Concurrent validity of the Groningen Meander Walking and Timed Up and Go tests in older adults with dementia.

Background and Purpose: The Groningen Meander Walking time (GMW-sec) test has not been clinically validated as a feasible assessment to test functional mobility skills. The purpose of this study was to determine the concurrent validity of the GMW-sec test with the Timed Up and Go (TUG) test in older adults with dementia. Methods: This study included a cross-sectional and between subjects design with one factor, which had three different levels of group. Consecutive sampling was used to recruit 145 elderly participants in dementia and senior care facilities. Participants were divided into three groups based on the result of a Mini-Mental Status Exam for Dementia Screening: 57 older adults with dementia, 25 older adults with mild cognitive impairment, and 63 healthy older adults. Results: Spearman rank order correlation showed that the TUG test had moderate association with the GMW-sec test not only in older adults with dementia (r = 0.69; p < 0.01), but also for the mild cognitive group (r = 0.63; p = 0.01) and healthy group (r = 0.47; p < 0.01). Older adults with dementia had a significant functional reduction for both GMW-sec and TUG tests compared to other two groups (p < 0.01). Discussion and Conclusion: Turning motions with the TUG test may cause similar challenges that relate to a curved walking path for the GMW-sec test in older adults with dementia. Both the TUG and GMW-sec tests could be effective approaches for screening the severity of cognitive impairment on functional mobility in people with dementia.

Outcome measures correlated with falls in nursing home residents-A pilot study.

Most fall risk and normal values are collected from the community-dwelling population, which is not representative of nursing home residents. The purpose of this study was twofold: 1) to determine the relationship of clinical impairment and activity limitation variables to the number of falls in nursing home residents; and 2) to determine the amount of variability that can be explained for the number of falls from these predictor variables. Seventeen active nursing home residents (83.7 ± 11.7 years) consented to participate. Mini-Mental Status Examination (MMSE), lower extremity handheld dynamometry, ankle plantar flexion (PF)/dorsiflexion (DF) active range of motion (AROM), hand grip strength, gait speed (GS), Timed Up and Go (TUG), and 5 Times Sit-to-Stand (5TSTS) were recorded in a single visit. Regression analysis was performed to identify the better clinical outcome tool to determine falls. This was followed by a stepwise multiple regression model to predict the criterion variable-number of falls. Of the clinical impairment measures collected, significant correlations with past falls include the following: right DF AROM (-0.436; p = 0.040) and right DF strength (-0.504; p = 0.023). Of the activity limitation measures collected, significant correlations with past falls include the following: 5TSTS (0.585; p = 0.007); TUG time (0.475; p = 0.027); and GS (0.457; p = 0.032). The stepwise multiple regression model explained 59% of the variance using right DF AROM, right DF strength, 5TSTS, and TUG time. These measures are benchmarks for the community dwelling population. The present study indicates that these measures might also be useful in determining fall risk screening for ambulatory nursing home residents.

Effect of bilateral step-up and -down training on motor function in a person with hemiparesis: a case report.

Gait training to facilitate the use of the paretic limb for persons with hemiparesis continues to be of interest to those in the clinical research domain. The purpose of this case report was to assess the outcomes of a repeated step-up and -down treatment, initiating with the paretic limb, on functional mobility, endurance and gait kinematic parameters in a person with hemiparesis. The participant was an 85-year-old female 3 years status post left hemiparesis, who reported overall good health. The participant was asked to step up on a 1-inch height wood box with her paretic limb. Once both feet were on top of the box, the participant initiated descent also with her paretic limb. The height of the box gradually progressed to 5 inches based on the participant's performance and tolerance. A metronome was used to facilitate rhythmic lower extremity movement patterns. The training duration for each treatment session was 7-15 min/day. The participant completed nine sessions spanning over 3 weeks. The outcome measure used to identify motor recovery was the Fugl-Myer (lower extremity). In addition, the timed up and go (TUG), the 6-min walk test (6 MWT) and gait kinematics were assessed to examine mobility and gait. The Fugl-Myer score and 6 MWT did not reflect a meaningful change (0% and +2.6%, respectively). However, TUG scores did show a meaningful change (+31.9%). With respect to gait kinematics, hip flexion on the paretic limb was improved from 11° to 18°, which indicates the normal range of hip motion during the initial swing phase in post-test.

Gait speed is limited but improves over the course of acute care physical therapy.

BACKGROUND: Gait is a common focus of physical therapists' management of patients in acute care settings. Walking speed, the distance a patient covers per unit time, has been advocated as a "sixth vital sign." However, the feasibility of measuring walking speed and the degree to which walking speed is limited or improves over the course of therapy in the acute care setting are unclear. PURPOSE: The purpose of this study of patients undergoing physical therapy during acute care hospitalization, therefore, was to determine whether walking speed can be measured in acute care and whether walking speed is limited and changes over the course of therapy. METHODS: This was an observational cross-sectional study. Participants were 46 hospital inpatients, mean age 75.0 years (SD = 7.8), referred to physical therapy and able to walk at least 20 ft. Information regarding diagnosis, comorbidities, physical assistance, device use, body height, and weight was obtained. Speed was determined during initial and final physical therapy visits while patients walked at their self-selected speed over a marked course in a hospital corridor. RESULTS: Therapists reported that walking speed was clinically feasible, requiring inexpensive, available resources, 4 minutes' additional time, and simple calculations for documentation. Initial walking speed was a mean of 0.33 m/s (SD = 0.21; 95% confidence interval [CI]: 0.27-0.39), whereas final speed was 0.37 m/s (SD = 0.20; 95% CI: 0.31-0.43). The Wilcoxon test showed the increase in walking speed (0.04 m/s) to be significant (P = .005) over a mean therapy period of 2.0 days (SD = 1.4) and total hospitalization period of 5.5 days (SD = 3.6). The effect size and standardized response mean were 0.19 and 0.36, respectively. Minimal detectable change was 0.18 m/s. CONCLUSION: Walking speed is a feasible measure for patients admitted to an acute care hospital. It shows that patients walk slowly relative to community requirements but that their speed improves even over a short course of therapy.

The effects of sequence difficulty and practice on proportional and nonproportional transfer.

Two experiments were designed to determine participants' ability to transfer a learned movement sequence to new spatial locations. A 16-element dynamic arm movement sequence was used in both experiments. The task required participants to move a horizontal lever to sequentially projected targets. Experiment 1 included two groups. One group practised a relatively easy 16-element movement sequence (easy long). The other group practised a more difficult 16-element movement sequence (difficult long). Approximately 24 hours after practice with their respective sequence both groups were administered a retention and two transfer tests. The only difference between the retention and transfer tests was the location of the targets. The short transfer target configuration was considered a proportional transfer because all the amplitudes between targets were reduced by the same proportion. The mixed transfer configuration was considered a nonproportional transfer because the targets did not have the same proportional distances between targets as the sequence they practised. The results indicated that participants could effectively transfer the difficult long sequence to the new target configurations regardless of whether the transfer required proportional and nonproportional spatial changes to the movement pattern. However, the easy long sequence was only effectively transferred in the proportional transfer condition. Experiment 2 assessed the effects of extended practice of the easy long sequence on proportional and nonproportional spatial transfer. The data indicated that participants could again effectively transfer the easy long sequence to proportional but not the nonproportional spatial transfer conditions regardless of the amount of practice (1 or 4 days). The results are discussed in terms of the mechanism by which response sequences become increasingly specific over extended practice in an attempt to optimize movement production and how this process interacts with the difficulty of the sequence.

Age-related effects in sequential motor learning.

BACKGROUND AND PURPOSE: When learning multi-element movement sequences, participants organize individual elements into subsequences. Imposing this type of structure on the elements leads to the efficient production of sequences because the processing of all but the first elements in a subsequence can be completed prior to their execution. The primary purpose of this study was to determine whether older adults organize lengthy movement sequences with the same efficiency as young adults. SUBJECTS AND METHODS: Participants were young adults (N=8, 19-23 years of age) and older adults (N=8, 65-68 years of age). The task required participants to move a lever as quickly as possible to targets sequentially projected on a tabletop. At various stages during practice, random practice blocks were inserted between the repeated sequence blocks. Repeated and random sequence retention tests were administered after 24 hours. RESULTS: The results indicated that the young adults performed the repeated sequences substantially faster than the older adults and that this difference increased over practice. On the retention tests, there were no differences in response time for the random sequence blocks, but the young performers were substantially faster than the older performers when repeated sequences were used. No differences were detected in the interview or on the recognition (chi square=1.22, P>.05) and completion (chi square=0.89, P>.05) tests designed to determine explicit or implicit knowledge of the sequences. DISCUSSION AND CONCLUSION: Analysis of the sequence structure indicated that the older adults did not organize their responses into subsequences as effectively as the young adults. The failure of older adults to optimally organize movement sequences may contribute to the overall slowing of sequential movement production.