI −8.8 to 4.5, p = .51). Conclusions Levothyroxine in older adults with mild subclinical hypothyroidism provides no change in physical or mental fatigability.

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The effect of unilateral muscle fatigue of hip abductor muscles on balance and functional capacity in community-dwelling older women

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2020.104222 ◽

2020 ◽

Vol 91 ◽

pp. 104222

Author(s):

Pâmela Precinotto Martins ◽

Jaqueline Mello Porto ◽

Flávio Tavares Vieira ◽

Isabella Ramirez Trimer ◽

Luana Letícia Capato ◽

...

Keyword(s):

Muscle Fatigue ◽

Older Women ◽

Functional Capacity ◽

Community Dwelling ◽

Hip Abductor

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Influence of Chronic Stroke on Functional Arm Reaching: Quantifying Deficits in the Ipsilesional Upper Extremity

Rehabilitation Research and Practice ◽

10.1155/2019/5182310 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Savitha Subramaniam ◽

Rini Varghese ◽

Tanvi Bhatt

Keyword(s):

Reaction Time ◽

Upper Extremity ◽

Movement Time ◽

Chronic Stroke ◽

Community Dwelling ◽

Stroke Survivors ◽

Initiation Time ◽

Peak Acceleration ◽

Movement Initiation ◽

And Performance

Purpose. The purpose of this study was to quantify ipsilesional upper extremity (UE) stand-reaching performance (kinematics and kinetics) among chronic stroke survivors.Method. Community-dwelling chronic stroke survivors (n=13) and age-similar healthy adults (n=13) performed flexion- and abduction-reaching tasks. Surface EMG and acceleration were sampled using wireless sensors from the prime movers (anterior and middle deltoid) and provided performance-outcome (reaction time, burst duration, movement time, and movement initiation time) and performance-production (peak acceleration) measures and were then evaluated.Results. Individuals with chronic stroke demonstrated significantly reduced performance outcomes (i.e., longer reaction time, burst duration, movement time, and movement initiation time) and performance production ability (i.e., smaller peak acceleration) compared to their healthy counterparts (p< 0.05) for both flexion- and abduction-reaching movements.Conclusion. Our results are suggestive of post-stroke deficits in ipsilesional motor execution during a stand-reaching task. Based on these findings, it is essential to integrate ipsilesional UE training into rehabilitation interventions as this might aid functional reaching activities of daily living and could ultimately help community-dwelling chronic stroke survivors maintain their independent living.

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The Effects of a Divided-Attention Timed Stepping Accuracy Task on Balance, Strength, Endurance, and Functional Performance in Healthy Older Adults: A Pilot Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2018-0010 ◽

2019 ◽

Vol 27 (4) ◽

pp. 521-528 ◽

Cited By ~ 1

Author(s):

Susan J. Leach ◽

Joyce R. Maring ◽

Ellen Costello

Keyword(s):

Older Adults ◽

Divided Attention ◽

Functional Performance ◽

Step Length ◽

Berg Balance Scale ◽

Primary Outcome Measure ◽

Community Dwelling ◽

Timed Up And Go ◽

Healthy Older Adults ◽

Stepping Accuracy

The aim of this study was to investigate whether a 6-week Divided-Attention Stepping Accuracy Task (DATSAT) intervention improved the primary outcome measure, maximal step length; other balance measures (Berg Balance scale and Timed Up and Go test); leg strength; endurance (6-min walk test); and functional tasks in 15 community-dwelling healthy older adults (age: 71.5 years, female: 46.7%) compared with 15 community-dwelling healthy older adults in a Bike and Strength (B&S) program (age: 73.8 years, female: 33.3%). Participants trained 3× per week, 30–60 min per session. Stepping-group differences were significant for all measures. B&S group improved in maximal step length (anterior and lateral), strength, and one functional task. Stepping group outperformed B&S group in Timed Up and Go and maximal step length posterior. B&S group outperformed stepping group in two strength measures. Exertion scores were lower for the stepping group. Overall, Divided-Attention Timed Stepping Accuracy Task training resulted in more within-group improvements and two between-group measures with less perceived effort and shorter intervention times.

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