Influence of lower limb isokinetic muscle strength and power on the occurrence of falls in community-dwelling older adults: A longitudinal study.

INTRODUCTION: Previous studies have highlighted the association between lower limb muscle strength and falls in older adults. However, a comprehensive understanding of the specific influence of each lower limb muscle group on fall occurrences remains lacking. OBJECTIVE: This study aimed to investigate the impact of knee, ankle, and hip muscle strength and power on falls in older adults, with the goal of identifying which muscle groups are more predictive of fall risk in this population. METHODS: This longitudinal observational study enrolled 94 community-dwelling older adults. Muscle strength and power of the ankle's plantiflexors and dorsiflexors, knee flexors and extensors, and hip flexors, extensors, adductors, and abductors were assessed using a Biodex System 4 Pro® isokinetic dynamometer. Fall occurrences were monitored through monthly telephone contact over a year. RESULTS: Participants, with a median age of 69 years (range 64-74), included 67% women, and 63.8% reported a sedentary lifestyle. Among them, 45,7% of older adults were classified as fallers. Comparative analyses revealed that non-fallers displayed significantly superior isokinetic muscle strength in the hip abductors and adductors, along with higher muscle power in the hip abductors, hip flexors, and knee flexors compared to fallers. Multivariate logistic regression analysis indicated that a 1 Nm/Kg increase in hip abductor strength reduced the chance of a fall by 86.3%, and a 1 Watt increase in hip flexor power reduced the chance of a fall by 3.6%. CONCLUSION: The findings indicate that hip abductor strength and hip flexor power can be considered protective factors against falls in independent older adults in the community. These findings may contribute to developing effective fall-prevention strategies for this population.

Prefrontal and Motor Planning Cortical Activity during Stepping Tasks Is Related to Task Complexity but Not Concern about Falling in Older People: A fNIRS Study.

This study investigated the effect of concern about falling on neural efficiency during stepping in older people. Community-dwellers aged >65 years were categorised as having low (n = 71) and high (n = 28) concerns about falling based on the Iconographical Falls Efficacy Scale (IconFES 10-item, scores <19 and ≥19, respectively). Participants performed a choice stepping reaction time test (CSRT), an inhibitory CSRT (iCSRT), and a Stroop stepping test (SST)) on a computerised step mat. Cortical activity was recorded using functional near-infrared spectroscopy. There were no significant differences in stepping response times or cortical activity in the dorsolateral prefrontal cortex (DLPFC), supplementary motor area (SMA), and premotor cortex (PMC) between those with and without concern about falling. However, stepping response times and cortical activity in the PFC, SMA, and PMC were significantly higher in the SST compared with the CSRT in the whole sample. PMC activity was also higher in the SST compared to the iCSRT. These findings demonstrate that cortical activity is higher in cognitively demanding stepping tasks that require selective attention and inhibition in healthy older people. The lack of association between concern about falling and neural efficiency during stepping in this older sample may reflect their only moderate scores on the IconFES.

Facilitating Access to Current, Evidence-Based Health Information for Non-English Speakers.

Scientific communication is crucial for the development of societies and the advancement of knowledge. However, many countries, and, consequently, their researchers, clinicians and community members, lack access to this information due to the information being disseminated in English rather than their native language. In this viewpoint, we aim to discuss the impacts of this problem and also outline recommendations for facilitating non-English speakers' access to current, evidence-based health information, thus extending the impact of science beyond academia. First, the authors discuss the barriers to accessing scientific health information for non-English speakers and highlight the negative impact of imposing English as a predominant language in academia. Next, the authors discuss the impacts of reduced access to clinical information for non-English speakers and how this reduced access impacts clinicians, clients, and health systems. Finally, the authors provide recommendations for enhancing access to scientific communication worldwide.

Effects of telehealth on functional capacity, mental health and quality of life among older people with dementia: LAPESI telehealth protocol for a randomized controlled trial.

BACKGROUND: Telehealth can be an alternative action at a distance that can help as a form of motor intervention, alleviating the deleterious effects arising from social distancing on functional capacity, mental health and quality of life among older people with dementia during the COVID-19 pandemic. PURPOSE: We aim to analyze the effects of a telehealth program on functional capacity, mental health and quality of life among older people with dementia and their caregivers. METHODS: seventy-eight individuals with mild and moderate dementia and their caregivers will answer an anamnesis and be evaluated through Clinical Dementia Assessment Score. They will also be evaluated by blinded examiners in terms of functional capacity (Activities of Daily Living Questionnaire and World Health Organization Disability Assessment Schedule 2.0), mental health (Mini-Mental State Examination, Clock Drawing Test, Verbal Fluency test and the Neuropsychiatric Inventor) and quality of life (Quality of Life in Alzheimer's Disease scale). Afterward, the volunteers will be randomized into the telehealth training group and the control group. The TR will perform systematic physical and cognitive exercises in 50-min sessions three times a week with professional monitoring, while the CG will receive non-systematized guidance, both for 12 weeks. Participants will be evaluated at baseline, immediately after the three-month interventions and with a 12-week follow- up. DISCUSSION: Technological approaches such as telehealth can be a viable alternative in home care service during times of pandemic. We expect that older people with dementia and their caregivers have high adherence to the telehealth program and improve their functional capacity, mental health and quality of life of older people with dementia. Telehealth is an alternative that can contribute to public policies and the development of effective intervention strategies that neutralize adverse outcomes. It can also be presented as an alternative to home care services, which could reduce demands for health resources.

Assessment of Force Production in Parkinson's Disease Subtypes.

Muscle weakness is a secondary motor symptom of Parkinson's disease (PD), especially in the subtype characterized by postural instability and gait difficulty (PIGD). Since the PIGD subtype also presents worse bradykinesia, we hypothesized that it also shows a decreased rate of force development, which is linked to an increased risk of falling in PD. Therefore, we investigated the effects of PD and PD subtypes on a force production profile and correlated the force production outcomes with clinical symptoms for each PD subtype. We assessed three groups of participants: 14 healthy older adults (OA), 10 people with PD composing the PIGD group, and 14 people with PD composing the tremor-dominant group. Three knee extension maximum voluntary isometric contractions were performed in a leg extension machine equipped with a load cell to assess the force production. The outcome measures were: peak force and rate of force development (RFD) at 50 ms (RFD50), 100 ms (RFD100), and 200 ms (RFD200). We observed lower peak force, RFD50, RFD100, and RFD200 in people with PD, regardless of subtypes, compared with the OA group (p < 0.05 for all comparisons). Together, our results indicated that PD affects the capacity to produce maximal and rapid force. Therefore, future interventions should consider rehabilitation programs for people with PD based on muscle power and fast-force production, and consequently reduce the likelihood of people with PD falling from balance-related events, such as from an unsuccessful attempt to avoid a tripping hazard or a poor and slower stepping response.

Impact of COVID-19 Pandemic on Life-Space Mobility of Older Adults Living in Brazil: REMOBILIZE Study.

Background: The COVID-19 pandemic hit Brazil in a scenario of substantial socioeconomic and health inequalities. It is unknown the immediate impact of social restriction recommendations (i.e., lockdown, stay-at-home) on the life-space mobility of older people. Objective: To investigate the immediate impact of COVID-19 pandemic on life-space mobility of community-dwelling Brazilian older adults and examine the social determinants of health associated with change in life-space mobility. Design: Baseline data from a prospective cohort study (REMOBILIZE Study). Setting: Community. Subject: A convenience snowball sample of participants aged 60 and older (n = 1,482) living in 22 states in Brazil. Methods: We conducted an online and phone survey using an adapted version of the Life-Space Assessment (LSA). Linear regression models were used to investigate social determinants of health on the change in LSA score. Results: Regardless of their gender and social determinants of health, participants showed a significant reduction in life-space mobility since COVID-19 pandemic outbreak. Life-space mobility reduction was higher among black individuals, those living alone and aged between 70 and 79. Other variables associated with change in life-space mobility, to a lesser extent, were sex, education and income. Conclusion: Social restriction measures due to pandemic caused substantial reduction in older adults' life-space mobility in Brazil. Social inequalities strongly affected vulnerable groups. Concerted actions should be put in place to overcome the deterioration in life-pace mobility amongst these groups. Failure in minimizing health inequalities amplified by the pandemic may jeopardize the desired achievements of the Decade of Healthy Aging.

Effect of different types of exercises on psychological and cognitive features in people with Parkinson's disease: A randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative and progressive disease marked by the presence of motor and non-motor symptoms, as psychological and cognitive impairment. Physical exercises have been prescribed as complementary therapy for PD, and the type of intervention and duration of the intervention should be taken into account. OBJECTIVE: We aimed to compare the effect of different exercise modalities (functional mobility, multimodal and cognitive) and length (4 and 8 months) on psychological and cognition in people with PD. This study followed the CONSORT extension for non-pharmacological trials. METHODS: In this randomized controlled trial, we assessed 107 participants between 2011 and 2013. At the end of 3 years, participants with PD (mild to moderate stages) who achieved the criteria were assessed considering 3 different groups of exercise: Multimodal (n=38), Functional Mobility (n=33) and Mental/Leisure (n=36). All 3 interventions were performed for 32 weeks, twice a week, with 60min for each session (64 sessions in total). Psychological and cognitive function were assessed at baseline and after 4 and 8 months. RESULTS: The Functional Mobility and Mental/Leisure training had a potential effect on maintaining cognitive function (executive function, attention and work memory). The Multimodal training did not show a benefit for cognitive features and was not even able to delay the progressive decline in cognitive functions; however, this modality had a positive effect on physical stress after 8 months of exercise. CONCLUSIONS: An intervention that requires high complexity and specific activities, such as locomotor and cognitive exercise, provides a maintenance effect against the degeneration in cognition associated with the progression of PD and thus can delay the progressive decline in cognitive function in PD.

RCVibro System: full description of a custom-made vibratory system and its reliability.

BACKGROUND: The use of local muscle vibration is a promising technique to improve motor performance in people with movement impairments. Majority of studies have failed to properly describe the used system and its reliability, making it difficult to transfer this promising technique to clinical practice. OBJECTIVE: To describe technical details of a custom-made vibratory system (RCVibro System), as well as to determine its reliability and functionality. METHODS: The vibration frequency and the electric potential difference/vibration frequency curve of six devices were assessed (at the same day and at different days), allowing us to determine the system reliability. In addition, the RCVibro System functionality was analyzed by the center-of-pressure behavior assessment during the tibialis anterior bilateral stimulation in fifteen young people. RESULTS: The RCVibro System showed a very-high reliability between assessments within the same day (ICC(2,6) ranging from 0.95 to 0.99; p<0.01) and between different days (ICC(2,6) ranging from 0.81 to 0.98; p<0.01). We also observed a forward center-of-pressure displacement (p<0.01) and an increase in the center-of-pressure velocity (p<0.01). CONCLUSION: We conclude that RCVibro System is a highly reliable system. The results demonstrate the potential usage of RCVibro System in clinical and research settings. Further investigation is needed in people with motor and neurological disorders.

Predictors of the functional reach test in people with parkinson's disease / Preditores do desempenho no teste de alcance funcional em pessoas com doença de parkinson

ABSTRACT Postural instability, a fundamental signal/symptom of Parkinson's disease (PD), is characterized by the association between postural alignment, joint range of motion, and muscular rigidity. The aim of the present study was to analyze the relationship between performance in the functional reach test (FRT) and associated factors such as joint range of motion and PD clinical features. Twenty-five people with PD in stages 1 and 1.5 of the Hoehn & Yahr scale participated in the study. The analyzed dependent variables were: FRT performance and scores in the items of clinical evaluation of the Unified Parkinson's Disease Rating Scale: pull-test, motor rigidity, and motor condition were used. The average distance in the FRT was 25.3 cm and the mean anterior-posterior displacement of the center of pressure was 2.69 cm. The ankle range of motion was associated with FRT performance, while postural stability was associated with the anterior-posterior displacement of the center of pressure during the FRT. We conclude that FRT performance in people with PD is determined by the individual level of balance and by the ankle joint amplitude and muscular rigidity and functional alterations due to aging are responsible for FRT performance.

RESUMO A instabilidade postural, um sinal/sintoma cardinal da doença de Parkinson (DP), é caracterizada pela associação entre alinhamento postural, amplitude de movimento e rigidez muscular. O objetivo foi analisar a relação entre o desempenho no teste de alcance funcional (TAF) e fatores relacionados a amplitude de movimento e aspectos clínicos da doença. Participaram 25 pessoas com DP nos estágios 1,0 e 1,5 da Hoehn e Yahr. As variáveis dependentes analisadas foram: desempenho no TAF e as pontuações nos itens da avaliação clínica da UnifiedParkinson'sDisease Rating Scale: teste de retropulsão, rigidez muscular e condição motora. A distância média no TAF foi de 25,3 cm e o deslocamento anteroposterior médio do centro de pressão foi de 2,69 cm. A amplitude de movimento articular do tornozelo está associada ao desempenho no TAF, enquanto a estabilidade postural está associada ao deslocamento anteroposterior do centro de pressão durante o TAF. Conclui-se que o desempenho no TAF em pessoas com DP é determinado pelo nível individual de equilíbrio e pela amplitude articular do tornozelo e a rigidez muscular e alterações funcionais do envelhecimento são responsáveis pelo desempenho no TAF.

PARKINSON'S DISEASE PATIENTS WITH DOMINANT HEMIBODY AFFECTED BY THE DISEASE RELY MORE ON VISION TO MAINTAIN UPRIGHT POSTURAL CONTROL.

This study assesses the association between disease onset side (dominant or non-dominant) and vision on postural control of Parkinson's disease patients. Patient volunteers composed two groups, according to the onset side affected: Dominant group (n=9; M age=66.1 yr., SD=7.2; 6 women, 3 men) and Non-dominant group (n=9; M age=67.4 yr., SD=6.4; 6 women, 3 men). The groups' postural control was assessed by posturography during quiet upright stance in two conditions, Eyes open and Eyes closed. Two-way analyses of variance (ANOVAs; group×condition) with repeated measures for the second factor assessed the differences associated with affected hemibody and vision on postural control. Analyses indicated that patients with the dominant side affected also presented significantly greater variation in center of pressure than those with the non-dominant side affected, mainly in the Eyes closed condition. The results demonstrate a higher reliance on vision in the dominant side, possibly to compensate somatosensory system impairments. These results also highlight the importance of analyzing the hemibody affected by the disease when postural control is assessed in this population.

Análise cinética e cinemática do levantar e andar em jovens e idosos / Kinetic and kinematic analysis of sit to walk task in young and elderly people / Análisis cinético y cinemático de la acción de levantarse y caminar en jóvenes y personas mayores

ResumoA tarefa de levantar e andar (LEA) é muito usada no dia a dia e há a necessidade de conhecer o comportamento de idosos nesse tipo de ação. Diante disso, o objetivo foi avaliar jovens (GJ) e idosos (GI) na tarefa de LEA. Foram realizadas avaliações cinéticas e cinemáticas e do desempenho da tarefa entre os grupos. Após a análise estatística, foi observada apenas diferença estatística para a variável de máxima força vertical durante a fase perda de contato com o assento ao término do levantar, assim como o tempo de desempenho dessa fase foi menor para o GJ. O envelhecimento causa um impacto significativo na força e contribui, assim, para um maior dispêndio de tempo ao levantar da cadeira. Com isso, maior atenção deve ser dada à fase de transição da LEA.

AbstractThe sit to walk (STW) is a task performed in daily life and is needed to know the older people behavior in this task. Therefore, the aim of this study was to evaluate young (YG) and older people (OG) when performing the STW. Kinetic, kinematic and task performance were assessed by each group. Statistical procedures showed differences only for vertical maximal ground reaction force during the seat off, such as the lower time to perform this phase for YG. The aging lead a significant impact in the strength force in limbs, due to this the elderly spend more time to rising up a chair. Therewith greater attention is necessary in transition phase, mainly by elderly exposure and increased chance of falls.

ResumenLa acción de levantarse y caminar (LYC) es muy frecuente en la vida diaria y es necesario saber cómo la realizan las personas mayores. Por tanto, el objetivo de este estudio ha sido evaluar a personas jóvenes (PJ) y personas mayores (PM) cuando realizan la acción de LYC. Se llevaron a cabo mediciones de tipo cinético, cinemático y del desempeño de esta acción en cada grupo. Los procedimientos estadísticos mostraron diferencias solo en la máxima fuerza vertical de reacción terrestre al levantarse del asiento, así como en el menor tiempo empleado por las PJ para llevar a cabo esta fase. El envejecimiento causa un impacto significativo en la fuerza de las extremidades y por ello las personas mayores necesitan más tiempo para levantarse de una silla. De esta manera, es necesario prestar mayor atención a la fase de transición de la acción de LYC.

Empeoramiento de la enfermedad de Parkinson y componentes de subtipo motor influencia la condición física / Agravo da doença de Parkinson e subtipo motor influencia componentes da capacidade física / Parkinson's disease severity and motor subtype influence physical capacity components

The severity of Parkinson's disease (PD) and PD's motor subtypes influence the components of physical capacity. The aim of this study was to investigate the impact of both PD severity and motor subtype in the performance of these components. Thirty-six PD patients were assigned into four groups: Tremor (TD) initial and TD mild, akinetic-rigid (AR) initial, and AR mild. Patients' strength, balance, coordination, mobility and aerobic capacity were evaluated and groups were compared using a two-way ANOVA (severity and subtype as factors). AR presents a poorer performance than TD in almost all tests. Also this performance was worsened with the advance of the disease in AR, contrary to TD. We conclude that AR and TD subgroups are different about their performance on physical capacity components, moreover, this performance worsens with the advance of the disease of the AR group, but not for TD.

A doença de Parkinson (DP) é caracterizada por diferentes subtipos motores e supõe-se que o desempenho dos componentes da capacidade física é influenciado por esses subtipos. O objetivo desse estudo foi investigar o impacto que a severidade e o subtipo da DP podem trazer sobre o desempenho dos componentes da capacidade física. Trinta e seis pacientes com DP foram distribuídos em quarto grupos: com dominância de tremor (TD) inicial e TD intermediário ou acinesia (AR) inicial e AR intermediário. A força, equilíbrio, coordenação, mobilidade e capacidade aeróbia foram avaliados. AR apresentou um pior desempenho que TD em nos testes. Esse desempenho foi pior com o aumento da severidade da doença em AR, mas não em TD. Conclui-se que os grupos AR e TD são diferentes em relação ao desempenho dos componentes da capacidade física, mas principalmente, esse desempenho piora com o avanço da doença em AR, mas não em TD.

La enfermedad de Parkinson (EP) se caracteriza por subtipos motor, y se supone que el rendimiento de los componentes físicos de capacidad es influenciada por aquellos subtipos. El objetivo de este estudio fue investigar el impacto tanto de la severidade y subtipo de la PD en el rendimiento de estos componentes. Treinta y seis pacientes con EP se distribuyeron en: Temblor (TD) inicial y TD suave, acinesia (AR) inicial y AR suave. Fuerza, equilibrio, coordinación, la movilidad y la capacidad aeróbica fueron evaluados. AR presenta un desempeño más pobre que TD en las pruebas. También este comportamiento se agravó con el avance de la enfermedad en AR, diferente que en TD. Como conclusión AR y TD son diferentes en respecto a su rendimiento en los componentes físicos de capacidad, pero sobre todo, esto empeora con el aumento de avance de la enfermedad en el grupo de AR, pero no en TD.