Integrated cognitive and physical fitness training enhances attention abilities in older adults.

Preserving attention abilities is of great concern to older adults who are motivated to maintain their quality of life. Both cognitive and physical fitness interventions have been utilized in intervention studies to assess maintenance and enhancement of attention abilities in seniors, and a coupling of these approaches is a compelling strategy to buttress both cognitive and physical health in a time- and resource-effective manner. With this perspective, we created a closed-loop, motion-capture video game (Body-Brain Trainer: BBT) that adapts a player's cognitive and physical demands in an integrated approach, thus creating a personalized and cohesive experience across both domains. Older adults who engaged in two months of BBT improved on both physical fitness (measures of blood pressure and balance) and attention (behavioral and neural metrics of attention on a continuous performance task) outcome measures beyond that of an expectancy matched, active, placebo control group, with maintenance of improved attention performance evidenced 1 year later. Following training, the BBT group's improvement on the attention outcome measure exceeded performance levels attained by an untrained group of 20-year olds, and showed age-equilibration of a neural signature of attention shown to decline with age: midline frontal theta power. These findings highlight the potential benefits of an integrated, cognitive-physical, closed-loop training platform as a powerful tool for both cognitive and physical enhancement in older adults.

Identifying falls remotely in people with multiple sclerosis.

BACKGROUND: Falling is common in people with multiple sclerosis (MS) but tends to be under-ascertained and under-treated. OBJECTIVE: To evaluate fall risk in people with MS. METHODS: Ninety-four people with MS, able to walk > 2 min with or without an assistive device (Expanded Disability Status Scale (EDSS ≤ 6.5) were recruited. Clinic-based measures were recorded at baseline and 1 year. Patient-reported outcomes (PROs), including a fall survey and the MS Walking Scale (MSWS-12), were completed at baseline, 1.5, 3, 6, 9, and 12 months. Average daily step counts (STEPS) were recorded using a wrist-worn accelerometer. RESULTS: 50/94 participants (53.2%) reported falling at least once. Only 56% of participants who reported a fall on research questionnaires had medical-record documented falls. Fallers had greater disability [median EDSS 5.5 (IQR 4.0-6.0) versus 2.5 (IQR 1.5-4.0), p < 0.001], were more likely to have progressive MS (p = 0.003), and took fewer STEPS (mean difference - 1,979, p = 0.007) than Non-Fallers. Stepwise regression revealed MSWS-12 as a major predictor of future falls. CONCLUSIONS: Falling is common in people with MS, under-reported, and under-ascertained by neurologists in clinic. Multimodal fall screening in clinic and remotely may help improve patient care by identifying those at greatest risk, allowing for timely intervention and referral to specialized physical rehabilitation.

Method for assessing brain changes associated with gluteus maximus activation.

STUDY DESIGN: Reliability study. OBJECTIVES: To determine the feasibility and reliability of using transcranial magnetic stimulation (TMS) to assess corticomotor excitability (CE) of the gluteus maximus. BACKGROUND: Sport-specific skill training targeting greater utilization of the gluteus maximus has been proposed as a method to reduce the incidence of noncontact knee injuries. The use of TMS to assess changes in CE may help to determine training-induced central mechanisms associated with gluteus maximus activation. METHODS: Within- and between-day reliability was measured in 10 healthy adults. The CE was measured by stimulating the gluteus maximus ìhotspotî at 120% and 150% of motor threshold, while subjects performed a double-leg bridge. An intraclass correlation coefficient (model 2,1), standard error of measurement, and minimal detectable change were calculated to determine the within- and between-day reliability for the following TMS variables: peak-to-peak motor-evoked potential (MEP) amplitudes, cortical silent period, and MEP latency. RESULTS: It is feasible to measure the CE of the gluteus maximus with TMS. The intraclass correlation coefficients for all TMS outcome measures ranged from 0.73 to 0.97. The ranges of minimal detectable change, with respect to mean values for each TMS variable, were larger for MEP amplitude (304.7-585.4 µV) compared to those for cortical silent period duration (25.3-40.8 milliseconds) and MEP latency (1.1-2.1 milliseconds). CONCLUSION: The present study demonstrated a feasible method for using TMS to measure CE of the gluteus maximus. Small minimal detectable change values for the cortical silent period and MEP latency provide a reference for future studies.

Functional outcomes can vary by dose: learning-based sensorimotor training for patients stable poststroke.

OBJECTIVE: This study aimed to determine whether the dose of learning-based sensorimotor training (LBSMT) significantly enhances gains in upper limb function in patients stable post stroke. METHODS: A total of 45 subjects stable poststroke participated in a 6-8-week LBSMT program of varied dosage: group I (n = 18; 1x/week, 1.5 hours/visit); group II (n = 19, 3x/week, 0.75 hours/visit); and group III (n = 8; 4x/week, 3 hours/visit). All subjects reinforced their training with home-based practice. The primary outcome measures were functional independence, strength, sensory discrimination, and fine motor skills. RESULTS: Across all individual subjects, significant gains were measured on the 4 dependent variables (improvement ranging from 9.0% to 38.9%; P < .001). Group III made greater gains than groups I and II on functional independence, sensory discrimination, and fine motor skills, with a significant linear trend by dose for functional independence (P < .001). Only 2-3 subjects in groups I and II, respectively, would need to be treated at the high dosage of group III for one more subject to achieve >50% gain in functional independence. CONCLUSIONS: Learning-based sensorimotor training based on the principles of neuroplasticity was associated with improved function in patients stable poststroke. The gains were dose specific with the greatest change measured in subjects participating in the high-intensity treatment group.