Usual and dual-task gait adaptations under visual stimulation in older adults at different ages.

BACKGROUND: During the walk along the streets, older adults are exposed to various visual stimuli that can affect their gait in a harmful or beneficial way. AIMS: To evaluate gait strategies during different situations with and without visual stimulation in older adults to identify the influence of the visual stimulus on these gait parameters. METHODS: A total of 200 older adults were divided into 4 groups according to age range between 60 and 102 years. Gait was evaluated in the following situations: (1) habitual gait (HG); (2) gait with the visual stimulation (GVS) provided by a pedestrian traffic light, and (3) GVS associated with a cognitive task (GVS-C). The GAITRite Platinum equipment was used to assess gait variables. RESULTS: Comparison of GVS and HG revealed that the visual stimulus influences the gait parameters and promotes a gait speed increase. However, to increase their gait speed, older adults aged 60-89 years used strategies of increased step length and cadence, whereas subjects older than 90 years used only strategies of increased cadence. In addition, comparison of GVS and GVS-C revealed a decrease in gait speed in all age ranges when the cognitive task was added, although this reduction was more pronounced in subjects older than 70 years. CONCLUSION: Visual stimulus influences the gait parameters in older adults and the strategy used is different depending on their age, a fact that shows that traffic light may be an interesting strategy to improve the gait performance during physical therapy.

What is the best clinical assessment tool for identification of adults aged ≥80 years at high risk of falls?

OBJECTIVES: To assess the Balance Evaluation Systems Test (BESTest), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG) test and gait speed to determine which is the most appropriate test for identification of adults aged ≥80 years at higher risk of falls, and to investigate the clinical usefulness of the combination of such tests by cumulative post-test probability (PoTP) for predicting the risk of falls. DESIGN: Longitudinal prospective study. PARTICIPANTS: Ninety-eight older adults (aged 80-102 years). INTERVENTIONS: Older adults were submitted to the clinical tests and followed-up in order to record the occurrence of falls. The capacity of the clinical tests to detect which older adults are at higher risk of falls was measured using the receiver operating characteristic curve, followed by calculation of PoTP for predicting the risk of falls. RESULTS: The BESTest and the Mini-BESTest demonstrated the best PoTP for predicting the risk of falls for a positive test (70%), followed by the TUG test (66%) and gait speed (63%). When performed in combination, a positive result on the TUG test, gait speed and Mini-BESTest increased the probability of older adults falling within the next 6months from 50% to 89%; a negative result on these three tests decreased the probability of older adults falling within the next 6months from 50% to 3%. CONCLUSION: The combination of TUG test, gait speed and Mini-BESTest provided the best approach. If all three tests are positive, there is an 89% chance of identifying an older person at risk of falling. If all three tests are negative, there would only be a 3% chance of obtaining a false-negative result.

Use of the BESTest and the Mini-BESTest for Fall Risk Prediction in Community-Dwelling Older Adults Between 60 and 102 Years of Age.

BACKGROUND AND PURPOSE: Reference values for the Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) need to be established to predict falls in older adults during every stage of aging. The purpose of this study was to determine the cutoff scores for the BESTest and the Mini-BESTest for community-dwelling older adults in order to predict fall risk. METHODS: A total of 264 older adults, of both sexes, between the ages of 60 and 102 years, were divided into 4 groups according to age range. After evaluation, participants received telephone follow-up for 6 months to record the number of fall episodes. To define the reference values of the tests in relation to fall risk prediction, a receiver operating characteristic curve was drawn to identify the area under the curve and the sensitivity and specificity of the tests. Statistical analyses were done using SPSS (Version 16.0-SPSS Inc) with a significance level of 5% (P ≤ .05). RESULTS: The cutoff scores to identify older adults with fall risk according to the BESTest and the Mini-BESTest in the different age groups were 99 and 25 points, respectively, for people 60 to 69 years of age, 92 and 23 points for the age group of 70 to 79 years, 85 and 22 points for people 80 to 89 years of age, and 74 and 17 points for people 90 years of age or older. CONCLUSION: The BESTest and the Mini-BESTest are good tools for predicting fall risk in the 6 months following an initial evaluation in community-dwelling Brazilian older adults. The study also determined that cutoff values vary for different age groups.

The influence of aging on the spatial and temporal variables of gait during usual and fast speeds in older adults aged 60 to 102 years.

BACKGROUND: With increases in life expectancy, it is important to understand the influence of aging on gait, given that this activity is related to the independence of older adults and may help in the development of health strategies that encourage successful aging in all phases of this process. RESEARCH QUESTION: To compare gait parameters with usual and fast speeds for independent and autonomous older adults throughout the aging process (60 to 102 years old), and also to identify which of the gait variables are best for identifying differences across the different age groups. METHODS: Two hundred older adults aged between 60 and 102 years were evaluated. The sample was divided into 3 age groups: 60 to 79 years, 80 to 89 years and 90 years and over. The analyzed gait variables were: speed (meters/s), cadence (steps/min), stride time (seconds), step length (centimeters), double support (percentage of the gait cycle), swing (percentage of the gait cycle), step length variability (CoV%) and stride time variability (CoV%). RESULTS: Group comparison regarding usual gait and fast gait revealed a significant difference in all gait variables. In addition, it can be seen that variables such as gait speed and step length showed greater effect sizes in intergroup comparison (usual gait: 0.48 and 0.47; fast gait: 0.36 and 0.40; respectively), possibly showing that these variables can better detect the changes observed with increasing age. CONCLUSION: There are differences in the gait performance of older adults from different age groups for usual and fast gait speeds, which is more evident regarding gait speed and step length variables. We recommend the use of usual gait for the identification of the effects of aging because, besides showing a higher effect size values it is more comfortable and requires less effort from older subjects.

POSTURAL CONTROL ASSESSMENT IN PHYSICALLY ACTIVE AND SEDENTARY INDIVIDUALS WITH PARAPLEGIA.

OBJECTIVE: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . METHODS: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . RESULTS: The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . CONCLUSION: The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.

OBJETIVO: O objetivo deste estudo foi avaliar a independência funcional e o controle de tronco durante tarefas de alcance máximo em indivíduos com lesão medular, que foram divididos em grupo sedentário (SSI, n = 10) e grupo fisicamente ativo (PASI, n=10). MÉTODOS: Foi realizada anamnese, identificação do nível e tipo de lesão (de acordo com o protocolo da ASIA - American Spinal Injury Association), e aplicou-se o questionário de Medida de Independência Funcional (MIF). Para a tarefa de alcance anterior e lateral os indivíduos foram instruídos a fazer o alcance máximo. Para comparação das médias dos dados foram aplicados o teste t não pareado e teste de Mann-Whitney, e as diferenças foram consideradas significativas quando p < 0,05. RESULTADOS: O grupo PASI teve melhor desempenho na realização de atividades de autocuidado (PASI: 40,8 ± 0,42 pontos, SSI 38,0 ± 3,58 pontos, p = 0,01), controle de esfíncter (PASI: 10,5 ± 1,84 pontos, SSI 8,2 ± 3,04 pontos, p = 0,02), transferências (PASI: 20,7 ± 0,48 pontos, SSI 16,9 ± 4,27 pontos, p = 0,04) e MIF total (PASI: 104,0 ± 2,30 pontos, SSI 105,1 ± 8,56 pontos, p = 0,01). No alcance máximo, o grupo PASI teve maior alcance médio em todas as direções avaliadas (p < 0,05) . CONCLUSÃO: A prática de exercício físico contínuo aumentou a independência funcional motora e o controle de tronco em indivíduos com lesão medular completa. Nível de Evidência II, Estudo Prospectivo Comparativo.

Postural control assessment in physically active and sedentary individuals with paraplegia / Avaliação do controle postural em indivíduos com paraplegia fisicamente ativos e sedentários

ABSTRACT Objective: The aim of this study was to evaluate functional independence and trunk control during maximum-range tasks in individuals with spinal cord injuries, who were divided into sedentary (SSI, n=10) and physically active (PASI, n=10) groups . Methods: Anamnesis was conducted and level and type of injury were identified (according to the American Spinal Injury Association protocol, ASIA) and the Functional Independence Measure (FIM) questionnaire was applied. For the forward and lateral reach task, the subjects were instructed to reach as far as possible. Mean data were compared using the unpaired t test and Mann-Whitney test and differences were considered significant when p<0.05 . Results: The PASI group performed better in self-care activities (PASI: 40.8±0.42 points, SSI: 38.0±3.58 points, p=0.01), sphincter control (PASI: 10.5±1.84 points, SSI: 8.2±3.04 points, p=0.02), transfers (PASI: 20.7±0.48 points, SSI: 16.9±4.27 points, p=0.04), and total FIM score (PASI: 104.0±2.30 points, SSI 105.1±8.56 points, p=0.01). On the maximum reach task, the PASI group had a greater average range in all directions evaluated (p<0.05) . Conclusion: The continuous practice of exercise increased motor function independence and trunk control in individuals with complete spinal cord injury. Level of Evidence II, Prospective Comparative Study.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a independência funcional e o controle de tronco durante tarefas de alcance máximo em indivíduos com lesão medular, que foram divididos em grupo sedentário (SSI, n = 10) e grupo fisicamente ativo (PASI, n=10). Métodos: Foi realizada anamnese, identificação do nível e tipo de lesão (de acordo com o protocolo da ASIA - American Spinal Injury Association), e aplicou-se o questionário de Medida de Independência Funcional (MIF). Para a tarefa de alcance anterior e lateral os indivíduos foram instruídos a fazer o alcance máximo. Para comparação das médias dos dados foram aplicados o teste t não pareado e teste de Mann-Whitney, e as diferenças foram consideradas significativas quando p < 0,05. Resultados: O grupo PASI teve melhor desempenho na realização de atividades de autocuidado (PASI: 40,8 ± 0,42 pontos, SSI 38,0 ± 3,58 pontos, p = 0,01), controle de esfíncter (PASI: 10,5 ± 1,84 pontos, SSI 8,2 ± 3,04 pontos, p = 0,02), transferências (PASI: 20,7 ± 0,48 pontos, SSI 16,9 ± 4,27 pontos, p = 0,04) e MIF total (PASI: 104,0 ± 2,30 pontos, SSI 105,1 ± 8,56 pontos, p = 0,01). No alcance máximo, o grupo PASI teve maior alcance médio em todas as direções avaliadas (p < 0,05) . Conclusão: A prática de exercício físico contínuo aumentou a independência funcional motora e o controle de tronco em indivíduos com lesão medular completa. Nível de Evidência II, Estudo Prospectivo Comparativo.

The effects of a simultaneous cognitive or motor task on the kinematics of walking in older fallers and non-fallers.

Human gait has been widely investigated under dual-task conditions because it has been demonstrated to be an important way to uncover differences in gait biomechanics between older fallers and non-fallers. However, exactly how simultaneous tasks affect the kinematics of walking remains unclear. In the present study, gait kinematic properties of older fallers and non-fallers were compared under cognitive and motor dual-task conditions. The gait kinematic properties of interest were recorded under three different conditions: walking at preferred speed, walking when performing a cognitive task (naming animals), and walking when performing a motor task (transferring a coin from one pocket to the other). The following variables were analyzed: gait speed, cadence, stride time, step length, single support, stride time variability, and the dual-task cost. In addition, functional balance was evaluated by means of the Balance Evaluation - Systems Test (BESTest). Two-way repeated-measures ANOVAs revealed significant main effects of walking conditions. However, no significant main effects of group (fallers vs. non-fallers) and no significant interaction effects between group and walking condition were observed. The BESTest revealed that functional balance in fallers was worse than in non-fallers. The cognitive task leads to more significant changes in gait kinematics than does a motor task and the step length and stride time variability were variables more sensitive to that cognitive influence.