EFFECT OF THE SMARTSTEP\u3csup\u3eTM\u3c/sup\u3e STABILIZATION SYSTEM ON BALANCE IN OLDER ADULTS IN AN INDEPENDENT LIVING RESIDENCE

An increase in postural sway is one of the risk factors that have been linked to an increased incidence of falls in the older adult population. Researchers have shown that peripheral sensation is crucial in maintaining a static posture for adults of all ages. It has been reported that older adults have decreased tactile sensation of the plantar surface of their feet. and when the sensory feedback was increased older adults had improved postural control. It was hypothesized that facilitation of the sole of the foot with the use of a semirigid foot orthotic would result in improved postural stability in older adults. Twenty-seven volunteers (19 females, 8 males, mean age: 87 ± 5 yrs) were recruited as subjects from a retirement community. All subjects were supplied with the SmartStep™ Stabilization System. There were a total of 5 Test Days for each subject. The first 2 Test Days were performed while the subjects wore their own shoes, while the last 3 Test Days were performed while the subjects wore the SmartStep™. Test Days 1 and 2 were performed 48 hours apart. Test Day 3 occurred 2 to 4 weeks after Test 2. Test Days 4 and 5 occurred 4-weeks after the prior Test Day. During the 8-weeks between Test Days 3 and 5, subjects were asked to wear the SmartStep™ as their daily shoe. Clinical measures of balance, force plate measurements, sensation testing, and confidence and activity scales were collected on all subjects throughout the eight week test period. Statistical significance was found for 3 of the clinical measures. The Timed “Up & Go” improved from 17.25 to 15.47 sec. The Functional Reach and Lateral Reach Tests demonstrated a decline in scores during the eight weeks. There was only 1 statistically significant finding for the force plate measures. The center of pressure displacement in the anteriorposterior direction was increased from 4.6 to 5.3 cm. No significant differences where reported for any other dependent variable. The results did not indicate statistically that the in-shoe orthotic enhanced postural stability in this group of subjects. However, there were indications that there was a subset of the current population that benefited from the intervention and this needs to be investigated further

Fifteen years of wireless sensors for balance assessment in neurological disorders

Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer's disease, Parkinson's disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined

Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders

The aging population and the increased prevalence of neurological diseases have raised the issue of gait and balance disorders as a major public concern worldwide. Indeed, gait and balance disorders are responsible for a high healthcare and economic burden on society, thus, requiring new solutions to prevent harmful consequences. Recently, wearable sensors have provided new challenges and opportunities to address this issue through innovative diagnostic and therapeutic strategies. Accordingly, the book “Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders” collects the most up-to-date information about the objective evaluation of gait and balance disorders, by means of wearable biosensors, in patients with various types of neurological diseases, including Parkinson’s disease, multiple sclerosis, stroke, traumatic brain injury, and cerebellar ataxia. By adopting wearable technologies, the sixteen original research articles and reviews included in this book offer an updated overview of the most recent approaches for the objective evaluation of gait and balance disorders

Design and implementation of an exercise intervention focused on postural stability, and evaluation of its impact on gait pattern and functional fitness of the older population

Conceção e implementação de um programa de exercício físico com ênfase na estabilidade postural, e avaliação dos seus efeitos no padrão de marcha e funcionalidade duma população idosa O processo de envelhecimento conduz ao declínio da funcionalidade e contribui para a prevalência e aumento da incidência de quedas na população idosa. Este fator constitui-se como um importante problema de saúde pública, relevante para o atual contexto social Europeu. O exercício físico apresenta-se como um fator determinante na prevenção e redução de quedas na população idosa, através da melhoria das capacidades físicas e pela alteração do padrão de marcha, contribuindo para a adoção de estratégias de resposta às circunstâncias relacionadas com a ocorrência de quedas. Os objetivos do presente estudo focaram-se na conceção e avaliação dos efeitos de um programa de exercício de longa duração, centrado na estabilidade postural e na melhoria da eficiência mecânica da marcha que, por sua vez, possa contribuir para o aumento da funcionalidade e autonomia da pessoa idosa. Os objetivos específicos da presente tese foram: 1 - Desenvolver uma revisão narrativa de forma a analisar as evidências mais recentes sobre os seguintes tópicos: (1) importância da funcionalidade da marcha no processo de envelhecimento ativo; (2) que parâmetros biomecânicos da marcha podem ser utilizados como expressão de funcionalidade da população idosa; e (3) se as intervenções com atividade física têm um efeito positivo nos parâmetros biomecânicos da marcha; 2 - Desenvolver um protocolo de estudo de intervenção com base num programa de exercício para a comunidade, que objetive a melhoria dos parâmetros da marcha e da funcionalidade de uma população idosa; 3 - Desenvolver um estudo quasi-experimental de forma a avaliar os efeitos de uma intervenção periodizada com base num programa de exercício para a comunidade, na melhoria dos parâmetros da marcha e da funcionalidade de uma população idosa, por comparação a uma intervenção não-periodizada; Decorrente da revisão da literatura e construção de protocolo de intervenção, foi aplicada uma intervenção com base num programa de exercício físico. Foram utilizadas metodologias específicas de avaliação biomecânica do padrão de marcha, da ocorrência de quedas, do estado de saúde, e da aptidão funcional desta população. Destacamos a importância social da intervenção que se pretende implementar na comunidade.Design and implementation of an exercise intervention focused on postural stability, and evaluation of its impact on gait pattern and functional fitness of an older population. The aging process leads to a decline in functional fitness and hence the increased prevalence of falls in the elderly. This type of event constitutes an important public health issue, relevant in the current European social context. Exercise plays a key role in the prevention and reduction of falls by improving physical capabilities and the change in gait pattern, contributing to the adoption of strategies responsive to the circumstances underlying their occurrence. The aim of this research was to design and evaluate the effect of an exercise program, longterm, focused on postural stability and improving the mechanical efficiency of walking, which, in turn, is expected to contribute to an increased functionality and autonomy of the older population. Thus, the purposes of this thesis were: 1 - To conduct a review in order to investigate the available evidence on the following topics: (1) how important is gait ability in relation to the active aging process; (2) which gait parameters can be used as expression of functionality of older adults, and (3) whether physical activity interventions have a positive effect on gait parameters; 2 - To develop a study protocol regarding a community-based exercise intervention for gait and functional improvement in an older population; 3 - To develop a quasi-experimental study in order to analyze the effects of a community-based periodized exercise intervention on the improvement of gait parameters and functional fitness in an older adults’ population when compared with a non-periodized program. In line with the literature review, a study protocol was built, and an exercise intervention was performed. Specific biomechanical methodologies were used in assessing the gait pattern, fall occurrence, health status, and functional fitness in this population. We highlight the important social role of this community intervention

The Role of Movement Analysis in Diagnosing and Monitoring Neurodegenerative Conditions: Insights from Gait and Postural Control

Quantifying gait and postural control adds valuable information that aids in understanding neurological conditions where motor symptoms predominate and cause considerable functional impairment. Disease-specific clinical scales exist; however, they are often susceptible to subjectivity, and can lack sensitivity when identifying subtle gait and postural impairments in prodromal cohorts and longitudinally to document disease progression. Numerous devices are available to objectively quantify a range of measurement outcomes pertaining to gait and postural control; however, efforts are required to standardise and harmonise approaches that are specific to the neurological condition and clinical assessment. Tools are urgently needed that address a number of unmet needs in neurological practice. Namely, these include timely and accurate diagnosis; disease stratification; risk prediction; tracking disease progression; and decision making for intervention optimisation and maximising therapeutic response (such as medication selection, disease staging, and targeted support). Using some recent examples of research across a range of relevant neurological conditions—including Parkinson’s disease, ataxia, and dementia— we will illustrate evidence that supports progress against these unmet clinical needs. We summarise the novel ‘big data’ approaches that utilise data mining and machine learning techniques to improve disease classification and risk prediction, and conclude with recommendations for future direction

Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults

Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants€™ fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance

Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults

Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance

Fourth Baltic Conference in Exercise and Sport Sciences, April 7-9, 2011, Tartu, Estonia

Abstrac

Wearable inertial sensors for human movement analysis

Introduction: The present review aims to provide an overview of the most common uses of wearable inertial sensors in the field of clinical human movement analysis.Areas covered: Six main areas of application are analysed: gait analysis, stabilometry, instrumented clinical tests, upper body mobility assessment, daily-life activity monitoring and tremor assessment. Each area is analyzed both from a methodological and applicative point of view. The focus on the methodological approaches is meant to provide an idea of the computational complexity behind a variable/parameter/index of interest so that the reader is aware of the reliability of the approach. The focus on the application is meant to provide a practical guide for advising clinicians on how inertial sensors can help them in their clinical practice.Expert commentary: Less expensive and more easy to use than other systems used in human movement analysis, wearable sensors have evolved to the point that they can be considered ready for being part of routine clinical routine