Increased Attentional Focus on Walking by Older Adults Limits Maximum Speed and Is Related to Dynamic Stability

<b><i>Background and Purpose:</i></b> Older adults with lower balance confidence demonstrate a reduced willingness to experience instability as the task of walking becomes more challenging (i.e., walking with a faster speed). However, the specific reason why is not known. The purpose of this study was to investigate the extent to which capacity of increasing walking speeds relates to the attentional requirements (i.e., automaticity) of walking. <b><i>Methods:</i></b> Sixteen young (31 ± 5.85 years) and 15 older participants (69 ± 3.04 years) began walking on a treadmill at 0.4 m/s, and speed was increased by 0.2 m/s until the participant either chose to stop or reached a speed of 2.0 m/s. Sixty steps were collected at steady-state speed for each walking trial. Kinematic data were collected, and the margin of stability in the anterior direction (MOS_AP) at heelstrike was quantified for each step. The timed up and go (TUG) and TUG dual (TUG_dual) task were performed, from which an automaticity index (TUG/TUG_dual × 100) was calculated. Older individuals were grouped based on whether they did or did not complete all walking speeds (i.e., completers [<i>n</i> = 9] or noncompleters [<i>n</i> = 6]). The fastest walking speed attempted (FSA), automaticity index, and MOS_AP were compared, and correlations were assessed between the FSA/MOS_AP and the automaticity index. <b><i>Results:</i></b> A significant difference was identified in an average MOS_AP at heelstrike between older completer and noncompleter groups (<i>p</i> &#x3c; 0.001). Further, older adults with lower automaticity index choose to stop walking at lower speeds (<i>p</i> = 0.001). The FSA was positively correlated with the automaticity index (ρ = 0.81, <i>p</i> &#x3c; 0.001). Finally, the average MOS_AP at FSA and the automaticity index were also negatively correlated (<i>r</i> = −0.85, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Older adults with lower automaticity of walking choose to stop walking at speeds before they completed all walking speeds, which may relate with increased attentional demands required to maintain dynamic stability at higher walking speeds. Given that these were otherwise healthy adults, the combination of FSA and an automaticity of walking may help to identify individuals who should be considered for an assessment to identify walking problems.

Role of Spasticity Severity on the Balance of Post-stroke Patients

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS &gt; 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

How Do You Increase Your Happiness?

Expanding factors already discussed in previous chapters, this chapter identified 12 factors/ways important for increasing happiness: Attitude, balance, confidence, dignity, engagement, family/friends, gratitude, health, ideals, joyful, kindness, love.

Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults

Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p&lt;.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.

Capturing Change in Balance Confidence over 30 Days: Insights Gained from a Micro-Longitudinal Study

Balance confidence reflects one’s estimate of their ability to maintain balance and avoid falls. Extensive literature has shown the relationships between balance confidence, functional limitations, and falls in later life. However, change in balance confidence, especially within short timescale, remains largely unknown and deserves further research. In this study, we aimed to investigate how older adults’ balance confidence would change over 30 days and explore whether baseline characteristics would explain the individual differences in change. We used data from the Daily Balance Project that employed intensive-repeated measurements to examine the dynamics of subjective and objective fall risk across a month. Twenty-one participants (age=78.6±5.8, 48%female) were enrolled, and individual characteristics were measured upon recruitment. Throughout the study, participants self-reported their daily balance confidence using the Activity-Specific Balance Confidence (ABC) Scale. We performed growth modeling techniques to examine change within a multilevel framework. Our results showed that overall, ABC scores were high (79.9±17.4) at first, but the linear change was non-significant (b=0.03, SE=0.21, p=.89) on average. However, we found that balance confidence increased in individuals with higher educational attainment (b=0.37, SE=0.13, p&lt;.01) and decreased among those with greater physical fall risk (b=-0.18, SE=0.07, p&lt;.01) and accurate understanding of fall risk at baseline (b=-0.24, SE= 0.12, p=.04). Although ABC scores were stable within the period of one month, our study highlights the distinction of individual characteristics in the process of balance confidence appraisal. We suggest that these nuances should be taken into account when developing more fine-grained fall risk assessments and interventions.

Awareness of Balance as an Intraindividual Dynamic of Objective and Subjective Experiences of Fall Risk in Daily Life

Falls are life-changing events in older adulthood. With an accurate understanding of balance, older adults can adapt to age-related changes in physical ability without prematurely restricting physical activity. The Daily Balance Project examines the implications of older adults’ awareness of fall risk in daily life. For 30-consecutive days, following a fall-risk assessment, 40 older adults used a smartphone to report balance confidence and then perform four balance assessment and a 30-second sit-to-stand task to measure postural sway and fall-risk. Measures of postural sway showed greater intraindividual variability than balance confidence and fall risk. Multilevel models showed that awareness of balance fluctuated during the study and varied across individual differences in baseline fall-risk. Baseline fall risk also differentiated how balance confidence and postural sway were linked to subsequent momentary fall risk assessments. The findings are discussed within the framework of action-perspectives of adult development and awareness of aging.

The Utility of Social Media Recruitment to Achieve a More Diverse Participant Sample

The COVID-19 pandemic created an immediate, lasting impact on recruitment methods in academic research, most notably in the field of gerontology. To protect older adult participants’ health during the COVID-19 crisis, the Daily Balance Project, a 30-day micro-longitudinal study of older adults' awareness of balance in daily life, shifted to complete remote administration. Our new remote protocol included developing new methodologies to recruit participants with varying degrees of fall risk and educational attainment. In this study, we present our approach to remote online recruitment and compare educational attainment, objective and subjective fall risk, and alignment of objective/subjective fall risk across three samples recruited via a) Fall Clinic registry (16 participants); b) University e-newsletter to faculty and staff (5 participants); c) social media recruitment (7 participants). Eligibility included being 65+ and wireless internet at home. For samples a and b, screening assessments were conducted via phone while baseline assessments were conducted in-person. For sample c, screener and baseline assessment were virtual. Analysis of recruitment methods aims to determine whether recruitment via social media platforms may provide a sample of participants with more variation in fall risk or alignment of subjective versus objective balance. Results demonstrate no significant differences in educational attainment (p=0.7949) or balance confidence (p=0.213), despite significant differences in the alignment of objective and subjective fall risk (p=0.031). Participants from samples a and b proved more able to accurately assess fall risk, while sample c had the most misalignment between subjective and objective fall risk assessments.

Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial

Objective Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. Design Multi-site, parallel, evaluator-masked randomized controlled trial. Setting Home-setting in three Canadian cities. Participants Community-dwelling lower limb prosthesis users over 50 years of age. Interventions The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. Main Measures Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. Results Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [−3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test −0.16 [−1.25, 0.92] s, nor short physical performance battery 0.48 [−0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. Conclusions The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. Clinical Trial Registration number, NCT 01942798.

Investigating Relationships between Balance Confidence and Balance Ability in Older Adults

Increasing balance confidence in older individuals is important towards improving their quality of life and reducing activity avoidance. Here, we investigated if balance confidence (perceived ability) and balance performance (ability) in older adults were related to one another and would improve after balance training. The relationship of balance confidence in conjunction with balance performance for varied conditions (such as limiting vision, modifying somatosensory cues, and also base of support) was explored. We sought to determine if balance confidence and ability, as well as their relationship, could change after several weeks of training. Twenty-seven healthy participants were trained for several weeks during standing and walking exercises. In addition, seven participants with a higher risk of imbalance leading to falls (survivors of stroke) were also trained. Prior to and after training, balance ability and confidence were assessed via the Balance Error Scoring System (BESS) and Activities Specific Balance Confidence (ABC) Scale, respectively. Both groups showed improvements in balance abilities (i.e., BESS errors significantly decreased after training). Balance confidence was significantly higher in the healthy group than in the stroke group; however, ABC results reflected that balance confidence did not significantly increase after training for each. The correlations between balance ability and balance confidence were explored. Encouragingly, healthy participants displayed a negative correlation between BESS errors and ABC (i.e., enhancements in balance confidence (increases in ABC Scale results) were related to improvements in balance ability (decreases in BESS errors)). For the stroke participants, despite improvements in balance ability, our results showed that there was no relation to balance confidence (i.e., no correlation between BESS errors and ABC) in this group.