Utilização de sensores inerciais no teste timed up and go: uma revisão narrativa / Use of inertial sensors in the timed up and go test: a narrative review

O teste funcional Timed Up and Go (TUG) é amplamente utilizado para avaliar o risco de queda, através do equilíbrio e mobilidade, por ser de fácil aplicação e boa reprodutibilidade na prática clínica. Porém, o TUG ainda possui algumas limitações, pois se concentra no tempo total em que o teste é realizado. Uma proposta de avaliação é através da utilização de sensores inerciais, baseados na tecnologia de sistemas microeletromecânicos, e vem sendo muito utilizados para análise do movimento humano. Logo, o objetivo desse estudo foi realizar uma revisão narrativa sobre o uso dos sensores inerciais nas medidas temporais e cinemáticas do TUG e suas subfases. Metodologia: Essa revisão narrativa foi realizada nas bases de dados PubMed, CENTRAL, BVS e PEDro, por meio do vocabulário MeSH entre o período de maio a junho de 2020. Os critérios de inclusão foram estudos que utilizaram sensores inerciais para avaliação de medidas temporais e cinemáticas do TUG e suas subfases. Resultados: Foram incluídos 11 artigos de um total de 2305 achados. Desses, 5 utilizaram os sensores de smartphones. Não houve padronização em relação à quantidade utilizada, nem à fixação e posicionamento. Os sensores conseguiram mostrar diferenças no TUG e suas subfases nas medidas temporais e cinemáticas nos diferentes grupos avaliados. Considerações Finais: Sensores inerciais são capazes de avaliar medidas temporais e cinemáticas do TUG e de suas subfases, mostrando serem ferramentas confiáveis. Entretanto, mesmo obtendo resultados satisfatórios, necessita-se de mais estudos abrangendo uma população maior.

The Timed Up and Go (TUG) functional test is widely used to assess the risk of falling through balance and mobility since it is easy to apply and presents good reproducibility in clinical practice. However, the TUG test still has some limitations, as it focuses on the total time the test is performed. A proposal for evaluation is the use of inertial sensors, based on the microelectromechanical system technology, which has been widely used for the analysis of human movement. Therefore, the objective of this study was to carry out a narrative review on the use of inertial sensors in the temporal and kinematic measurements of TUG and its subphases. Methodology: This narrative review was carried out in the PubMed, CENTRAL, BVS, and PEDro databases using the MeSH vocabulary between the period of May to June 2020. The inclusion criteria were studies using inertial sensors to evaluate temporal and kinematic measurements of the TUG and its subphases. Results: A total of 11 articles were selected from 2305 hits. From these, five (5) used smartphone sensors. There was no standardization regarding the quantity used, nor their fixation and positioning. The sensors were able to show differences in the TUG and its subphases in the temporal and kinematic measurements in the different groups evaluated. Final Considerations: Inertial sensors are capable of evaluating temporal and kinematic measurements of the TUG and its subphases, showing that they are reliable tools. Nevertheless, although satisfactory results were obtained, further studies are needed covering a larger population.

Timed Up And Go Performance In Older People With Diabetes Mellitus: Associations With Sensorimotor Function, Balance, Cognition, And Falls

Background: The Timed up and Go Test (TUG) is often used as a mobility measure in older people. However, it is unclear whether the TUG is useful for identifying fall risk in people with diabetes mellitus (DM) and which physical and cognitive/psychological factors influence the performance of this test. Objectives: To investigate whether slow TUG times (standard test and when performed with a secondary cognitive task (c-TUG)) are a risk factor for falls in older people with DM and to determine the relative contributions of a range of sensorimotor, balance and cognitive/psychological factors to TUG performance in this population. Methods: Community-dwelling people (n=103, mean age 61.57, SD=6.3) underwent the TUG and c-TUG tests as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, cognition, and fear of falling. Participants were then followed up for falls for six months. Results: Negative binomial regression analyses revealed that each 1s increase in TUG and c-TUG times increased the risk of falling by 29% and 13%, respectively. Multiple regression analyses identified vibration sense (p<0.001), knee extension strength (p=0.001, r²=0.430), edge contrast sensitivity (p=0.002), neuropathy examination score (p=0.001, r²=0.498) and controlled leaning balance (p=0.033) as significant and independent explanatory predictors of TUG performance. The regression model for c-TUG was similar, vibration sense (p=0.042), knee extension strength (p=0.009, r²=0.256), neuropathy examination score (p=0.156, r²=0.272) and sway path-floor (p=0.042) except that the MOCA cognitive assessment (p=0.015) was included instead of edge contrast sensitivity. The combined explanatory variable models explained 43% and 26% of the variance in TUG and c-TUG times, respectively. Conclusions: Slow TUG and c-TUG times significantly increased the risk of falls in community-dwelling older people with DM. Poor TUG and c-TUG performances were related independently to decreased vibration sense, lower limb weakness, and poor balance, with the c-TUG additionally influenced by cognitive function.

Validación del Timed Up and Go Test como Predictor de Riesgo de Caídas en Sujetos con Artritis Reumatoidea: Parte II: Validez Concurrente y Predictiva / Validation of the Timed Up and Go Test as Predictor of Risk of Falls in Subjects with Rheumatoid Arthritis: Part II: Concurrent and Predictive Validity

Introducción: Los sujetos con Artritis Reumatoidea (AR) tienen un elevado riesgo de caídas respecto a la población sana. El Timed Up and Go test (TUG) es utilizado para predecir el riesgo de caídas pero no ha sido validado en sujetos con AR. Objetivos: El objetivo primario fue establecer la validez predictiva y la validez concurrente a velocidad habitual y máxima segura en sujetos con diagnóstico de AR. El objetivo secundario fue establecer si el TUG tiene mayor valor predictivo evaluado a velocidad habitual o a velocidad máxima segura. Sujetos y método Los sujetos fueron ingresados mediante muestreo no probabilístico consecutivo. Para la validez concurrente se correlacionó el TUG con la Berg Balance Scale (BBS) y el Test de Marcha de 10 metros (TM10m). La validez predictiva fue calculada utilizando curva de características operativas para el receptor y el área bajo la curva. Resultados: Se evaluaron 115 participantes para la validez concurrente y 98 para la predictiva. Las correlaciones entre el TUG a velocidad habitual y el TUG a velocidad máxima segura con la BBS y el TM10m resultaron fuertes (rango de -0,65 a -0,78). La capacidad predictiva del TUG resultó baja tanto a velocidad habitual como a velocidad máxima segura. Conclusión: El TUG en sus dos versiones presentó una fuerte validez concurrente al ser comparado con la BBS y el TM10m. El TUG presentó una baja validez predictiva tanto a velocidad habitual como a velocidad máxima segura para predecir el riesgo de caídas en sujetos con AR.

Background: Subjects with Rheumatoid Arthritis (RA) have a high risk of falling. The Timed Up and Go test (TUG) is used to predict the risk of falls but it has not been validated in subjects with RA. Purpose: The primary objective was to establish the predictive validity and the concurrent validity of TUG at the preferred walking speed or fastest speed possible as a predictor of falls in subjects with RA. The secondary objective was to establish if the TUG has a higher predictive value evaluated at the preferred walking speed or fastest speed possible. Subjects and method: The subjects were admitted by consecutive non-probabilistic sampling. To establish the concurrent validity, the TUG was correlated with the Berg Balance Scale (BBS) and the 10-meter Walk Test (TM10m). Predictive validity was calculated using the operating characteristics curve for the receiver and the area under the curve. Results: 115 participants were evaluated for concurrent validity and 98 for predictive validity. The correlations between the usual speed TUG and fastest speed TUG with the BBS and the TM10m were strong (range from -0.65 to -0.78). The predictive capacity of the TUG was low at both normal speed and maximum safe speed. Conclusion: The TUG in its both versions presented a strong concurrent validity compared to the BBS and the TM10m.The TUG presented a low predictive validity both at normal speed and at maximum safe speed to predict the risk of falls in subjects with RA.

A predictive value of the timed "up and go" test on the fall risk assessment of inpatients with stroke / 中国实用护理杂志

Objective@#To explore the predictive value of the timed "up and go" test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation.@*Methods@#A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed "up and go" test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients.@*Results@#The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95%CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05).While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05).@*Conclusions@#Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients.

A predictive value of the timed "up and go" test on the fall risk assessment of inpatients with stroke / 中国实用护理杂志

Objective To explore the predictive value of the timed "up and go" test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation. Methods A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed "up and go" test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients. Results The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95% CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05). While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05). Conclusions Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients.

Differences in Timed Up and Go and Gait Speed Tests between Older Adults with High and Low Falls Risk / Jurnal Sains Kesihatan Malaysia

Falls is one of the main problems in older adults, which indirectly contributes to deterioration of quality of life, morbidityand mortality. The purpose of this study was to examine the difference in values between Timed Up and Go (TUG) andgait speed tests among community dwelling older adults with high and low risk of falls classified using PPA (PhysiologicalProfile Assessment). This cross-sectional study involved 278 older adults aged between 60 to 88 years, recruited fromsenior citizen club around Klang Valley. 40.6% older adults had high risk of falls and mostly were women (75%). Theresults of the study showed that there was a significant (p < 0.05) difference in TUG and Gait speed tests performancebetween older adults with high and low risk of falls. Declined mobility (longer time of TUG test) and increased age wereidentified as significant (p < 0.05) risk factors for falls in this study. The TUG test reference values obtained in this studymay be useful for early identification, prevention and management of falls among community dwelling older adults.

Serum 25-hydroxyvitamin D levels are associated with functional capacity but not with postural balance in osteoporotic postmenopausal women

OBJECTIVES: In post-menopausal women with osteoporosis, insufficient vitamin D levels decrease calcium fixation in the bones and calcium transport in the sarcoplasmic reticulum, which impairs muscle strength, possibly leading to detrimental consequences for the preservation of functional capacity and postural balance, fall prevention, and fracture risk. The aim of this study was to evaluate the association between vitamin D levels and knee muscle strength, postural balance and functional mobility among postmenopausal women with osteoporosis. METHODS: This cross-sectional study included 63 osteoporotic older women (aged 60.6±3.1 years). The subjects completed the Timed Up and Go Test to measure functional mobility, and postural balance was assessed on the AccuSway Plus portable force platform. Maximal strength was tested using an isokinetic dynamometer for knee flexion and extension. The subjects were assessed as a group and were divided into quartiles according to their vitamin D levels. Clinicaltrials.gov: NCT02771834. RESULTS: Vitamin D status was independently associated with the normalized peak torque of the knee extensors (β=0.59; p=0.04) and Timed Up and Go Test (β=-0.07; p<0.001). No between-group differences were observed in the demographic and clinical variables or postural balance; however, significant differences were observed in the Timed Up and Go Test, and the group with the highest vitamin D levels exhibited better performance than the group with the lowest vitamin D levels (p<0.001). CONCLUSION: The serum vitamin D levels were independently associated with normalized knee extension strength and functional mobility in postmenopausal women with osteoporosis.

Contrastive analysis of timed up and go test, maximum walking speed test on evaluating stroke patients' function / 中国康复医学杂志

Objective:To explore the efficiency of timed up and go test (TUGT) and maximum walking speed test (MWST) on evaluating stroke patients' motor function.Method:Fifty stroke patients were assessed with TUGT,MWST,Berg balance scale (BBS),Barthel Index (BI) and Fugl-meyer assessment.The levels of association among five methods were examined with Pearson correlation coefficients.The predictive efficiency was analyzed by using receiver operating characteristic curve (ROC).Result:The significant negative correlation was shown between TUG and BBS,BI and FMA score (P ＜ 0.05) and the same significant negative correlation was shown between MWST and BBS,BI and FMA score (P＜0.05).The Pearson correlation coefficients of TUG was higher than the MWST's.The area under the ROC curve for the TUG was significantly higher than that of the MWST.Conclusion:The TUG is closely correlated with the balance ability,moto function and active of daily living in stroke patients.The TUG could serve as a screening tool for detection of individuals with stroke.

Contrastive analysis of timed up and go test, maximum walking speed test on evaluating stroke patients' function / 中国康复医学杂志

Objective:To explore the efficiency of timed up and go test (TUGT) and maximum walking speed test (MWST) on evaluating stroke patients' motor function.Method:Fifty stroke patients were assessed with TUGT,MWST,Berg balance scale (BBS),Barthel Index (BI) and Fugl-meyer assessment.The levels of association among five methods were examined with Pearson correlation coefficients.The predictive efficiency was analyzed by using receiver operating characteristic curve (ROC).Result:The significant negative correlation was shown between TUG and BBS,BI and FMA score (P ＜ 0.05) and the same significant negative correlation was shown between MWST and BBS,BI and FMA score (P＜0.05).The Pearson correlation coefficients of TUG was higher than the MWST's.The area under the ROC curve for the TUG was significantly higher than that of the MWST.Conclusion:The TUG is closely correlated with the balance ability,moto function and active of daily living in stroke patients.The TUG could serve as a screening tool for detection of individuals with stroke.

Optimal cutoff values of TUG and Chair Stand for detecting risk of cognitive impairment in Japanese elderly adults / 体力科学

<p>This study evaluates the pertinent cutoffs of Timed Up and Go (TUG) and Chair Stand (CS) tests for detecting cognitive impairment risk in Japanese elderly. Subjects were community-dwelling adults aged 65 or older (N = 455, 129 men and 326 women). Cognitive function was examined using Urakami’s test for Alzheimer’s disease; physical function was examined by TUG and CS. The maximum score for cognitive function was 15; impairment was defined as 12 or less. Receiver operating characteristic (ROC) analyses were performed to find an appropriate cutoff of TUG and CS for cognitive impairment. Furthermore, the sensitivity and specificity of the combined use of these measures independently distinguishing between subjects with and without a risk for cognitive impairment were determined. Fifty-four subjects (12%) scored as impaired on Urakami’s test. The optimal TUG cutoff for cognitive impairment was 6 seconds and 9 seconds for CS. The combined use of TUG and CS, based on a subject being positive on at least one measure, yielded sensitivity of 78% and specificity of 50%. Area under the ROC curve of TUG and CS were respectively 0.67 and 0.66. When divided into two groups according to the TUG cutoff value, the odds ratio of cognitive impairment in the slower group was 2.1 (95% confidence interval 1.25-3.37). For CS cutoff, the slower-group odds ratio was 3.57 (95% confidence interval 2.20-5.81). For TUG and CS combined, the slower-group odds ratio was 2.11 (95% confidence interval 1.03-4.34). TUG and CS are thus potent predictors for cognitive impairment among elderly adults.</p>

Assessments of Physical Function and Related Factors among Community-dwelling Aged People / 中国康复理论与实践

Objective To evaluate the physical functions of community-dwelling older adults, and analyze the related factors. Methods From September to October, 2016, 80 adults over 55-year-old in one community in Wuhan, Hubei, China were selected with convenience sampling. General situation was collected through questionnaires. Physical functions were measured by tests of grip strength, Five-Times-Sit-to-Stand Test (FTSST), modified Clinical Test of Sensory Interaction and Balance (mCTSIB) and TimedUp and GoTest (TUGT). Their correlation was analyzed. Results The average grip strength of the participants was (27.46 ± 9.66) kg; the average time of FTSST was (11.58 ± 4.03) s;there was only one (1.25%) participant observed with an impairment in mCTSIB;the average time of TUGT was (9.05±3.47) s. Grip strength was correlated with gender (r=-0.669), education level (r=0.238), the score of Mini-Mental State Examina-tion (MMSE) (r=-0.302) and activities of daily living (ADL) (r=-0.344) (P<0.05). The time of FTSST was correlated to gender (r=0.274), the score of MMSE (r=0.243) and ADL (r=0.321) (P<0.05). The time of TUGT was correlated to gender (r=0.255), education level (r=-0.362), income level (r=-0.245), the score of Self-rating Depression Scale (r=0.223), the score of MMSE (r=0.328) and ADL (r=0.354) (P<0.05). Conclusion The levels of grip strength, FTSST and TUGT are related to the demographic characters in community-dwell-ing older adults. Little abnormity has been found in mCTSIB.

The Association Between Fall History and Physical Performance Tests in the Community-Dwelling Elderly: A Cross-Sectional Analysis

OBJECTIVE: To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population. METHODS: A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests. RESULTS: SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers. CONCLUSION: This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.

The timed up and go test and maximum walking speed test for evaluating the walking ability of stroke patients / 中华物理医学与康复杂志

Objective To explore the effectiveness of the timed up and go test (TUGT) and the maximum walking speed test (MWST) in evaluating stroke patients' motor function.Methods Twenty-two stroke patients were assessed using the TUGT and MWST,and the temporal-spatial parameters of their gait were also assessed.The correlations among the TUGT times,walking speed and the gait parameters were quantified using Pearson correlation coefficients.Results The TUGT time was (18.57±7.41) s,significantly correlated with step length and velocity (P＜0.05).Walking speed showed a significant positive correlation with step length,velocity and step length (P＜ 0.05).The TUGT times were negatively correlated with walking speed (r=-0.712,P=0.000).Conclusion The MWST and TUGT both can assess stroke patients' motor function effectively.

Age and education influence the performance of elderly women on the dual-task Timed Up and Go test / Idade e educação influenciam o desempenho de mulheres idosas no teste Timed Up and Go com dupla tarefa

Gait variability is related to functional decline in the elderly. The dual-task Timed Up and Go Test (TUG-DT) reflects the performance in daily activities. Objective To evaluate the differences in time to perform the TUG with and without DT in elderly women with different ages and levels of education and physical activity. Method Ninety-two elderly women perfomed the TUG at usual and fast speeds, with and without motor and cognitive DT. Results Increases in the time to perform the TUG-DT were observed at older ages and lower educational levels, but not at different levels of physical activity. More educated women performed the test faster with and without DT at both speeds. When age was considered, significant differences were found only for the TUG-DT at both speeds. Conclusion Younger women with higher education levels demonstrated better performances on the TUG-DT. .

Alterações da marcha são indícios de declínio funcional em idosos. O TUG com dupla tarefa (TUG-DT) reflete o desempenho das atividades do cotidiano. Objetivo Avaliar as diferenças no tempo de execução do TUG com e sem DT em idosas com diferentes faixas etárias, e níveis de escolaridade e atividade física. Método Noventa e duas idosas foram avaliadas pelo TUG nas velocidades usual e máxima, sem e com DT cognitiva e motora. Resultados Houve aumento no tempo de execução do TUG-DT em idosas com maior faixa etária e menor escolaridade, mas não para diferentes níveis de atividade física. Aquelas com maior escolaridade realizaram o teste mais rápido com e sem DT nas duas velocidades. Com relação à faixa etária, foram obervadas diferenças apenas nos testes com DT nas duas velocidades. Conclusão Idosas mais jovens com maior escolaridade demonstraram um melhor desempenho no TUG com DT. .

Using the Imagined Timed Up and Go Test to Identify Fall Risk over the 6-Month Period after Discharge in Patients with Stroke / The Japanese Journal of Rehabilitation Medicine

Objective : To determine whether or not the time difference index of the Timed Up and Go test (TUG) and the imagined TUG (iTUG), which reflects motor imagery capacity, has utility in predicting falls in patients with stroke. Method : A follow-up study of falls occurring over the 6-month period after discharge was performed in 47 patients with stroke. Baseline values were evaluated at discharge for subject age, sex, disease name, paralysis side, disease duration, fall history, whether a gait assistive device was used, mini-mental state examination (MMSE), TUG, and the time difference (delta time) between TUG and iTUG. A logistic regression analysis was performed using the number of falls and evaluation results, and the predictive factors for falls were extracted. Results : Thirty-three patients were followed for the entire 6-month period, and the fall rate was 48.5%. According to the results of the analysis, only delta time was a significant fall factor (<i>p</i><0.01), and the cutoff value for fall prediction was 0.88%. Conclusion : Our results show that delta time could be used to identify the likelihood of a fall occurrence over the 6-month period after discharge in patients with stroke.

Revisão de dois instrumentos clínicos de avaliação para predizer risco de quedas em idosos / Review of two clinical assessment tools to predict risk of falls in elderly

Introdução: Quedas são um problema clínico comum nos idosos, que pode reduzir sua mobilidade e independência. O uso de instrumentos simples para detecção do risco de quedas é fundamental para prevenção e tratamento de tais eventos. Não há, porém, consenso quanto aos testes mais adequados para cada situação. Objetivo: Revisar estudos sobre eficácia, sensibilidade e especificidade dos testes Timed Up and Go Test e Berg Balance Scale, a fim de verificar qual é o mais apropriado para predizer quedas em idosos. Métodos: Realizou-se revisão bibliográfica nas bases de dados MEDLINE, PubMed, ISI, LILACS e Portal de Periódicos CAPES, entre os anos de 2001 e 2011. Resultados: Foram selecionados 37 artigos, sendo 17 sobre a Berg Balance Scale e 20 sobre o Timed Up and Go Test. A revisão mostrou que os dois testes podem ser bons preditores de quedas, mas os artigos diferiram quanto à definição de queda e caidor, tipo de estudo, quantidade e característica da amostra e avaliação de quedas, levando a diferentes resultados quanto a nota de corte, sensibilidade, especificidade e predição de quedas. Há controvérsias quanto à capacidade de predição em perfis específicos, como os idosos ativos. Conclusão: Os testes avaliados são eficazes para predição de quedas, desde que adaptados para cada perfil. Novos estudos devem ser realizados com metodologia homogênea, a fim de favorecer a comparação de resultados sobre a eficácia desses testes. .

Introduction: Fall is a common problem in the elderly and it can reduce their mobility and independence. The use of simple tools to detect risk of falls is essential to prevent and treat such events. However, there is no consensus about the most appropriate tools for each situation. Objective: To review studies about efficacy, sensitivity and specificity of Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) in order to ascertain which is the most appropriate to predict falls in the elderly. Methods: We performed a literature review from MEDLINE, PubMed, ISI, LILACS and Portal de Periódicos CAPES databases, between 2001 and 2011. Results: We selected 17 different articles about BBS and 20 articles about TUGT. The review showed the two tools can be good predictors of falls. However, the articles differed in definition of fall and faller, type of study, quantity and characteristics of sample and assessment of falls, leading to different results as cutoff scores, sensitivity, specificity and prediction of fall. There is controversy about the ability of tools to predict falls in specific samples, such as active elderly. Conclusion: TUGT and BBS are effective to predict falls, provided they are adapted to each sample. Further studies should be performed using articles with homogeneous methods in order to support comparison of results about the effectiveness of tools. .

Using a portable gait rhythmogram to objectively evaluate acupuncture-mediated improvements in gait disturbance caused by Parkinson's disease:a case report / 全日本鍼灸学会雑誌

[Objective]We report herein the use of acupuncture to counteract gait disturbance in a patient with Parkinson's disease (PD). A portable gait rhythmogram was used to objectively demonstrate gait improvements. <BR>[Case]Case:A 72-year-old woman, who a 64 experienced a tremor of the right hand and was diagnosed with PD. Symptoms improved with anti-PD medication, but at 71 years old, she experienced heaviness of the neck and shoulders and stiffness of the anterior thighs, and her step length decreased. Acupuncture therapy was initiated to relieve these symptoms. <BR>Present illness:On examination, she presented a wobbly gait, cold feet, and reported frequent falling. Heaviness in the neck and shoulders extended from the neck to the suprascapular region, and increasing heaviness resulted in a forward-flexed posture and decreased step length. Muscle hypertonia of the quadriceps muscles was bilaterally observed, explaining the perceived stiffness in the thighs. She was at stage III on the Hoehn and Yahr Scale. <BR>Acupuncture therapy:Acupuncture therapy was performed weekly for 12 weeks to alleviate the muscle hypertonia associated with muscular rigidity. Acupuncture points comprised the points in the muscle hypertonia where tenderness was observed, including BL 10, DU 16, ST 32, SP 10 and ST 34. <BR>Evaluation:A portable gait rhythmogram was used to measure the ground reaction force (GRF), velocity and step length. Dynamic balance functions and PD symptoms, were respectively evaluated using the Timed Up and Go Test (TUGT) and Unified Parkinson's Disease Rating Scale (UPDRS). Evaluations were conducted on initial examination and after the 12th therapy session.<BR>[Results]After the fourth session, perceived stiffness in the neck, shoulder region and thighs decreased. all frequency decreased from 5 times/day to 3times/day (4th session) and then once/day (7th session). There were no falls after the 8th session. Reduction in gait disturbance was objectively observed as follows:Increases were observed in GRF (0.15 to 0.17 m/s 2), gait velocity (49 to 53m/min), and step length (47 to 49 cm), while TUGT time decreased (11.8 to 9.5 s). Improvements in PD symptoms were also observed with decreased UPDRS score (41 to 28 points).<BR>[Discussion and Conclusion]The use of acupuncture therapy achieved improvements in Parkinson-related gait disturbance (objectively demonstrated using a portable gait rhythmogram). Acupuncture improved not only gait disorder but also other PD symptoms.

Relationship between Gait Speed and Muscle Strength of Lower Extremities or Physical Functional Tests / 中国康复理论与实践

Objective To explore the relevance between gait speed and muscle strength of lower extremities, or several kinds of physical functional tests. Methods 341 community-dwelling individuals (160 males, 181 females) aged 65-94 years were selected. They were divid-ed into suspected sarcopenia group (n=137) and normal group (n=204) by their gait speed less or more than 0.8 m/s. It was compared be-tween both groups with the basic physical characteristics, strength of iliopsoas, quadriceps, hamstrings and tibialis anterior, and the scores of One Leg Standing Test, Berg Balance Scale, Functional Gait Assessment, Functional Stretch Test and Timed Up and Go Test. Results The subjects were older in the suspected sarcopenia group than in the normal group. The difference of body weight, height were not statistically significant between groups. The strength of the muscles in bilateral lower limbs was not significantly different between both groups (P>0.05), while the gait speed positively correlated with the strength of iliopsoas, quadriceps and hamstrings (r=0.121-0.227, P0.05). Gait speed positively correlated with the scores of One Leg Standing Test, Berg Balance Scale, Functional Gait Assessment, Functional Stretch Test (P<0.05), and negatively correlated with the score of Timed Up and Go Test (r=-0.502, P<0.001). The scores of all the tests were significantly different between 2 groups (P<0.05), except that of Functional Stretch Test (P=0.28). Conclu-sion Sarcopenia diagnosis is not only depended on the strength of muscle of lower extremity, but also their functions.

The Association of Gait Disturbance and Cognitive Impairment

BACKGROUND: The incidence and prevalence of gait disturbance increases as age increases. The importance of cognitive aspects of gait disturbances has been studied in various types of dementia and MCI. This study was performed to identify relationship between cognitive impairment and change in gait, and investigate specific domains of cognitive function that may have affects in gait disturbance. METHODS: Three hundred eighty three participants over 60 years old volunteered for the study. Three stages evaluation were performed, dementia screening and timed up and go test (TUG), work up for cognitive impairment and dementia, and classifying cognitive impairment and dementia into subcategories by evaluating cause of the disease. To evaluate cognitive impairment, MMSE-KC (MMSE in the Korean version of the CERAD assessment packet) and Korean version of Consortium to Establish a Registry of Alzheimer's Disease (CERAD-K) assessment were used. One hundred forty one people were excluded from study and 242 people were analyzed. Timed Up and Go test (TUG) was performed for evaluation of gait disturbance. Relationship in every subcategory of CERAD-K and TUG was studied by correlation and multiple logistic analysis. RESULTS: Of the 242 participants, 122 were without cognitive impairment, 51 had mild cognitive impairment, 56 had Alzheimer's disease and 13 had vascular dementia. These four groups showed different results in TUG. Normal group had the lowest values in TUG compare to other groups significantly. MMSE score also correlated with the value of TUG (r=-0.528, p<0.001). Every subcategory of CERAD-K score had significant correlation with the value of TUG. But there were no specific subcategory that had predominant effect in TUG. Only age was an independently significant factor influencing TUG (p<0.05). CONCLUSIONS: This study shows that increase in age and impairment in cognitive function has an association with gait disturbance. Therefore clinician should be concerned about cognitive factors for evaluation of a patient who has gait disturbance.