Correlation Between Executive Function and Walk While Crossing Over an Obstacle Under Different Gait Phases.

Background and Purpose: Dual walking task such as crossing over an obstacle may serve as an excellent tool for predicting early cognitive decline. Thus, this study aimed to investigate correlation between walking while crossing over an obstacle and executive functions under different gait phases to validate the use of walking with an obstacle for predicting early cognitive decline. Methods: A cross-sectional study was conducted on 48 elderly individuals from 2 day-care centers and 3 welfare-centers in Seoul and Gyeonggi, Korea. Executive function tests (Trail Making Test, Stroop test) and dual walking tests (gait speed, cadence, stance time, gait cycle time) were performed and compared using partial correlation analysis. Results: There were significant correlations between executive function and most of the gait variables (stance time, cadence, and gait cycle time) (p<0.05) when crossing over an obstacle while walking. Especially, stance time exhibited significant correlations with most executive functions (p<0.05). Conclusions: When evaluating executive function during walking with an obstacle, post-obstacle-crossing phase and stance time need to be observed.

Concurrent Validity of Dual-Task Walking Speed With CERAD-NP Assessment Battery in Community-Dwelling Older Adults.

Objective: To explore the concurrent validity of the dual-task walking speed assessments in older adults using the Consortium to Establish a Registry for Alzheimer's Disease Neuro-Psychological (CERAD-NP) Assessment Battery. Design: Cross-sectional design. Setting: Welfare care centers, Senior complex centers, and Dementia prevention care centers. Participants: A total of 163 community-dwelling older adults (N=163) were recruited using consecutive sampling. Participants were composed of 65 older adults with cognitive decline and 98 without cognitive decline. Interventions: Not applicable. Main Outcome Measures: This study assessed the concurrent validity between dual-task walking speed assessments and the Total II score of CERAD-NP using Spearman's rank order correlations. The effect of the dual-task walking speed assessments on the Total II score was further investigated through multiple linear regression analysis. Results: There was a moderate and statically significant association between the Total II score and all 8 dual-task walking speed assessments (P<.05). The Total II score was strongly associated with the dual tasks of walking on a straight path while counting backward and crossing over an obstacle (r=0.698, r=0.697, respectively; P<.05). According to multiple linear regression, only the dual task of walking while counting backward was significantly associated with the Total II score (P<.05). Conclusion: The dual-task walking speed assessments, which involved walking and performing a secondary task such as counting backward or crossing an obstacle on a straight path, were highly indicative of cognitive decline. The combination of results from both tasks may provide a more comprehensive evaluation of cognitive decline compared with relying solely on a single-task assessment.

Effects of curved path walking compared to straight path walking in older adults with cognitive deficits: A systematic review and network meta-analysis.

OBJECTIVE: To determine whether the existing literature provides evidence that curved path walking time can be a reliable marker of cognitive impairment among older adults using a network meta-analysis (NMA). DATA SOURCES: PubMed, Web of Science, ScienceDirect, Scopus, and Korean Studies Information Service System (KSISS) electronic databases were searched in December 2019. STUDY SELECTION: Studies that included the following variables were selected: (P): patients with cognitive impairment, (I): straight path versus curved path walking, (C): control group without cognitive impairment, (O): walking time, and (S): cross-sectional or longitudinal study design. In total, 21 studies were selected for the NMA, which was performed to compare the standardized mean difference (SMD) of walking time on curved and straight paths. RESULTS: Older adults with dementia had significantly longer walking times than older adults with mild cognitive impairment (MCI) for both straight path walking and curved path walking. The SMD of straight path walking time was 0.59 (95% credible interval [CrI]: 0.39, 0.81) for older adults with MCI and 0.90 (95% CrI: 0.65, 1.16) for older adults with dementia. The SMD of walking time on a curved path was 0.52 (95% CrI: -0.22, 1.26) for older adults with MCI and 1.98 (95% CrI: 1.20, 2.92) for those with dementia. In older adults with dementia, the correlation coefficient of the Fisher's z value was higher for curved path walking than for straight path walking. CONCLUSION: The way people with dementia walk exhibits signs of cognitive impairments. NMA confirmed that older adults with dementia requires significantly longer time to walk the same distance than healthy controls or older adults with MCI for both curved and straight path walking.

Gait characteristics during crossing over obstacle in patients with glaucoma using insole foot pressure.

BACKGROUND: Glaucoma, is the most common cause of irreversible visual deficits, presents as an injury to the optic nerve and it is mainly associated with elevated intraocular pressure. The main symptom of glaucoma is a reduction of the visual field, which is usually a source of complaint at the advanced stage of disease. Because of visual deficit, gait dysfunctions, including low gait speed and increased bumping into objects, postural sway, and falling are occurred. Many studies have used stopwatch or motion-sensing devices to report on gait function following glaucoma. However, there are few reports on gait dysfunction assessed by examining foot pressure. This study investigated gait ability following glaucoma according to different gait conditions by assessing foot pressure. METHODS: Thirty older adults (15 in the sex- and age-matched normal group and 15 in the glaucoma group) were recruited for this study. All participants were walked under 2 different gait conditions in an F-scan system and the subject' assessments were randomly assigned to rule out the order effect. Conditions included: gait over an obstacle in a straight 6 m path, gait in a straight path without an obstacle in the 6 m path. Gait variables included cadence, gait cycle, stance time, center of force (COF) deviation, and COF excursion. About 10 minutes were taken for gait evaluation. RESULTS: When walking without an obstacle on a 6 m path, there were significant differences between the 2 groups in gait speed, cadence, gait cycle, and stance time (P < .05). There were significant differences when walking with an obstacle on a 6 m path (P < .05). Two-way analysis of variance showed significant effects associated with "glaucoma" not gait condition on all outcomes except for COF deviation and excursion. Also, there was no the interaction effect between "glaucoma" and "gait condition." CONCLUSION: We demonstrated that glaucoma patients selected the gait strategy such as lower gait function in both gait conditions particularly, slower gait speed and cadence and longer gait cycle and stance time, as determined by examining foot pressure. We believe that our results could help to improve the quality of life of patients with glaucoma.

Concurrent validity of the Groningen Meander Walking and Timed Up and Go tests in older adults with dementia.

Background and Purpose: The Groningen Meander Walking time (GMW-sec) test has not been clinically validated as a feasible assessment to test functional mobility skills. The purpose of this study was to determine the concurrent validity of the GMW-sec test with the Timed Up and Go (TUG) test in older adults with dementia. Methods: This study included a cross-sectional and between subjects design with one factor, which had three different levels of group. Consecutive sampling was used to recruit 145 elderly participants in dementia and senior care facilities. Participants were divided into three groups based on the result of a Mini-Mental Status Exam for Dementia Screening: 57 older adults with dementia, 25 older adults with mild cognitive impairment, and 63 healthy older adults. Results: Spearman rank order correlation showed that the TUG test had moderate association with the GMW-sec test not only in older adults with dementia (r = 0.69; p < 0.01), but also for the mild cognitive group (r = 0.63; p = 0.01) and healthy group (r = 0.47; p < 0.01). Older adults with dementia had a significant functional reduction for both GMW-sec and TUG tests compared to other two groups (p < 0.01). Discussion and Conclusion: Turning motions with the TUG test may cause similar challenges that relate to a curved walking path for the GMW-sec test in older adults with dementia. Both the TUG and GMW-sec tests could be effective approaches for screening the severity of cognitive impairment on functional mobility in people with dementia.

The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. METHODS: Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were "cerebrovascular accident (CVA)," "stroke", and "virtual reality". Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. RESULTS: The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. CONCLUSION: The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.

Comparison of the Effectiveness of Whole Body Vibration in Stroke Patients: A Meta-Analysis.

OBJECTIVES: The goals of this study were to assess the effectiveness of WBV (whole body vibration) training through an analysis of effect sizes, identify advantages of WBV training, and suggest other effective treatment methods. METHODS: Four databases, namely, EMBASE, PubMed, EBSCO, and Web of Science, were used to collect articles on vibration. Keywords such as "vibration" and "stroke" were used in the search for published articles. Consequently, eleven studies were selected in the second screening using meta-analyses. RESULTS: The total effect size of patients with dementia in the studies was 0.25, which was small. The effect size of spasticity was the greatest at 1.24 (high), followed by metabolism at 0.99 (high), balance, muscle strength, gait, and circulation in the decreasing order of effect size. CONCLUSIONS: The effect sizes for muscle strength and balance and gait function, all of which play an important role in performance of daily activities, were small. In contrast, effect sizes for bone metabolism and spasticity were moderate. This suggests that WBV training may provide a safe, alternative treatment method for improving the symptoms of stroke in patients.

The Korean version of relative and absolute reliability of gait and balance assessment tools for patients with dementia in day care center and nursing home.

[Purpose] This study was aimed to determine the relative and absolute reliability of Korean version tools of the Berg Balance Scale (BBS), the Timed Up and Go (TUG), the Four-Meter Walking Test (4MWT) and the Groningen Meander Walking Test (GMWT) in patients with dementia. [Subjects and Methods] A total of 53 patients with dementia were tested on TUG, BBS, 4MWT and GMWT with a prospective cohort methodological design. Intra-class Correlation Coefficients (ICCs) to assess relative reliability and the standard error of measurement (SEM), minimal detectable change (MDC95) and its percentage (MDC%) to analyze the absolute reliability were calculated. [Results] Inter-rater reliability (ICC(2,3)) of TUG, BBS and GMWT was 0.99 and that of 4MWT was 0.82. Inter-rater reliability was high for TUG, BBS and GMWT, with low SEM, MDC95, and MDC%. Inter-rater reliability was low for 4MWT, with high SEM, MDC95, and MDC%. Test-retest (ICC(2,3)) of TUG, BBS and GMWT was 0.96-0.99 and Test-retest (ICC(2,3)) of 4MWT was 0.85. The test-retest was high for TUG, BBS and GMWT, with low SEM, MDC95, and MDC%, but it was low for 4MWT, with high SEM, MDC95, and MDC%. [Conclusion] The relative reliability was high for all the assessment tools. The absolute reliability has a reasonable level of stability except the 4MWT.

Effects of Physical Activity Programs on the Improvement of Dementia Symptom: A Meta-Analysis.

Objective. To confirm that physical activity program improves the symptoms of dementia and the most effective physical activity was selected to help establish exercise programs. Methods. Three databases, PubMed, Science Direct, and Willey online, were used to collect articles. The databases were published between January 2005 and December 2015. Keywords such as "dementia," and "physical activity" were used in searching for papers. As a result, nine studies were selected in the second screening of the meta-analyses. Results. The improvement in the dementia symptom of physical capacity was 1.05 (high effect size, 95% CI: 0.03 to 0.73), ability of activity of daily living was 0.73 (slightly high effect size, 95% CI: 0.23 to 1.23), cognitive function was 0.46 (medium effect size, 95% CI: 0.26 to 0.66), and psychological state was 0.39 (lower than the medium effect size, 95% CI: 0.01 to 0.77). Conclusion. The physical activity for patients with dementia had an effect on the improvement of physical capacity and combined exercise was the most effective physical activity.

Correlation between Trunk Posture and Neck Reposition Sense among Subjects with Forward Head Neck Postures.

OBJECTIVE: To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP). METHODS: In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA) test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation and calculated the root mean square error in trials for each subject. Spearman's rank correlation coefficients and regression analysis were used to assess the degree of correlation between the trunk posture and HRA value, and a significance level of α = 0.05 was considered. RESULTS: There were significant correlations between the HRA value of right side neck flexion and pelvic side tilt angle (p < 0.05). If pelvic side tilting angle increases by 1 degree, right side neck flexion increased by 0.76 degrees (p = 0.026). However, there were no significant correlations between other neck motions and trunk postures. CONCLUSION: Verifying pelvic postures should be prioritized when movement is limited due to the vitiation of the proprioceptive sense of neck caused by FHP.

Effects of Nordic walking on physical functions and depression in frail people aged 70†years and above.

[Purpose] This study investigated the effects of Nordic walking on physical functions and depression in frail people aged 70 years and above. [Subjects] Twenty frail elderly individuals ≥70 years old were assigned to either a Nordic walking group (n=8) or general exercise group (n=10). [Methods] The duration of intervention was equal in both groups (3 sessions/week for 12 weeks, 60 min/session). Physical function (balance, upper extremity strength, lower extremity strength, weakness) and depression were examined before and after the interventions. [Results] With the exception of upper extremity muscle strength, lower extremity strength, weakness, balance, and depression after Nordic walking demonstrated statistically significant improvement. However, in the general exercise group, only balance demonstrated a statistically significant improvement after the intervention. There were significant differences in the changes in lower extremity muscle strength, weakness and depression between the groups. [Conclusion] In conclusion, Nordic walking was more effective than general exercise. Therefore, we suggest that Nordic walking may be an attractive option for significant functional improvement in frail people over 70 years old.

Effects of the active release technique on pain and range of motion of patients with chronic neck pain.

[Purpose] To compare the influences of the active release technique (ART) and joint mobilization (JM) on the visual analog scale (VAS) pain score, pressure pain threshold (PPT), and neck range of motion (ROM) of patients with chronic neck pain. [Subjects] Twenty-four individuals with chronic neck pain were randomly and equally assigned to 3 groups: an ART group, a joint mobilization (JM) group, and a control group. Before and after the intervention, the degree of pain, PPT, and ROM of the neck were measured using a VAS, algometer, and goniometer, respectively. [Results] The ART group and JM group demonstrated significant changes in VAS and ROM between pre and post-intervention, while no significant change was observed in the control group. Significant differences in the PPT of all muscles were found in the ART group, while significant differences in all muscles other than the trapezius were found in the JM group. No significant difference in PPT was observed in any muscle of the control group. The posthoc test indicated no statistically significant difference between the ART and JM group, but the differences of variation in VAS, PPT, and ROM were greater in the ART group than in the JM and control groups. [Conclusion] ART for the treatment of chronic neck pain may be beneficial for neck pain and movement.

The effectiveness of intensive mobilization techniques combined with capsular distension for adhesive capsulitis of the shoulder.

[Purpose] The aim of this study was to determine the synergistic effect of intensive mobilization techniques combined with capsular distension for patients with adhesive capsulitis (AC). [Subjects] The subjects were 53 patients with AC (mean age, 56.0 ± 7.6 years). [Methods] Patients were randomized to one of four treatment groups: intensive mobilization after one steroid injection with capsular distension (IMSID); intensive mobilization (IM); one steroid injection with capsular distension (SID); and general physical therapy only (GPT). The IMSID, IM, and SID groups also received general physical therapy for 20 minutes. All treatments were performed twice per week for 4 weeks. Patients were assessed using the Shoulder Pain and Disability Index (SPADI), Constant-Murley Shoulder Function Assessment Score (CS), Active Range of Motion (AROM), and Verbal Numeric Score (VNS). [Results] There were significant post-intervention differences in all the measured values in each of the groups, except for external rotation ROM in the SID group. The IMSID group showed the greatest differences among the groups. There were significant differences among the means of all the groups. [Conclusion] The most effective treatment for AC was the combination of the intensive mobilization and steroid injection with capsular distension, which helped to control inflammation, extend joint space, and recover ROM.

The effects of aerobic exercise and strengthening exercise on pain pressure thresholds.

[Purpose] We assessed the effects of aerobic exercise and strengthening exercise on pain pressure thresholds (PPTs) over time. [Subjects and Methods] Fifteen healthy participants were recruited and randomly divided into 3 groups: aerobic exercise, strengthening exercise, and control. The subjects in the aerobic group walked on a treadmill for 40 min at 6.5 km/h. The subjects in the strength group performed circuit training that included bench press, lat pull down, biceps curl, triceps extension, and shoulder press based on the perceived exertion for 40 min. The subjects in the control group rested without any exercise in a quiet room for 40 min. The PPTs of 5 potential muscle trigger points before exercise, and immediately after 10 and 40 min of exercise or rest were measured using an electronic algometer (JTECH Medical, USA). The Friedman's, Kruskal-Wallis, and Mann-Whitney tests were performed using SPSS 18.0 (IBM, Korea). [Results] The PPTs of all subjects decreased after 10 min of exercise, but the difference was not statistically significant. The PPTs of the control group decreased after 40 min. Furthermore, the PPTs of 3 muscles increased after 40 min of aerobic exercise and of 6 muscles after 40 min of strengthening exercise. No significant difference in PPTs was noted among the groups. [Conclusion] The results show that 40 min is a more appropriate exercise time, although the efficacy of controlling pain did not differ between strengthening exercise and aerobic exercise.

The Changes of COP and Foot Pressure after One Hour's Walking Wearing High-heeled and Flat Shoes.

[Purpose] This study aimed to determine the most appropriate height for shoe heels by measuring the displacement of the COP (center of pressure) and changes in the distribution of foot pressure after walking in flat (0.5 cm), middle-heeled (4 cm), and high-heeled (9 cm) shoes for 1 hour. [Methods] A single-subject design was used, with 15 healthy women wearing shoes with heels of each height in a random order. The foot pressure and displacement of COP before and after walking in an ordinary environment for 1 hour were measured using an FDM-S (zebris Medical GmbH, Germany). [Results] The distribution of foot pressure did not change significantly after walking in middle-heeled (4 cm) shoes but did change significantly after walking in either flat (0.5 cm) or high-heeled (9 cm) shoes. Similarly, the COP was not significantly displaced after walking in middle-heeled (4 cm) shoes but was significantly displaced after walking in either flat (0.5 cm) or high-heeled (9 cm) shoes. [Conclusion] Both flat and high-heeled shoes had adverse effects on the body. Middle-heeled (4 cm) shoes are preferable to both flat (0.5 cm) and high-heeled (9 cm) shoes for the health and comfort of the feet.

The Effect of Self-directed Exercise Using a Task Board on Pain and Function in the Upper Extremities of Stroke Patients.

[Purpose] We evaluated the effect of self-directed exercise using a task board on function and pain in the upper extremities of stroke patients [Subjects and Methods] We used the one group pre-post test design. Seven stroke patients who were selected based on the inclusion criteria participated in the program once a week for 10 weeks. The self-directed exercise comprised 5 stages that were divided according to the level of difficulty. The exercise was performed for 60 minutes using a special task board that we designed. The FMA (Fugl-Meyer Motor Assessment), VAS (Visual Analogue Scale), and speed of stacking were assessed to evaluate the amount of use of the affected arm at before and after intervention. [Results] The scores of the VAS and FMA, but not that of the speed of stacking cups, were improved. There was no significant correlation between the changes in VAS, FMA, and the speed of stacking cups. [Conclusion] The findings suggest that self-directed exercise with the task board could improve the levels of function and pain in the upper extremities. We suggest that self-directed exercise can be utilized as a clinical rehabilitation program and improve therapeutic effects.