Which obstacle attributes place additional demands on higher-level cognitive function in patients with Parkinson's disease?

BACKGROUND: Previous reports show that patients with Parkinson's disease (PD) rely on prefrontal activation to compensate for impaired motor function during complex activities such as obstacle negotiation. However, the influence of the properties of the obstacles on prefrontal activation has not been systematically evaluated. Here, we examined the effects of obstacle height and anticipation time on prefrontal activation in patients with PD and older adults. METHODS: 34 patients with PD (age: 67.4 ± 5.7 years; 14 women) and 26 older adults (age: 71.3 ± 8.9 years; 11 women) walked in an obstacle course while negotiating anticipated and unanticipated obstacles (long/short available time response, ART) at heights of 50 mm and 100 mm. Prefrontal activation was measured using functional Near-Infrared Spectroscopy (fNIRS); obstacle negotiation performance was measured using Kinect cameras. RESULTS: PD patients showed greater increases in prefrontal activation during and after obstacle crossing compared to the older adults (p < 0.001). Obstacle height affected prefrontal activity only when crossing anticipated obstacles (ARTxheight interaction, p = 0.011), in which case higher obstacles were accompanied by higher prefrontal activity. PD patients showed higher levels of activation during unanticipated obstacles, compared to older adults (groupXART: p = 0.015). Different correlations between prefrontal activation and obstacle negotiation strategies were observed in patients and controls. CONCLUSIONS: These results point to the use of prefrontal activation as a compensatory mechanism in PD. Moreover, the higher activation observed when negotiating more challenging obstacles suggests that there is greater reliance on cognitive resources in these demanding situations that may contribute to the higher risk of falls in PD patients.

Age-associated changes in obstacle negotiation strategies: Does size and timing matter?

INTRODUCTION: Tripping over an obstacle is one of the most common causes of falls among older adults. However, the effects of aging, obstacle height and anticipation time on negotiation strategies have not been systematically evaluated. METHODS: Twenty older adults (ages: 77.7±3.4years; 50% women) and twenty young adults (age: 29.3±3.8years; 50% women) walked through an obstacle course while negotiating anticipated and unanticipated obstacles at heights of 25mm and 75mm. Kinect cameras captured the: (1) distance of the subject's trailing foot before the obstacles, (2) distance of the leading foot after the obstacles, (3) clearance of the leading foot above the obstacles, and (4) clearance of the trailing foot above the obstacles. Linear-mix models assessed changes between groups and conditions. RESULTS: Older adults placed their leading foot closer to the obstacle after landing, compared to young adults (p<0.001). This pattern was enhanced in high obstacles (group*height interaction, p=0.033). Older adults had lower clearance over the obstacles, compared to young adults (p=0.007). This was more pronounced during unanticipated obstacles (group*ART interaction, p=0.003). The distance of the leading foot and clearance of the trailing foot after the obstacles were correlated with motor, cognitive, and functional abilities. CONCLUSIONS: These findings suggest that there are age-related changes in obstacle crossing strategies that are dependent on the specific characteristics of the obstacle. The results have important implications for clinical practice, suggesting that functional exercise should include obstacle negotiation training with variable practice of height and available response times. Further studies are needed to better understand the effects of motor and cognitive abilities.

Application of the voluntary step execution test to identify elderly fallers.

OBJECTIVES: To assess the use of the Voluntary Step Execution Test to identify fallers. DESIGN: Cross-sectional retrospective. SETTING: Two self-care, residential facilities. PARTICIPANTS: a total of 100 healthy old volunteers (mean age = 78.4 +/- 5.7). MEASUREMENTS: The study investigated the use of the Voluntary Step Execution Test to identify fallers under single and dual-task conditions. Berg Balance Test (BBS) and Timed Get Up and Go (TUG) were used to assess balance and gait function. RESULTS: There were no significant differences found between fallers and non-fallers in BBS and TUG (50.5 +/- 4.6 versus 52.5 +/- 3.4 and 9.4 +/- 3.4 versus 7.98 +/- 2.3 respectively). There were no statistically significant differences between non-fallers and fallers across all step execution parameters under the single-task condition. However, adding cognitive load to the Voluntary Step Execution Test revealed statistically significant increases in duration of the preparatory phase, swing time and the time to foot-contact (P = 0.035;P = 0.033 and P = 0.037, respectively). Based on the coefficients of the logistic regression model participants with dual-task step execution times of > or =1,100 ms had five times the risk of falling than participants with execution times of <1,100 ms. CONCLUSIONS: The study provides evidence that a simple, safe measure of step execution under dual-task conditions can identify elderly individuals at risk for falls.

Impact of flow path length and flow rate on phosphorus loss in simulated overland flow from a humic gleysol grassland soil.

In this overland flow simulation experiment, the relationships between flow path length, flow rate and the concentration of different P fractions were investigated. Overland flow was simulated using a 3 mx0.12 m laboratory flume. To remove the impact of rainfall on P lost in overland flow, simulated rainfall was not used during these experiments. Instead overland flow was generated by pumping water into the flume at the surface of the grass sod. The experimental setup allowed for the variation in flow path length and flow rate between and during experimental runs. The results demonstrated that an increase in flow path length caused an increase in Total Dissolved P (TDP), Dissolved Reactive P (DRP) and Total Reactive P (TRP) concentration in overland flow (p<0.01) while an increase in flow rate resulted in a decrease in the concentration of these P fractions in overland flow due to dilution (p<0.01). Total P (TP), Particulate P (PP) and Dissolved Organic P were not affected by the variables tested during this study. When flow path length was increased in conjunction with flow rate, there was an increase in TDP, DRP, and TRP concentrations despite the impact of greater dilution. The results indicate that variations in flow path length during a rainfall event may play a role in determining the concentration of dissolved P fractions in overland flow at field scale.

The impact of agricultural management practices on nutrient losses to water: data on the effects of soil drainage characteristics.

Against the background of increasing nutrient concentrations in Irish water bodies, this study set out to gain information on the potential of agricultural grassland to lose nutrients to water. Overland flow, flow from artificial subsurface drains and stream flow were gauged and sampled during heavy rainfall events. Dissolved reactive phosphorus (DRP), potassium (K), total ammonia (TA), and total oxidised nitrogen (TON) were measured in water samples. When the nutrient concentrations in water were examined in relation to the grassland management practices of the study catchments it emerged that soil P levels, the application of organic and inorganic fertilisers before heavy rainfall and the presence of grazing animals could all influence nutrient concentrations in surface and subsurface drainage water. Overall, the drainage characteristics of soil were found to have a considerable influence on the potential of land to lose nutrients to water.