Standing, Transition, and Walking Ability in Older Adults: The Case for Independently Evaluating Different Domains of Mobility Function

<b><i>Background:</i></b> Independent mobility is a complex behavior that relies on the ability to walk, maintain stability, and transition between postures. However, guidelines for assessment that details <i>what</i> elements of mobility to evaluate and <i>how</i> they should be measured remain unclear. <b><i>Methods:</i></b> Performance on tests of standing, sit-to-stand, and walking were evaluated in a cohort of 135 complex, comorbid, and older adults (mean age 87 ± 5.5 years). Correlational analysis was conducted to examine the degree of association for measures within and between mobility domains on a subset of participants (<i>n</i> = 83) able to complete all tasks unaided. Participants were also grouped by the presence of risk markers for frailty (gait speed and grip strength) to determine if the level of overall impairment impacted performance scores and if among those with risk markers, the degree of association was greater. <b><i>Results:</i></b> Within-domain relationships for sit-to-stand and walking were modest (rho = 0.01–0.60). Associations either did not exist or relationships were weak for measures reflecting different domains (rho = −0.35 to 0.25, <i>p</i> &#x3e; 0.05). As expected, gait speed differed between those with and without frailty risk markers (<i>p</i> &#x3c; 0.001); however, balance and sit-to-stand measures did not (<i>p</i> ≥ 0.05). <b><i>Conclusions:</i></b> This study highlights the need to independently evaluate different mobility domains within an individual as a standard assessment approach. Modest within-domain relationships emphasize the need to account for multiple, unique control challenges within more complex domains. These findings have important implications for standardized mobility assessment and targeted rehabilitation strategies for older adults.

Effectiveness of Exergaming-based Interventions for Mobility Performance in Older Adults with Parkinson’s Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials (Preprint)

BACKGROUND Background: Although physical exercises can help older adults with Parkinson’s disease to retain their mobility function, older adults are less motivated to attend repeated and intensive physical training. Exergaming-based interventions have the potential to provide a more engaged and enjoyable therapy. However, few meta-analysis studies discussed the effectiveness of exergaming-based interventions on the mobility performance of older adults with Parkinson’s disease. OBJECTIVE Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of exergaming-based interventions on mobility performance in older adults with Parkinson’s disease. METHODS Methods: Seven databases (Web of Science, Medline, Academic Search Premier, CINAHL Complete, PsycINFO, PsychARTICLE, and PubMed) were searched to identify the RCTs which examined the effectiveness of exergaming on the mobility performance of older adults with Parkinson’s disease up to September 2021. Using meta-analysis, we assessed mobility performance between intervention groups and control groups by comparing basic mobility function with the Timed Up and Go (TUG), walking capability with 6-Minute Walk Test (6MWT), postural balance function with the Berg Balance Scale (BBS), and gait ability with gait velocity, stride length, and the Functional Gait Assessment (FGA). RESULTS Results: After scanning 1110 articles, we identified and meta-analyzed 16 trials, including a total of 508 older adults with Parkinson’s disease. The results revealed statistical differences between intervention groups and control groups in the TUG (MD = -0.87; 95% CI = -1.60 to -0.15; P = .018), 6MWT (MD = 39.56; 95% CI = 1.21 to 77.91; P = 0.043), BBS (MD = 2.28; 95% CI = 1.42 to 3.14; P < .001), and FGA (MD = 1.40; 95% CI = -0.03 to 2.82; P = .054). The detectable clinically difference of the outcomes were discussed and the implications were provided. CONCLUSIONS Conclusions: Exergaming is superior to traditional training in improving PD older adults’ basic mobility skills, walking capability, and postural balance function, while it has an equal effect with traditional physical training in enhancing PD older adults’ gait ability.

Practicability of a Virtual Consultation to Evaluate the Shoulder Joint

Objective In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. Methods Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. Results 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 – 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. Conclusion Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.

On a One-Dimensional Hydrodynamic Model for Semiconductors with Field-Dependent Mobility

We consider a one-dimensional, isentropic, hydrodynamical model for a unipolar semiconductor, with the mobility depending on the electric field. The mobility is related to the momentum relaxation time, and field-dependent mobility models are commonly used to describe the occurrence of saturation velocity, that is, a limit value for the electron mean velocity as the electric field increases. For the steady state system, we prove the existence of smooth solutions in the subsonic case, with a suitable assumption on the mobility function. Furthermore, we prove uniqueness of subsonic solutions for sufficiently small currents.

Pendulum test in chronic hemiplegic stroke population: additional ambulatory information beyond spasticity

Spasticity measured by manual tests, such as modified Ashworth scale (MAS), may not sufficiently reflect mobility function in stroke survivors. This study aims to identify additional ambulatory information provided by the pendulum test. Clinical assessments including Brünnstrom recovery stage, manual muscle test, MAS, Tinetti test (TT), Timed up and go test, 10-m walk test (10-MWT), and Barthel index were applied to 40 ambulant chronic stroke patients. The pendular parameters, first swing excursion (FSE) and relaxation index (RI), were extracted by an electrogoniometer. The correlations among these variables were analyzed by the Spearman and Pearson partial correlation tests. After controlling the factor of motor recovery (Brünnstrom recovery stage), the MAS of paretic knee extensor was negatively correlated with the gait score of TT (r = − 0.355, p = 0.027), while the FSE revealed positive correlations to the balance score of TT (r = 0.378, p = 0.018). RI were associated with the comfortable speed of 10-MWT (r = 0.367, p = 0.022). These results suggest a decrease of knee extensor spasticity links to a better gait and balance in chronic stroke patients. The pendular parameters can provide additional ambulatory information, as complementary to the MAS. The pendulum test can be a potential tool for patient selection and outcome assessment after spasticity treatments in chronic stroke population.

Incorporating a rehabilitation ethos into the management of canine osteoarthritis

Osteoarthritis is a painful and debilitating degenerative condition with an extremely high incidence. Consequently, it is frequently encountered in first opinion practice and was recently cited as a primary cause of welfare compromise through extensive population studies carried out by Vet Compass, a division of the Royal Veterinary College. In the preceding article of this series (https://doi.org/10.12968/coan.2021.0014), the author provided a brief overview of the complexity of chronic pain associated with osteoarthritis and advocated for a polypharmacy approach guided by the clinical presentation. However, pain is only one clinical manifestation of degenerative joint disease. Osteoarthritis affects the whole joint and local support structures, as well as impacting the entire musculoskeletal system. Interventions targeting the multitude of consequences of this disease are likely to have greater impact on long-term analgesia, independent mobility, function, longevity and overall health-related quality of life. This article introduces the clinical reasoning and evidence base associated with an integrated multimodal approach to a multifaceted and complex disease.

Locomotive syndrome in hemodialysis patients and its association with quality of life—a cross-sectional study

Background Locomotive syndrome (LS) is defined as impairment of mobility function. This study aimed to clarify LS and its association with quality of life in hemodialysis patients. Methods This is a cross-sectional study. The subjects were chronic kidney disease patients undergoing maintenance hemodialysis treatment. LS was assessed using two physical tests (two-step test, stand-up test) and one self-reported test (Geriatric Locomotive Function Scale-25). LS has two stages of severity; the beginning of the decline in mobility function is known as Locomo stage 1, and the progression of the decline of mobility function is known as Locomo stage 2. We used SF-36 to assess quality of life and examined their relationships with the Locomo stages. Chi-square test, Kruskal-Wallis test, Jonckheere-Terpstra test, and Mantel-Haenszel test were used for analysis. Multiple linear regression was used to model the cross-sectional association of Locomo stages with each component and summary score of SF-36. Results A total of 76 hemodialysis patients were included. The number of subjects with Locomo stage 1 and stage 2 were 19 (25%) and 53 (70%), respectively, while only four (5%) subjects did not have mobility dysfunction. Each component and summary score of the SF-36 for physical function, role emotional, physical component summary, and mental component summary were significantly associated with Locomo stages. Conclusion A high prevalence and severity of LS in hemodialysis patients was found, and the severity was associated with quality of life.

Correlation of medial longitudinal arch morphology with body characteristics and locomotive function in community-dwelling older women: A cross-sectional study

Purpose: This cross-sectional study aimed to investigate the effects of foot arch deformities on physical characteristics, muscular strength, and motor function in older women depending on the presence or absence of pain. Methods: Overall, 145 community-dwelling women aged 65 to 90 years were included in this study. We measured the foot arch height ratio (AHR, dorsal height/truncated foot length) and classified participants with AHR values above, below, or within 1.5 standard deviations into the high-arched group (HAG), Low-Arched Group (LAG), or normal-arched group (NAG), respectively. We also compared body characteristics (age, height, weight, body mass index (BMI), and skeletal mass index), muscle strength (handgrip strength and intrinsic foot strength (IFS)), and locomotive function (two-step value and gait speed) among the three groups. Results: Locomotive examination and muscle strength showed significant differences among the three groups only in the presence of pain; in the two-step test, HAG, NAG, and LAG values were 0.98 cm/cm, 1.19 cm/cm, and 1.18 cm/cm, respectively. The IFS measured 19.2 N, 24.2 N, 31.0 N, respectively, in the HAG, NAG, and LAG. Conclusion: This study suggests that decreased IFS affects the mobility function of high-arched feet in older women. Although there was no significant difference in the evaluation of pain, HAG showed the highest average value, which is considered to contribute to the decreased two-step value. It has been suggested that a high-arched foot in the presence of pain is associated with IFS weakness and may affect the decline of mobility function in older women.

Research on the Influence of Urban-rural Dual Structure on the Social Mobility Function of Rural Education — Based on the Empirical Investigation of the Loss of Rural Junior High School Students in S City, Hubei Province

Based on the empirical investigation of the loss of rural junior high school students in S City, Hubei Province, this article explores the weakening of the social mobility function of rural education under the dual structure of urban and rural areas, and points out the deep-seated reasons — the urban-centric orientation of the national education system under the dual urban-rural structure. At the same time, the article reveals the harm of the weakening of the social mobility function of rural education under the urban-rural dual structure.

A Multi-DoF Prosthetic Hand Finger Joint Controller for Wearable sEMG Sensors by Nonlinear Autoregressive Exogenous Model

The loss of mobility function and sensory information from the arm, hand, and fingertips hampers the activities of daily living (ADL) of patients. A modern bionic prosthetic hand can compensate for the lost functions and realize multiple degree of freedom (DoF) movements. However, the commercially available prosthetic hands usually have limited DoFs due to limited sensors and lack of stable classification algorithms. This study aimed to propose a controller for finger joint angle estimation by surface electromyography (sEMG). The sEMG data used for training were gathered with the Myo armband, which is a commercial EMG sensor. Two features in the time domain were extracted and fed into a nonlinear autoregressive model with exogenous inputs (NARX). The NARX model was trained with pre-selected parameters using the Levenberg–Marquardt algorithm. Comparing with the targets, the regression correlation coefficient (R) of the model outputs was more than 0.982 over all test subjects, and the mean square error was less than 10.02 for a signal range in arbitrary units equal to [0, 255]. The study also demonstrated that the proposed model could be used in daily life movements with good accuracy and generalization abilities.