Fall history in older adults impacts acceleration profiles after a near collision with a moving pedestrian hazard.

BACKGROUND: Environmental hazards (e.g., pedestrian traffic) cause falls and testing environment impacts gait in older adults. However, most fall risk evaluations do not assess real-world moving hazard avoidance. AIMS: This study examined the effect of fall history in older adults on acceleration profiles before, during, and after a near collision with a moving hazard, in laboratory and real-world settings. METHODS: Older adults with (n = 14) and without a fall history (n = 15) performed a collision avoidance walking task with a sudden moving hazard in real-world and laboratory settings. Gait acceleration and video data of participants' first-person views were recorded. Four mixed effects multilevel models analyzed the magnitude and variability of mean and peak anteroposterior and mediolateral acceleration while walking before, during, and after the moving hazard in both environments. RESULTS: In the real-world environment, older adults without a fall history increased their mean anteroposterior acceleration after the moving hazard (p = 0.046), but those with a fall history did not (p > 0.05). Older adults without a fall history exhibited more intersubject variability than those with a fall history in mean (p < 0.001) and peak anteroposterior (p = 0.015) acceleration across environments and epochs. Older adults without a fall history exhibited a slower peak mediolateral reaction during the moving hazard (p = 0.014) than those with a fall history. CONCLUSIONS: These results suggest that compared to older adults with a fall history, older adults without a fall history are more adaptable and able to respond last-minute to unexpected hazards. Older adults with a fall history exhibited more homogenous responses.

An interprofessional experience preparing a collaborative workforce to care for older adults.

The development and evaluation of an interprofessional education (IPE) pre-professional geriatrics experience involving learners from 10 different health discipline programs is described. The experience provided learners with opportunities to use small-group collaborative approaches in two 3-hour interprofessional sessions. Learners gained exposure to geriatric principles and awareness of the needs of older adults and their families using case studies developed by experienced interprofessional faculty. Learners completed pre- and post-experience surveys and worksheets on their confidence to function in interprofessional teams, knowledge of other disciplines, perceptions of importance of each discipline in providing older adult care, and the qualities considered for a successful team. Data were collected over three offerings of the experience (2016, 2017, 2018) and analyzed using paired sample t-tests and ANOVA. A total of 562 learners participated with outcome measures indicating increased knowledge of older adult services different health professionals provide and increased confidence in knowing when to complete care referrals. Mean increase in learners' confidence to function in interprofessional teams was significant, suggesting the experience was effective in facilitating confidence in functioning and improving views of other disciplines' roles. This experience demonstrated that learners gained exposure to apply geriatric principle skills and critical thinking as interprofessional team members.

Dual-tasking impacts gait, cognitive performance, and gaze behavior during walking in a real-world environment in older adult fallers and non-fallers.

INTRODUCTION: Everyday walking often involves simultaneous performance of a cognitive task in environments with competing auditory and visual stimuli. Previous research has not evaluated task performance in these situations, where older adults are known to fall, limiting our understanding of how older adults adjust their gait, visual scanning (gaze), and cognitive processing to avoid falls (or not). The purpose of this study was to examine the effect of dual-task walking in a high-distraction real-world environment on cognitive performance, gait performance, and gaze behavior in older adult fallers relative to non-fallers. METHODS: Fourteen community-dwelling, older adult fallers (76.6 ± 9.1 years, 11 females) and 15 community-dwelling, older adult non-fallers (77.4 ± 7.6 years, 11 females) participated. Participants performed single-task walking, single-task cognitive (seated category naming), and dual-task walking (category naming + walking) trials for 1 min each in a real-world environment (busy hospital lobby). Gait speed, stride length variability, stride duration variability, gaze fixation duration on 6 areas of interest (AOIs), and percentage of time fixating on 6 AOIs were recorded during single- and dual-task walking trials. Number of correct responses, time to first response, and mean subsequent response time (measure of rate of decline of response retrieval throughout trial) were determined for single-task cognitive and dual-task walking trials. Two-way MANCOVAs and MANOVAs were used to compare the effects of fall status and task condition on gait and cognitive variables. Hierarchical linear regression models were used to assess predictors of gaze behavior variables. RESULTS: Compared to single-task, during dual-task trials, participants walked 0.21 m/s slower, had 1.5 fewer verbal responses, and a 2823 ms shorter mean subsequent response time, indicating a faster declining rate of retrieval during the cognitive task. Additionally, during dual-task walking, participants fixated their gaze on Far People (AOI) for a significantly smaller percentage of time and on the Near Walking Path (AOI) for a significantly greater percentage of time than during single-task walking. During all trials, being a non-faller predicted a longer average fixation duration on the Far Environment (AOI) than for fallers. Environmental busyness, baseline gait speed, and baseline executive function impacted gaze behavior. CONCLUSION: All participants exhibited dual-task decrements in gait and cognitive performance and changes in gaze behavior from single- to dual-task walking. Perhaps of more importance, non-fallers appear to have had more freedom to divert their gaze to less relevant environmental stimuli while walking, and two measures of fall risk impacted patterns of gaze behavior differently. Thus, overt visual attention during walking in real-world environments should be further explored in relation to fall risk.

Attentional prioritization in dual-task walking: Effects of stroke, environment, and instructed focus.

BACKGROUND: The impact of high distraction, real-world environments on dual-task interference and flexibility of attentional prioritization during dual-task walking in people with stroke is unknown. RESEARCH QUESTION: How does a real-world environment affect dual-task performance and flexible task prioritization during dual-task walking in adults with and without stroke? METHODS: Adults with stroke (n = 29) as well as age-, gender-, and education-matched adults without stroke (n = 23) participated. Single and dual-task walking were examined in two different environments (lab hallway, hospital lobby). Two different dual-task combinations were assessed (Stroop-gait, speech-gait). Each dual-task was performed first without explicit instruction about task prioritization (no-priority) and then with gait-priority instruction and Stroop/speech-priority instruction in randomized order. RESULTS: People with stroke had significantly slower dual-task gait speed (Stroop only) in the lobby than the lab, but the effect was not clinically meaningful. Stroop reaction time for all participants was also slower in the lobby than the lab. All participants slowed their walking speed while generating spontaneous speech, but this effect was not influenced by environment. The dual-task attention allocation strategy was generally inflexible to instructed prioritization in adults with and without stroke in both environments, however, the volitional attention allocation strategy differed for the two dual-task conditions such that speech was prioritized in the speech-gait dual-task and gait appeared to be prioritized in the Stroop-gait dual-task. SIGNIFICANCE: Although dual-tasking slows walking speed and verbal responses to auditory stimuli in people with stroke, the effects are not considerably impacted by a more complex, distracting environment. Adults with and without stroke may have difficulty overriding the preferred attention allocation strategy during dual-task walking, especially for habitual dual-tasks such as walking while speaking. It may also be that the cognitive control strategy governing task prioritization is influenced by degree of cognitive engagement.

Effect of the environment on gait and gaze behavior in older adult fallers compared to older adult non-fallers.

INTRODUCTION: Compared to controlled laboratory settings, the real world is highly distracting with constant demands on visual attention to avoid hazards and falling. Fall-risk assessments do not adequately take into account the potential role of everyday distractions and environmental hazards. The purpose of this project was to identify the effect of the environment on gait and gaze behavior during walking in older adult fallers relative to non-fallers. METHODS: Thirteen older adult fallers (76.8±9.4 years, 3.2±2.3 falls in last year) and 13 age-matched non-fallers (78.3±7.3 years, 0 falls in last year) participated. Participants walked in a real-world and lab setting while gait and gaze were recorded. Gait variables were stride length variability, stride duration variability, and stride velocity. Gaze was analyzed for percentage of time fixating and average fixation duration coded across 6 areas of interest (AOIs) in the visual surroundings. RESULTS: Non-fallers walked faster than fallers, but there were no other group or environment effects on gait. For gaze behavior, fallers had shorter fixation durations on the near environment than non-fallers, but only in the real world. In the real world relative to the lab, fallers decreased fixation durations on the near environment but increased durations on near people. In the real world, participants spent a greater proportion of time fixating on people than on the walking path or the near environment compared to the lab. After adjusting for baseline gait speed, fallers had shorter fixation durations than non-fallers in both environments. CONCLUSIONS: Our results indicate that in a busy environment, older adults concentrate most of their overt visual attention on people when navigating their walking path. Fallers in particular focus longer on people near to them and have overall shorter fixations than non-fallers. Visual focus while walking in a busy environment should be further explored as a fall-risk factor.

Test-retest reliability and minimal detectable change for measures of balance and gait in adults with cerebral palsy.

BACKGROUND: Walking and balance often begin to deteriorate in ambulant adults with cerebral palsy (CP) in early adulthood. The decline in walking and balance imposes a more sedentary lifestyle, increases falls risk, negatively affects health, participation, and quality of life, and ultimately results in increased disability. Available research is not sufficient to guide interventions to improve walking and balance in this population. To advance research in this area, there is a need for measures of gait and balance with proven psychometrics for adults with CP. RESEARCH QUESTION: The goal of this study was to determine test-retest reliability and minimal detectable change (MDC) values and to assess score distribution for the Balance Evaluation Systems Test (BESTest) and the Four Square Step Test (FSST) as measures of balance, for the Activities-specific Balance Confidence (ABC) Scale and the Modified Fall Efficacy Scale (MFES) as measures of balance confidence, and for over-ground spatiotemporal gait parameters at comfortable gait speed (CGS) and fast gait speed (FGS). METHODS: Twenty ambulant adults with CP (mean age 32.7 years), GMFCS-E&R Levels I and II, were tested twice within an average of 10 days. Test-retest reliability was evaluated using intra-class correlation coefficients (ICC2,1), and MDC95 values were calculated using standard error of measurement values. RESULTS: The test-retest reliability of most outcome measures was good to excellent. ICC values were: BESTest = 0.99, BESTest sections 0.88 to 0.98, FSST = 0.91, ABC=0.86, MFES = 0.9, CGS = 0.88, and FGS = 0.98. MDC values were: BESTest total = 4.9%, BESTest sections 8.7%-21.2%, FSST = 3.7 s, ABC = 18%, MFES = 1 point, CGS = 0.26 m/s, and FGS = 0.14 m/s. Most outcome scores were broadly distributed over scales ranges. SIGNIFICANCE: Adults with CP demonstrated stable test-retest performance on the selected measures. These measures could be useful to assess balance and gait of adults with CP. The MDC values can help evaluate whether observed changes exceed the expected random test-retest variations.

Relationships between gait variability and ambulatory activity post stroke.

BACKGROUND: Fall risk and balance confidence are related to gait variability and ambulatory activity post stroke, yet whether a relationship exists between gait variability and ambulatory activity is unknown. Knowing if gait variability measured under naturalistic conditions is related to ambulatory activity could explain more about the relationship between falls and walking activity post-stroke. OBJECTIVES: To examine relationships between spontaneous, daily ambulatory activity and gait variability during single- and dual-task walking, in low- and high-distraction settings in adults post stroke. METHODS: Sixteen community-dwelling adults post stroke participated in a cross-sectional study. Spatiotemporal gait parameters were recorded during single- and cognitive-motor dual-task walking in low- and high-distraction settings. Coefficient of variation was calculated for stride length and stride duration. Average walking bout duration, maximum walking bout duration, and total number of steps per day were captured using an activity monitor. Correlations between ambulatory activity measures and gait variability were examined. RESULTS: In the high-distraction setting, single-task stride duration variability was negatively related to all three ambulatory activity measures, but the strongest relationship was a negative correlation between dual-task stride duration variability and average walking duration. In the low-distraction setting, single-task stride duration variability was negatively related to maximum walking duration. None of the other variability measures were related to ambulatory activity. CONCLUSIONS: The finding that stride duration variability in a high-distraction environment, with or without an additional cognitive task, is related to ambulatory activity in community-dwelling stroke survivors suggests that assessments incorporating attentional demands of real-world walking may be useful additions to clinical practice.

Relationship Between Dual-Task Gait Speed and Walking Activity Poststroke.

BACKGROUND AND PURPOSE: Gait speed does not adequately predict whether stroke survivors will be active in the community. This may be because traditional single-task gait speed does not sufficiently reproduce the demands of walking in the real world. This study assessed whether dual-task gait speed accounts for variance in daily ambulatory activity above what can be predicted with habitual (single task) gait speed in community-dwelling stroke survivors. METHODS: Twenty-eight community-dwelling individuals, 58.2 years of age (SD=16.6), 8.9 months poststroke (interquartile range, 3.7-19.4), completed a gait and cognitive task in single- and dual-task conditions. Daily ambulatory activity was captured using a physical activity monitor. A regression analysis examined R2 changes with single- and dual-task gait speed. RESULTS: Single-task gait speed explained 15.3% of the variance in daily ambulatory activity (P=0.04). Adding dual-task gait speed to the regression model increased the variance explained by an additional 20.6% (P=0.04). CONCLUSIONS: Gait speed assessed under attention-demanding conditions may improve explanation of variance in daily ambulatory activity after stroke.

The role of movement errors in modifying spatiotemporal gait asymmetry post stroke: a randomized controlled trial.

OBJECTIVE: Current rehabilitation to improve gait symmetry following stroke is based on one of two competing motor learning strategies: minimizing or augmenting symmetry errors. We sought to determine which of those motor learning strategies best improves overground spatiotemporal gait symmetry. DESIGN: Randomized controlled trial. SETTING: Rehabilitation research lab. SUBJECTS: In all, 47 participants (59 ± 12 years old) with chronic hemiparesis post stroke and spatiotemporal gait asymmetry were randomized to error augmentation, error minimization, or conventional treadmill training (control) groups. INTERVENTIONS: To augment or minimize asymmetry on a step-by-step basis, we developed a responsive, "closed-loop" control system, using a split-belt instrumented treadmill that continuously adjusted the difference in belt speeds to be proportional to the patient's current asymmetry. MAIN MEASURES: Overground spatiotemporal asymmetries and gait speeds were collected prior to and following 18 training sessions. RESULTS: Step length asymmetry reduced after training, but stance time did not. There was no group × time interaction. Gait speed improved after training, but was not affected by type of asymmetry, or group. Of those who trained to modify step length asymmetry, there was a moderately strong linear relationship between the change in step length asymmetry and the change in gait speed. CONCLUSION: Augmenting errors was not superior to minimizing errors or providing only verbal feedback during conventional treadmill walking. Therefore, the use of verbal feedback to target spatiotemporal asymmetry, which was common to all participants, appears to be sufficient to reduce step length asymmetry. Alterations in stance time asymmetry were not elicited in any group.

Preventing falls in assisted living: Results of a quality improvement pilot study.

Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP). Resident posture and gait improved, likely due to exercise and/or physical therapy. Effective falls prevention QI programs can be implemented in AL, and are advised to (1) establish and maintain a falls team to create a culture focused on the reduction of falls risk; (2) teach staff to assess residents using the Morse Falls Scale to increase their awareness of residents' falls risk and improvement; and (3) modify existing exercise programs to address balance and lower body strength.

Effects of Physical Exercise Interventions on Gait-Related Dual-Task Interference in Older Adults: A Systematic Review and Meta-Analysis.

Dual-task interference during walking can substantially limit mobility and increase the risk of falls among community-dwelling older adults. Previous systematic reviews examining intervention effects on dual-task gait and mobility have not assessed relative dual-task costs (DTC) or investigated whether there are differences in treatment-related changes based on the type of dual task or the type of control group. The purpose of this systematic review was to examine the effects of physical exercise interventions on dual-task performance during walking in older adults. A meta-analysis of randomized controlled trials (RCTs) compared treatment effects between physical exercise intervention and control groups on single- and dual-task gait speed and relative DTC on gait speed. A systematic search of the literature was conducted using the electronic databases PubMed, CINAHL, EMBASE, Web of Science, and PsycINFO searched up to September 19, 2014. Randomized, nonrandomized, and uncontrolled studies published in English and involving older adults were selected. Studies had to include a physical exercise intervention protocol and measure gait parameters during continuous, unobstructed walking in single- and dual-task conditions before and after the intervention. Of 614 abstracts, 21 studies met the inclusion criteria and were included in the systematic review. Fourteen RCTs were included in the meta-analysis. The mean difference between the intervention and control groups significantly favored the intervention for single-task gait speed (mean difference: 0.06 m/s, 95% CI: 0.03, 0.10, p < 0.001), dual-task gait speed (mean difference: 0.11 m/s, 95% CI 0.07, 0.15, p < 0.001), and DTC on gait speed (mean difference: 5.23%, 95% CI 1.40, 9.05, p = 0.007). Evidence from subgroup comparisons showed no difference in treatment-related changes between cognitive-motor and motor-motor dual tasks, or when interventions were compared to active or inactive controls. In summary, physical exercise interventions can improve dual-task walking in older adults primarily by increasing the speed at which individuals walk in dual-task conditions. Currently, evidence concerning whether physical exercise interventions reduce DTC or alter the self-selected dual-task strategy during unobstructed walking is greatly lacking, mainly due to the failure of studies to measure and report reciprocal dual-task effects on the non-gait task.

Association of self-efficacy and outcome expectations with physical activity in adults with arthritis.

Background and Purpose. The purpose of this study is to determine whether higher baseline levels of (a) self-efficacy for physical activity, (b) self-efficacy for arthritis self-management, and (c) outcome expectations for exercise are associated with higher physical activity levels following an exercise intervention for adults with arthritis. Methods. A secondary analysis of the intervention cohort (n = 130) within a randomized controlled trial of the People with Arthritis Can Exercise program was performed. Multiple linear regression evaluated the relationship between physical activity at a time point three months after the completion of an exercise intervention and three main explanatory variables. Results. After controlling for baseline physical activity, neither self-efficacy for arthritis self-management nor outcome expectations for exercise related to three-month physical activity levels. There was a relationship between three-month physical activity and self-efficacy for physical activity. Conclusions. Future research is needed to evaluate the ability of self-efficacy-enhancing programs to increase physical activity in adults with arthritis.

A structural equation model relating physical function, pain, impaired mobility (IM), and falls in older adults.

The current study used a structural equation model to investigate the interrelationships among physical function, pain, IM, and falls in 511 American older adults. The model included 11 measurement variables (tandem stance, single leg stance, 360° turn, chair stand, arm curl, sit and reach, back scratch, normative score of 6-min walk or 2-min step, timed up and go, pain, and fall) and four latent variables (balance, strength, flexibility, and IM). The final model with the combined sample demonstrated good fit with the participant data (χ(2)(31)=30.0, N=499, p=0.52; Goodness of Fit Index (GFI)=0.99). Balance had a significant and the largest effect on IM (standardized regression weights=-1.05, p<0.001). Strength, endurance, flexibility, and pain had small effects on IM (standardized regression weights<0.2). The findings suggest that balance and mobility testing should be a priority in fall screening and prevention programs.

"Dance Dance Revolution" Used by 7- and 8-Year-Olds to Boost Physical Activity: Is Coaching Necessary for Adherence to an Exercise Prescription?

OBJECTIVE: To increase opportunities for physical activity (PA) for children in children's homes, we used a "Dance Dance Revolution" (DDR) (Konami of America, Redwood City, CA) coaching protocol for 7- and 8-year-olds. SUBJECTS AND METHODS: We randomly assigned youth to either an Enhanced (coaching) or Basic (no coaching) group. A DDR prescription of 120 minutes/week was provided to 40 children. Motor learning principles guided the coaching protocol, provided by adult graduate students, which took place weekly during weeks 1-5. PA was measured with accelerometry, DDR logs, and Sony (New York, NY) Playstation(®)2 memory cards at baseline and at week 10. RESULTS: Total accelerometer-measured PA was not significantly different between the groups at baseline or week 10; however, vigorous PA increased significantly in both groups at week 10. DDR logs showed a large range from 0 to 660 minutes/week of dance time. Respective playing time for each week (1 and 10) averaged 149 and 64 minutes for the Basic group and 184 and 47 minutes for the Enhanced group. Coaching significantly increased DDR use patterns in this population of youngsters during weeks 1 through 5 (P<0.001). CONCLUSION: Adult coaching deserves further study to determine how to maintain high levels of participation in exergames for youth who live in an obesogenic environment.

Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants.

INTRODUCTION: Deficits after breast cancer treatment have been examined by comparing the surgically affected upper extremity to the unaffected extremity. It is not possible to know precisely if anti-cancer treatment such as radiation and chemotherapy had any effect on the unaffected arm. The purpose of this study was to compare ROM, strength, and shoulder function between breast cancer survivors and healthy, matched controls. METHODS: Shoulder pain and function was assessed using the Disabilities of the Arm Shoulder Hand (DASH) and the Pennsylvania Shoulder Score (PSS). Active and passive range of motion (ROM) for shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, internal rotation (IR) at 90° of abduction were measured on the affected side using a digital inclinometer. Strength was measured using a hand held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, internal rotation, ER, scaption, and horizontal adduction. RESULTS: Significant differences were found between the two groups for the DASH (p < 0.001) and PSS (p < 0.001), active flexion (p < 0.001), 90° ER (p = 0.020), extension (p = 0.004) and passive flexion (p < 0.001) and 90° ER (p = 0.012). All 7 of the shoulder girdle strength measures were significantly different between groups for abduction and upward rotation (p = 0.006), depression and adduction (p = 0.001), flexion (p < 0.001), ER (p = 0.004), IR (p = 0.001), scaption (p < 0.001), and adduction (p < 0.001). DISCUSSION/CONCLUSIONS: These results provide preliminary evidence to suggest clinicians focus on these particular ROM, strength, and shoulder function measures when treating a breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Shoulder ROM, strength, and function are important to assess in BCS.

Walking in old age and development of metabolic syndrome: the health, aging, and body composition study.

BACKGROUND: The specific health benefits of meeting physical activity guidelines are unclear in older adults. We examined the association between meeting, not meeting, or change in status of meeting physical activity guidelines through walking and the 5-year incidence of metabolic syndrome in older adults. METHODS: A total of 1,863 Health, Aging, and Body Composition (Health ABC) Study participants aged 70-79 were followed for 5 years (1997-1998 to 2002-2003). Four walking groups were created based on self-report during years 1 and 6: Sustained low (Year 1, <150 min/week, and year 6, <150 min/week), decreased (year 1, >150 min/week, and year 6, <150 min/week), increased (year 1, <150 min/week, and year 6, >150 min/week), and sustained high (year 1, >150 min/week, and year 6, >150 min/week). Based on the Adult Treatment Panel III (ATP III) panel guidelines, the metabolic syndrome criterion was having three of five factors: Large waist circumference, elevated blood pressure, triglycerides, blood glucose, and low high-density lipoprotein (HDL) levels. RESULTS: Compared to the sustained low group, the sustained high group had a 39% reduction in odds of incident metabolic syndrome [adjusted odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.40-0.93], and a significantly lower likelihood of developing the number of metabolic syndrome risk factors that the sustained low group developed over 5 years (beta = -0.16, P = 0.04). CONCLUSIONS: Meeting or exceeding the physical activity guidelines via walking significantly reduced the odds of incident metabolic syndrome and onset of new metabolic syndrome components in older adults. This protective association was found only in individuals who sustained high levels of walking for physical activity.

Head and shoulder posture affect scapular mechanics and muscle activity in overhead tasks.

Forward head and rounded shoulder posture (FHRSP) is theorized to contribute to alterations in scapular kinematics and muscle activity leading to the development of shoulder pain. However, reported differences in scapular kinematics and muscle activity in those with forward head and rounded shoulder posture are confounded by the presence of shoulder pain. Therefore, the purpose of this study was to compare scapular kinematics and muscle activity in individuals free from shoulder pain, with and without FHRSP. Eighty volunteers were classified as having FHRSP or ideal posture. Scapular kinematics were collected concurrently with muscle activity from the upper and lower trapezius as well as the serratus anterior muscles during a loaded flexion and overhead reaching task using an electromagnetic tracking system and surface electromyography. Separate mixed model analyses of variance were used to compare three-dimensional scapular kinematics and muscle activity during the ascending phases of both tasks. Individuals with FHRSP displayed significantly greater scapular internal rotation with less serratus anterior activity, during both tasks as well as greater scapular upward rotation, anterior tilting during the flexion task when compared with the ideal posture group. These results provide support for the clinical hypothesis that FHRSP impacts shoulder mechanics independent of shoulder pain.

The effect of an exercise-based balance intervention on physical and cognitive performance for older adults: a pilot study.

BACKGROUND: Several exercise-based falls prevention interventions produced significant long-term reductions in fall rate, but few demonstrate long-term improvements in falls risk factors. A strong body of evidence supports a protective effect of aerobic or strength-training exercise on cognition. Individuals participating in an exercise-based balance improvement program may also experience this protective effect. This may contribute to the decreased rate of falls reported in the literature. PURPOSE: To determine if individuals participating in an evidence-based exercise program to reduce falls would demonstrate improvements in both physical and cognitive performance. METHODS: In this nonexperimental, pretest, posttest design study, 76 adults (65-93 years) participated in a scripted 12-week, 24 session exercise-based balance improvement program. Each 60 minute class incorporated balance, strength, endurance, and flexibility exercises. Participants completed baseline assessments of physical and cognitive performance measures 1 week prior and 1 week following the intervention. RESULTS: Fifty-two participants completed posttest measures. There were significant improvements in 3 physical performance measures (chair rise time, 360 degree turn, and 4 square step test). There also was similar improvement in the Symbol Digit Modality Test, a measure of processing speed and mental flexibility. When participants were dichotomized into 2 groups based on achieving/not achieving, a baseline walking speed of at least 1.0 meters/second, secondary analysis revealed greater improvements in cognitive performance measures of Trails A and Trails B tests by faster walkers compared to slower walkers. CONCLUSIONS: Participation in balance programs can have a positive impact on cognition and physical outcomes. This may provide insight about how exercise influences fall risk. Therapists can utilize this information clinically by educating patients about the potential positive effect of balance exercises on cognition.

Development of a clinical measure of dual-task performance in walking: reliability and preliminary validity of the Walking and Remembering Test.

OBJECTIVES: (1) To examine the reliability of a new clinical measure of simultaneous walking with performance of a working memory task, the Walking and Remembering Test (WART). (2) To compare older adult to younger adult WART performance to illustrate preliminary validity. SUBJECTS: Convenience sample of 25 young adults (ages 22-35) and 25 older adults (ages 65-86) performed the WART twice. METHODS: Subjects walked 6.1 meters at their fastest safe speed along a path requiring a narrowed base of support in both single and dual-task (with simultaneous digit span task) conditions. Reductions in walking and cognitive performance were examined in the dual-task condition for older adults as compared to younger adults. MAIN OUTCOME MEASURES: Walking time, step accuracy, digit span memory accuracy, and dual-task costs for walking and cognitive tasks. RESULTS: Inter-rater reliability ICC (2,1) values were > or = .97 for walking time and digit span accuracy. Rater agreement of steps off the path was excellent (93%) for young adults and good (76%) for older adults. Test-retest reliability ICC (2,1) values for walking time were > or = .79. Older adults were slower and remembered shorter digit spans, and demonstrated greater dual-task costs for digit span accuracy and steps off the path than younger adults, but relative dual-task costs for walking time were not significantly different between groups. CONCLUSIONS: The WART is a reliable clinical measure of dual-task memory and walking that can be administered safely with community-dwelling older adults. Expected greater dual-task costs for older adults were observed, but not as strongly as anticipated in this group of very active subjects. The WART provides information that may be useful in targeting patients for intervention to reduce risk of falls in dual-task conditions, but needs validation with older adults across a greater range of walking ability.