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

2019 ◽  
Vol 27 (4) ◽  
pp. 521-528 ◽  
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.

scholarly journals Perturbation Training for Fall-Risk Reduction in Healthy Older Adults: Interference and Generalization to Opposing Novel Perturbations Post Intervention

2021 ◽  
Vol 3 ◽  
Author(s):  
Tanvi Bhatt ◽  
Yiru Wang ◽  
Shuaijie Wang ◽  
Lakshmi Kannan
Keyword(s):  
Older Adults ◽  
Fall Risk ◽  
Step Length ◽  
Community Dwelling ◽  
Control Group ◽  
Reactive Control ◽  
Ctrl Group ◽  
Healthy Older Adults ◽  
Perturbation Training ◽  
Perturbed Walking

This study examined the effects of perturbation training on the contextual interference and generalization of encountering a novel opposing perturbation. One hundred and sixty-nine community-dwelling healthy older adults (69.6 ± 6.4 years) were randomly assigned to one of the three groups: slip-perturbation training (St, n = 67) group received 24 slips, trip-perturbation training (Tt, n = 67) group received 24 trips, and control (Ctrl: n = 31) group received only non-perturbed walking trials (ClinicalTrials.gov NCT03199729; https://clinicaltrials.gov/ct2/show/NCT03199729). After training, all groups had 30 min of rest and three post-training non-perturbed walking trials, followed by a reslip and a novel trip trial for St, a retrip and a novel slip trial for Tt, and randomized novel slip and trip trials for Ctrl. The margin of stability (MOS), step length, and toe clearance of post-training walking trials were compared among three groups to examine interferences in proactive adjustment. Falls, MOS at the instant of recovery foot touchdown, and hip height of post-training perturbation trials were investigated to detect interferences and generalization in reactive responses. Results indicated that prior adaptation to slip perturbation training, resulting in walking with a greater MOS (more anterior) and a shorter step length (p < 0.01) than that of the Ctrl group, would be associated with a greater likelihood to forward balance loss if encountered with a trip. The trip adaptation training mainly induced a higher toe clearance during walking (p < 0.01) than the Ctrl group, which could lead to reduced effectiveness of the reactive response when encountered with a novel slip. However, there was no difference in the reactive MOS, limb support, and falls between the control group and the slip and trip training groups on their respective opposing novel perturbation post-training (MOS, limb support, and falls for novel slip: Tt = Ctrl; for the novel trip: St = Ctrl, both p > 0.05). Current findings suggested that, although perturbation training results in proactive adjustments that could worsen the reactive response (interference) when exposed to an unexpected opposing perturbation, older adults demonstrated the ability to immediately generalize the training-induced adaptive reactive control to maintain MOS, to preserve limb support control, and to reduce fall risk.

scholarly journals Functional Balance Assessment of Older Community Dwelling Adults: A Systematic Review of the Literature

2007 ◽  
Author(s):  
Felicity Langley ◽  
Shylie Mackintosh
Keyword(s):  
Older Adults ◽  
Concurrent Validity ◽  
Berg Balance Scale ◽  
Community Dwelling ◽  
Balance Assessment ◽  
Timed Up And Go ◽  
Functional Balance ◽  
Balance Scale ◽  
Balance Tests ◽  
Community Dwelling Older Adults

Background: For allied health professionals wishing to assess the functional balance of older adults living in the community, the vast number of functional balance tests available makes it difficult to decide which assessment is most appropriate. Objective: To identify the reliability, concurrent validity and clinical practicality of functional balance tests with community dwelling older adults. Methods: A systematic review of published literature relevant to 17 functional balance tests was undertaken. The 17 functional balance tests were identified by a preliminary literature search and through consultation with an expert in the field of functional balance assessment. Studies published in English before January 2007, assessing the use of these functional balance tests with community dwelling adults aged 65 years or above were included. The CINAHL, MEDLINE, Ageline, Amed, PubMed, Cochrane library, PEDro and Joanna Briggs Institute databases were searched. The methodological quality of studies was assessed using a checklist criteria adapted from the Cochrane Working Group for Screening and Diagnostic Tests. Results: Eight databases were searched and 21 studies were included. The majority of studies demonstrated low to moderate methodological quality scores. Despite limitations reported for clinical application with community dwelling older adults, the Berg Balance Scale and the Timed Up and Go Test have been most rigorously tested. Reliability and concurrent validity of the Balance Screening Tool and the Fullerton Advanced Balance Scale had also been established in this population, however only one study was retrieved for each. Conclusion: The Berg Balance Scale and Timed Up and Go Test have published reliability, validity with community dwelling older adults. Further testing of other functional balance tests is required to establish their reliability and validity in this target population.

Assessment of Functional Performance in Acute Geriatric Psychiatry – Time for New Strategies?

2019 ◽  
Vol 33 (6) ◽  
pp. 316-323
Author(s):  
Rieke Trumpf ◽  
Tobias Morat ◽  
Wiebren Zijlstra ◽  
Peter Haussermann ◽  
Tim Fleiner
Keyword(s):  
Older Adults ◽  
Correlation Coefficient ◽  
Functional Performance ◽  
Intraclass Correlation ◽  
Geriatric Psychiatry ◽  
Clinical Population ◽  
Performance Tests ◽  
Timed Up And Go ◽  
Healthy Older Adults ◽  
New Strategies

Objectives: The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression. Method: A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient ( rs). Results: A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and rs for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and rs were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB). Conclusion: Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.

Gait Parameters of Older Adults according to Their Fall History and Functional Capacity While Walking at Different Speeds

Gerontology ◽  
2021 ◽  
pp. 1-12
Author(s):  
Letícia Pophal da Silva ◽  
Natália Boneti Moreira ◽  
Paulo Barbosa de Freitas ◽  
Gleber Pereira ◽  
André Luiz Felix Rodacki
Keyword(s):  
Older Adults ◽  
Functional Capacity ◽  
Walking Speed ◽  
Principal Component ◽  
Step Length ◽  
Community Dwelling ◽  
Timed Up And Go ◽  
Gait Parameters ◽  
Spatiotemporal Parameters ◽  
Walking Speeds

Introduction: It is believed that functional capacity and fall history are factors capable of influencing the gait parameters of older adults. Thus, the objective of this study was to verify whether gait parameters of community-dwelling older adults differ according to their functional capacity and fall history when walking at self-selected walking speed (SSWS) and fast walking speed (FWS) using principal component analysis (PCA). Methods: Two hundred ninety-five participants (82.3% women and 17.7% men) were allocated in four groups according to their fall history and functional capacity: non-fallers with higher functional capacity (NFHFC, n = 94; 69.3 ± 5.5 years), non-fallers with lower functional capacity (NFLFC, n = 114; 72.0 ± 8.1 years), fallers with higher functional capacity (FHFC, n = 29; 70.0 ± 6.0 years), and fallers with lower functional capacity (FLFC, n = 58; 72.5 ± 8.2 years). Fall history, anthropometric data, functional capacity by short physical performance battery and mobility by Timed Up and Go (TUG), and spatiotemporal gait parameters were evaluated. Results: Data analysis indicated that FLFC presented the lowest scores, especially in the Five Times Sit-to-Stand Test and TUG. The PCA showed that the first principal component (PC1) explained the most substantial amount of the data variability in both walking speeds (SSWS and FWS), predominantly including temporal parameters. PC2 composed by spatial outcomes (stride and step length and walking speed) showed the highest effect size. PC1 and PC2 were able to differentiate functional status, regardless of fall history. Conclusions: Functional capacity showed great importance when analyzing gait parameters at different walking speeds (SSWS and FWS), regardless of fall history. Older adults with high functional capacity demonstrate better performance during gait. Besides, spatiotemporal parameters are the main factors explaining gait variability, both in SSWS and FWS.

Additional Functional Performance Gains After 24-Week Unstable Strength Training With Cognitive Training in Community-Dwelling Healthy Older Adults: A Randomized Trial

2020 ◽  
pp. 1-11
Author(s):  
Valéria Mayaly Alves de Oliveira ◽  
André Luiz Torres Pirauá ◽  
Bruno Remígio Cavalcante ◽  
Natália Barros Beltrão ◽  
Wevans Monthier de Farias ◽  
...  
Keyword(s):  
Older Adults ◽  
Confidence Interval ◽  
Strength Training ◽  
Cognitive Training ◽  
Dual Task ◽  
Functional Performance ◽  
Community Dwelling ◽  
Timed Up And Go ◽  
Single Task ◽  
Performance Gains

The authors investigated the effects of unstable strength training (UST) without or with cognitive training (C+UST) on functional performance in community-dwelling older adults. A total of 50 participants were randomly assigned (1:1) to either 24 weeks of thrice-weekly UST (n = 25) or C+UST (n = 25). All participants performed moderate-intensity strength exercises using unstable surfaces, and C+UST participants simultaneously received cognitive training in addition to UST. Primary outcomes included measures of functional performance: single- and dual-task timed up and go tests. Secondary outcomes included dynamic balance, mobility, handgrip strength, flexibility, quality of life, and concern about falling. The authors observed similar improvements on functional performance through the interventions. The C+UST group experienced additional gains at completion (single-task timed up and go: −0.90 s, 95% confidence interval [–2.38, –0.03]; dual-task timed up and go: –4.80 s, 95% confidence interval [–8.65, –0.95]) compared with the UST group. Moreover, significant differences were observed in mobility (sitting-rising test: −1.34, 95% confidence interval [−2.00, −0.20]) at 24 weeks. Both exercise modes improved single-task functional performance, while adding cognitive-training-optimized dual-task functional performance gains.

scholarly journals Reliability of the Maximal Step Length Test and Its Correlation with Motor Function in Chronic Stroke Survivors

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Shamay S. M. Ng ◽  
Mimi M. Y. Tse ◽  
Patrick W. H. Kwong ◽  
Isaac C. K. Fong ◽  
Sun H. Chan ◽  
...  
Keyword(s):  
Older Adults ◽  
Intraclass Correlation ◽  
Step Length ◽  
Berg Balance Scale ◽  
Minimal Detectable Change ◽  
Stroke Survivors ◽  
Healthy Older Adults ◽  
Abc Scale ◽  
Walking Speeds ◽  
Test Retest Reliability

Objective. This study aimed to (1) investigate the interrater, intrarater, and test-retest reliabilities, as well as the minimal detectable change, of the Maximal Step Length test (MSL) in stroke survivors, (2) examine the concurrent validity of MSL with other stroke-specific impairment measurements in stroke survivors, and (3) compare the MSL performances of stroke survivors and those of age-matched healthy older adults in different directions. Design. Cross-sessional study. Setting. University-based research laboratory. Participants. Stroke survivors (n = 48) and age-matched healthy older adults (n = 39). Methods. Stroke survivors were assessed with MSL, lower limb muscle strength, Limits of Stability (LOS) Test, Berg Balance Scale (BBS), 5-meter walk test, and Activities-specific Balance Confidence (ABC) scale by two trained assessors in 1 session. Their performance on MSL was reassessed 1 week later to establish the test-retest reliability. Healthy older adults were assessed with MSL only. Intraclass correlation coefficient (ICC) was used to assess the reliability of MSL and Spearman’s rho was used to quantify the strength of correlations between MSL and secondary outcomes. Between-group differences of MSL were assessed with the independent t-test. Results. The MSL exhibited excellent intrarater, interrater, and test-retest reliabilities [ICC: 0.885–1.000]. Significant correlations (ρ: 0.447–0.723) were demonstrated between MSLs in most directions and muscle strengths of the affected legs, BBS scores, and walking speeds. The step lengths differed significantly between stroke survivors and healthy older adults in the forward, backward, and sideways directions on both the affected and less affected sides. Conclusions. The MSL is a reliable, valid, and easily administered test of the stepping capabilities of stroke survivors. Stroke survivors had significant shorter MSLs in all directions than the age-matched healthy older adults.

Standing from the Floor in Community-Dwelling Older Adults

2016 ◽  
Vol 24 (2) ◽  
pp. 207-213 ◽  
Author(s):  
Dennis Wayne Klima ◽  
Catherine Anderson ◽  
Dina Samrah ◽  
Dipal Patel ◽  
Kevin Chui ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Performance ◽  
Functional Performance ◽  
Motor Pattern ◽  
Community Dwelling ◽  
Performance Assessments ◽  
Performance Tests ◽  
Timed Up And Go ◽  
Performance Time ◽  
Community Dwelling Older Adults

While considerable research has targeted physical performance in older adults, less is known about the ability to rise from the floor among community-dwelling elders. The purposes of the study were to (1) examine physical performance correlates of timed supine to stand performance and (2) identify the predominant motor pattern used to complete floor rise. Fifty-three community-dwelling adults over the age of 60 (x = 78.5 ± 8.5; 36 [68%] females) performed a timed supine to stand test and physical performance assessments. Forty-eight subjects (90.6%) demonstrated an initial roll with asymmetrical squat sequence when rising to stand. Supine to stand performance time was significantly correlated with all physical performance tests, including gait speed (r = −.61; p < .001), grip strength (r = −.30; p < .05), and Timed Up and Go (TUG) performance (r = .71; p < .001). Forty-eight percent of the variance in rise time (p < .001) was attributed to TUG velocity. Findings serve to enhance both functional performance assessment and floor rise interventions.

scholarly journals Relationship of the sacral slope with early gait derangements in robust older women

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Leda Magalhaes Oliveira ◽  
Suely Roizenblatt ◽  
Flavio Duarte Silva ◽  
Arnaldo Roizenblatt ◽  
Artur Rocha Correa Fernandes ◽  
...  
Keyword(s):  
Older Women ◽  
Step Length ◽  
Berg Balance Scale ◽  
Community Dwelling ◽  
Early Investigation ◽  
Sacral Slope ◽  
Compensatory Mechanism ◽  
Performance Tests ◽  
Timed Up And Go ◽  
Balance Scale

Abstract Background Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry. Methods In this cross-sectional study, 54 community-dwelling women ≥60 years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30-m walk distance. Results The sample, aged 72 ± 6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (− 0.339), Berg Balance Scale (+ 0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+ 0.405), RMS, (+ 0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP. Conclusions Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

scholarly journals 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

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.

scholarly journals Impact of Malnutrition Status on Muscle Parameter Changes over a 5-Year Follow-Up of Community-Dwelling Older Adults from the SarcoPhAge Cohort

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 407
Author(s):  
Laetitia Lengelé ◽  
Olivier Bruyère ◽  
Charlotte Beaudart ◽  
Jean-Yves Reginster ◽  
Médéa Locquet
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Physical Performance ◽  
Community Dwelling ◽  
Timed Up And Go ◽  
P Values ◽  
Student’S T ◽  
The Impact ◽  
Community Dwelling Older Adults

This study aimed to assess the impact of malnutrition on the 5-year evolution of physical performance, muscle mass and muscle strength in participants from the SarcoPhAge cohort, consisting of community-dwelling older adults. The malnutrition status was assessed at baseline (T0) according to the “Global Leadership Initiatives on Malnutrition” (GLIM) criteria, and the muscle parameters were evaluated both at T0 and after five years of follow-up (T5). Lean mass, muscle strength and physical performance were assessed using dual X-ray absorptiometry, handgrip dynamometry, the short physical performance battery test and the timed up and go test, respectively. Differences in muscle outcomes according to nutritional status were tested using Student’s t-test. The association between malnutrition and the relative 5-year change in the muscle parameters was tested using multiple linear regressions adjusted for several covariates. A total of 411 participants (mean age of 72.3 ± 6.1 years, 56% women) were included. Of them, 96 individuals (23%) were diagnosed with malnutrition at baseline. Their muscle parameters were significantly lower than those of the well-nourished patients both at baseline and after five years of follow-up (all p-values < 0.05), except for muscle strength in women at T5, which was not significantly lower in the presence of malnutrition. However, the 5-year changes in muscle parameters of malnourished individuals were not significantly different than those of well-nourished individuals (all p-values > 0.05).

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