High density muscle size and muscle power are associated with both gait and sit-to-stand kinematic parameters in frail nonagenarians.

Frailty is an important concept in clinical and demographic research in the elderly because of its incidence level and its relationship with adverse outcomes. Functional ability declines with advanced age, likely due to changes in muscle function. This study aimed to examine the relationship between muscle quality and muscle power with kinematics from functional tests in a population of 21 institutionalized frail nonagenarian (91.3 ± 3.1 years). Here, muscle quality was measured by segmenting areas of high- and low-density fibers with computerized tomography. In addition, muscle strength and muscle power were obtained through maximal strength and power tests using resistance exercises. Finally, functional capacity outcomes (i.e., balance, gait velocity and sit-to-stand ability), as well as kinematic parameters, were evaluated from a tri-axial sensor used during a battery of functional tests. Our results show that lower limb muscle quality, maximal strength and power output present statistically significant relationships with different kinematic parameters, especially during the sit-to-stand and gait tests (e.g. leg power and maximum power during sit-to-stand (r = 0.80) as well as quadriceps muscle mass and step asymmetry (r = -0,71). In particular, frail individuals with greater muscle quality needed less trunk range of motion to make the transition between sitting and standing, took less time to stand up, and exerted a major peak power of force. As a conclusion, a loss of muscle quality and power may lead to motor control impairments such as gait, sit-to-stand and balance that can be the cause of adverse events such as falls.

Quantifying physical functional trajectory in hospitalized older adults using body worn inertial sensors.

Acute medical illness requiring hospitalization usually is a critical event in the trajectory leading to disability in older adults. Functional decline frequently occurs during hospitalization, resulting in a loss of Independence in activities of daily living after discharge. The aim of the study was to assess the functional decline in different ADLs of hospitalized elderly patients in an Acute Care for Elderly (ACE) unit incorporating a body-worn inertial sensor and accompanying custom algorithms. 38 hospitalized older adults (age ≥ 75) were included. The patients completed different functional tasks, including a balance test, Gait Velocity Test (GVT), verbal and arithmetic dual-task gait, and a sit-to-stand ability test at admission and discharge. Movement-related parameters were acquired from a unique tri-axial inertial sensor unit. Maximal muscle strength and muscle power output endpoints were also assessed. The results indicated that significant improvements (p < 0.05) were found at discharge compared with the admission values for gait variability and spatiotemporal parameters in the 4- and 6-meter GVT. These significant gains were also obtained in the verbal GVT. In contrast, a significant reduction was found in the functional status measured with the Barthel Index scale. Regarding to the sit-to-stand ability, lower peak power was observed in the sit-to-stand phase of the task at discharge. In conclusion, inertial sensor unit and our custom, validated, algorithms represent a feasible tool for measuring and monitoring functional trajectory during hospitalization in older adults and they are sensitive to detect differences in movement pattern parameters in different ADLs such as walking and the ability to stand from a seated position.

Modeling of Noisy Acceleration Signals From Quasi-Periodic Movements for Drift-Free Position Estimation.

OBJECTIVE: We present a novel approach to drift-free position estimation from noisy acceleration signals, which often arise from quasi-periodic small-amplitude body movements. In contrast to the existing methods, this data-driven strategy is designed to properly describe time-variant harmonic structures in single-channel acceleration signals for low signal-to-noise ratios. METHODS: It comprises three processing steps: 1) short-time modeling of acceleration dynamics (instantaneous harmonic amplitudes and phases) in the analysis frame, 2) analytical integration that yields short-time position, and 3) overlap-add recombination for full-length position synthesis. RESULTS: The comparative results, obtained from the medio-lateral X-acceleration components from 30-s chair stand test recordings, suggest that the proposed method outperforms two state-of-the-art reference methods in terms of Euclidean error, root mean square error, correlation coefficient, and harmonic-to-noise ratio. CONCLUSION: A major benefit of the method is that acceleration signal components unrelated to movement are suppressed in the whole analysis bandwidth, which allows for position estimation completely free of low-frequency artifacts. SIGNIFICANCE: We believe that the method can be useful in frailty assessment in elderly population, as well as in clinical applications related to gait analysis in aging and rehabilitation.

Gait Velocity and Chair Sit-Stand-Sit Performance Improves Current Frailty-Status Identification.

Frailty is characterized by a loss of functionality and is expected to affect 9.9% of people aged 65 and over. Here, current frailty classification is compared with a collection of selected kinematic parameters. A total of 718 elderly subjects (319 males and 399 females; age: 75.4 ± 6.1 years), volunteered to participate in this study and were classified according to Fried's criteria. Both the 30-s chair stand test (CST) and the 3-m walking test were performed and a set of kinematic parameters were obtained from a single inertial unit. A decision tree analysis was used to: 1) identify the most relevant frailty-related parameters and 2) compare validity of this classification. We found that a selected set of parameters from the 30-s CST (i.e., range of movement, acceleration, and power) were better at identifying frailty status than both the actual outcome of the test (i.e., cycles' number) and the normally used criteria (i.e., gait speed). For the pre-frail status, AUC improves from 0.531 using the actual test outcome and 0.516 with gait speed to 0.938 with the kinematic parameters criteria. In practice, this could improve the presyndrome identification and perform the appropriate actions to postpone the progression into the frail status.

Dual Task Gait Performance in Frail Individuals with and without Mild Cognitive Impairment.

BACKGROUND: Several studies have stated that frailty is associated with cognitive impairment. Based on various studies, cognition impairment has been considered as a component of frailty. Other authors have shown that physical frailty is associated with low cognitive performance. Dual task gait tests are used as a strong predictor of falls in either dementia or frailty. Consequently, it is important to investigate dual task walking tests in elderly populations including control robust oldest old, frail oldest old with mild cognitive impairment (MCI) and frail oldest old without MCI. METHODS: Dual task walking tests were carried out to examine the association between frailty and cognitive impairment in a population with advanced age. Forty-one elderly men and women participated in this study. The subjects from control, frail with MCI and frail without MCI groups, completed the 5-meter walk test at their own gait velocity. Arithmetic and verbal dual task walking performance was also assessed. Kinematic data were acquired from a unique tri-axial inertial sensor. RESULTS: The spatiotemporal and frequency parameters related to gait disorders did not show any significant differences between frail with and without MCI groups. CONCLUSIONS: The evaluation of these parameters extracted from the acceleration signals led us to conclude that these results expand the knowledge regarding the common conditions in frailty and MCI and may highlight the idea that the impairment in walking performance does not depend of frailty and cognitive status.

Gait Variability Related to Muscle Quality and Muscle Power Output in Frail Nonagenarian Older Adults.

BACKGROUND: Frailty has become the center of attention of basic, clinical, and demographic research because of its incidence level and the gravity of adverse outcomes with age. Moreover, with advanced age, motor variability increases, particularly in gait. Muscle quality and muscle power seem to be closely associated with performance on functional tests in frail populations. Insight into the relationships among muscle power, muscle quality, and functional capacity could improve the quality of life in this population. In this study, the relationship between the quality of the muscle mass and muscle strength with gait performance in a frail population was examined. METHODS: Twenty-two institutionalized frail elderly individuals (93.1 ± 3.6) participated in this study. Muscle quality was measured by segmenting areas of high- and low-density fibers as observed in computed tomography images. The assessed functional outcomes were leg strength and power, velocity of gait, and kinematic gait parameters obtained from a tri-axial inertial sensor. FINDINGS: Our results showed that a greater number of high-density fibers, specifically those of the quadriceps femoris muscle, were associated with better gait performance in terms of step time variability, regularity, and symmetry. Additionally, gait variability was associated with muscle power. In contrast, no significant relationship was observed between gait velocity and either muscle quality or muscle power. INTERPRETATION: Gait pattern disorders could be explained by a deterioration of the lower limb muscles. It is known that an impaired gait is an important predictor of falls in older populations; thus, the loss of muscle quality and power could underlie the impairments in motor control and balance that lead to falls and adverse outcomes.

Do frailty and cognitive impairment affect dual-task cost during walking in the oldest old institutionalized patients?

The objective of this study was to investigate dual-task costs in several elderly populations, including robust oldest old, frail oldest old with MCI, frail oldest old without MCI, and frail elderly with dementia. Sixty-four elderly men and women categorized into frail without MCI (age 93.4 ± 3.2 years, n = 20), frail with MCI (age 92.4 ± 4.2 years, n = 13), robust (age 88.2 ± 4.1 years, n = 10), and patients with dementia (age 88.1 ± 5.1 years, n = 21). Five-meter gait ability and timed-up-and-go (TUG) tests with single and dual-task performance were assessed in the groups. Dual-task cost in both 5-m habitual gait velocity test and TUG test was calculated by the time differences between single and dual-task performance. The robust group exhibited better 5-m gait and TUG test performances in the single and dual-task conditions compared with the other three groups (P < 0.001), and the frail and frail + MCI groups exhibited better performances than the dementia group (P < 0.001). No significant differences were observed between the frail and frail + MCI groups. However, all groups exhibited lower gait velocities in the verbal and arithmetic task conditions, but the dual-task cost of the groups were similar. Robust individuals exhibited superior single and dual-task walking performances than the other three groups, and the frail and frail + MCI individuals exhibited performances that were superior to those of the patients with dementia. However, the dual-task costs, i.e., the changes in gait performance when elderly participants switch from a single to a dual task, were similar among all four of the investigated groups. Therefore, these results demonstrated that the magnitude of the impairment in gait pattern is independent of frailty and cognitive impairment status.

Biomechanical jumping differences among elite female handball players with and without previous anterior cruciate ligament reconstruction: a novel inertial sensor unit study.

Persistent biomechanical and jumping capacity alterations have been observed among female athletes who have sustained anterior cruciate ligament (ACL) injuries. The purpose of this study was to examine if biomechanical jumping differences persist among a cohort of elite female handball players with previous ACL reconstruction several years after return to top-level competition. In order to achieve this goal, a direct mechanics simplified analysis by using a single Inertial Sensor Unit (IU) was used. Twenty-one elite female (6 anterior cruciate ligament reconstructed and 15 uninjured control players) handball players were recruited and evaluated 6.0 ± 3.5 years after surgical anterior cruciate ligament reconstruction. Bilateral and unilateral vertical jumps were performed to evaluate the functional performance and a single inertial sensor unit was employed in order to collect 3D acceleration and 3D orientation data. Previously ACL-reconstructed analysed athletes demonstrated significant (p < 0.05) alterations in relation to the three-dimensional axis (X-Y-Z) supported accelerations and differing jump phase durations, including jumping performance values, in both bilateral and unilateral jumping manoeuvres several years after ACL reconstruction. Identification of the encountered deficits through the use of an IU devise could provide clinicians with a new reliable tool for movement analysis in a clinical setting.

Frailty assessment based on trunk kinematic parameters during walking.

BACKGROUND: Physical frailty has become the center of attention of basic, clinical and demographic research due to its incidence level and gravity of adverse outcomes with age. Frailty syndrome is estimated to affect 20 % of the population older than 75 years. Thus, one of the greatest current challenges in this field is to identify parameters that can discriminate between vulnerable and robust subjects. Gait analysis has been widely used to predict frailty. The aim of the present study was to investigate whether a collection of parameters extracted from the trunk acceleration signals could provide additional accurate information about frailty syndrome. METHODS: A total of 718 subjects from an elderly population (319 males, 399 females; age: 75.4 ± 6.1 years, mass: 71.8 ± 12.4 kg, height: 158 ± 6 cm) volunteered to participate in this study. The subjects completed a 3-m walk test at their own gait velocity. Kinematic data were acquired from a tri-axial inertial orientation tracker. FINDINGS: The spatio-temporal and frequency parameters measured in this study with an inertial sensor are related to gait disorders and showed significant differences among groups (frail, pre-frail and robust). A selection of those parameters improves frailty classification obtained to gait velocity, compared to classification model based on gait velocity solely. INTERPRETATION: Gait parameters simultaneously used with gait velocity are able to provide useful information for a more accurate frailty classification. Moreover, this technique could improve the early detection of pre-frail status, allowing clinicians to perform measurements outside of a laboratory environment with the potential to prescribe a treatment for reversing their physical decline.

Drift-free position estimation for periodic movements using inertial units.

Latest advances in microelectromechanical systems have made inertial units (IUs) a powerful tool for human motion analysis. However, difficulties in handling their output signals must be overcome. The purpose of this study was to develop the novel "PB-algorithm" based on polynomial data fitting, splines interpolation, and the wavelet transform, one after the other, to cancel drift disturbances in position estimation for periodic movements. High-accuracy position measurements from an optical system (Vicon Nexus 1.0) were used to validate the proposed method and comparison with another drift-correction algorithm was provided. Results indicate the accuracy with respect to the Vicon's reference signal (euclidean error lower than 54.62 × 10(-3) m and correlation coefficient higher than 0.968). A reduction of the root-mean-square error of 68.74% was obtained when the proposed two-step method was compared with a modified-band limited Fourier linear combiner. All methods were applied to data from the 30-s chair stand test, which is one of the most used clinical tests dealing with lower body strength assessment, falls prediction, and gait disorders in older adults. The relevance of this study is that after cancelling drift disturbances, and obtaining an accurate Z-position estimation, it is possible to evaluate the sit-to-stand and stand-to-sit transitions from the whole test.

Kinematic parameters to evaluate functional performance of sit-to-stand and stand-to-sit transitions using motion sensor devices: a systematic review.

Clinicians commonly use questionnaires and tests based on daily life activities to evaluate physical function. However, the outcomes are usually more qualitative than quantitative and subtle differences are not detectable. In this review, we aim to assess the role of body motion sensors in physical performance evaluation, especially for the sit-to-stand and stand-to-sit transitions. In total, 53 full papers and conference abstracts on related topics were included and 16 different parameters related to transition performance were identified as potentially meaningful to explain certain disabilities and impairments. Transition duration is the most used to evaluate chair-related tests in real clinical settings. High-fall-risk fallers and frail subjects presented longer and more variable transition duration. Other kinematic parameters have also been highlighted in the literature as potential means to detect age-related impairments. In particular, vertical linear velocity and trunk tilt range were able to differentiate between different frailty levels. Frequency domain measures such as spectral edge frequency were also higher for elderly fallers. Lastly, approximate entropy values were larger for subjects with Parkinson's disease and were significantly reduced after treatment. This information could help clinicians in their evaluations as well as in prescribing a physical fitness program to correct a specific deficit.

Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians.

This randomized controlled trial examined the effects of multicomponent training on muscle power output, muscle mass, and muscle tissue attenuation; the risk of falls; and functional outcomes in frail nonagenarians. Twenty-four elderly (91.9 ± 4.1 years old) were randomized into intervention or control group. The intervention group performed a twice-weekly, 12-week multicomponent exercise program composed of muscle power training (8-10 repetitions, 40-60 % of the one-repetition maximum) combined with balance and gait retraining. Strength and power tests were performed on the upper and lower limbs. Gait velocity was assessed using the 5-m habitual gait and the time-up-and-go (TUG) tests with and without dual-task performance. Balance was assessed using the FICSIT-4 tests. The ability to rise from a chair test was assessed, and data on the incidence and risk of falls were assessed using questionnaires. Functional status was assessed before measurements with the Barthel Index. Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography. The intervention group showed significantly improved TUG with single and dual tasks, rise from a chair and balance performance (P < 0.01), and a reduced incidence of falls. In addition, the intervention group showed enhanced muscle power and strength (P < 0.01). Moreover, there were significant increases in the total and high-density muscle cross-sectional area in the intervention group. The control group significantly reduced strength and functional outcomes. Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population.

An evaluation of the 30-s chair stand test in older adults: frailty detection based on kinematic parameters from a single inertial unit.

BACKGROUND: A growing interest in frailty syndrome exists because it is regarded as a major predictor of co-morbidities and mortality in older populations. Nevertheless, frailty assessment has been controversial, particularly when identifying this syndrome in a community setting. Performance tests such as the 30-second chair stand test (30-s CST) are a cornerstone for detecting early declines in functional independence. Additionally, recent advances in body-fixed sensors have enhanced the sensors' ability to automatically and accurately evaluate kinematic parameters related to a specific movement performance. The purpose of this study is to use this new technology to obtain kinematic parameters that can identify frailty in an aged population through the performance the 30-s CST. METHODS: Eighteen adults with a mean age of 54 years, as well as sixteen pre-frail and thirteen frail patients with mean ages of 78 and 85 years, respectively, performed the 30-s CST while their trunk movements were measured by a sensor-unit at vertebra L3. Sit-stand-sit cycles were determined using both acceleration and orientation information to detect failed attempts. Movement-related phases (i.e. impulse, stand-up, and sit-down) were differentiated based on seat off and seat on events. Finally, the kinematic parameters of the impulse, stand-up and sit-down phases were obtained to identify potential differences across the three frailty groups. RESULTS: For the stand-up and sit-down phases, velocity peaks and "modified impulse" parameters clearly differentiated subjects with different frailty levels (p < 0.001). The trunk orientation range during the impulse phase was also able to classify a subject according to his frail syndrome (p < 0.001). Furthermore, these parameters derived from the inertial units (IUs) are sensitive enough to detect frailty differences not registered by the number of completed cycles which is the standard test outcome. CONCLUSIONS: This study shows that IUs can enhance the information gained from tests currently used in clinical practice, such as the 30-s CST. Parameters such as velocity peaks, impulse, and orientation range are able to differentiate between adults and older populations with different frailty levels. This study indicates that early frailty detection could be possible in clinical environments, and the subsequent interventions to correct these disabilities could be prescribed before further degradation occurs.

Functional capacity, muscle fat infiltration, power output, and cognitive impairment in institutionalized frail oldest old.

This study examined the neuromuscular and functional performance differences between frail oldest old with and without mild cognitive impairment (MCI). In addition, the associations between functional capacities, muscle mass, strength, and power output of the leg muscles were also examined. Forty-three elderly men and women (91.9±4.1 years) were classified into three groups--the frail group, the frail with MCI group (frail+MCI), and the non-frail group. Strength tests were performed for upper and lower limbs. Functional tests included 5-meter habitual gait, timed up-and-go (TUG), dual task performance, balance, and rise from a chair ability. Incidence of falls was assessed using questionnaires. The thigh muscle mass and attenuation were assessed using computed tomography. There were no differences between the frail and frail+MCI groups for all the functional variables analyzed, except in the cognitive score of the TUG with verbal task, which frail showed greater performance than the frail+MCI group. Significant associations were observed between the functional performance, incidence of falls, muscle mass, strength, and power in the frail and frail+MCI groups (r=-0.73 to r=0.83, p<0.01 to p<0.05). These results suggest that the frail oldest old with and without MCI have similar functional and neuromuscular outcomes. Furthermore, the functional outcomes and incidences of falls are associated with muscle mass, strength, and power in the frail elderly population.

Automatic evaluation of the 30-s chair stand test using inertial/magnetic-based technology in an older prefrail population.

The aim of this study was to evaluate the inertial measures of the 30-s chair stand test using modern body-fixed motion sensors. Polynomial data fitting was used to correct the drift effect in the position estimation. Thereafter, the three most important test cycles phases ("impulse," "stand up," and "sit down") were characterized and automatically analyzed. Automated test control is provided, making it possible for researchers without engineering knowledge to run the test. A collection of meaningful data based on kinematic variables is selected for further research. The proposed methodology for data analysis is a feasible tool for use in clinical settings. This method may not only improve rehabilitation therapies but also identify people at risk for falls more accurately than simply evaluating the number of cycles.