Biomechanical gait pattern changes associated with functional fitness levels and falls in the elderly

Doutoramento em Motricidade Humana na especialidade de BiomecânicaThis thesis aimed to provide a better understanding on the determinant factors for falling in Portuguese older adults, with a special emphasis on the biomechanical changes in gait patterns associated with the functional fitness decline in this population. Our methodological approach to this problem encompassed two different levels of analysis: in the first part two epidemiological studies were conducted in order to establish the determinant factors for falling within the Portuguese older adults; in the second part three laboratory-based studies were performed in order to determine the influence of functional fitness levels on elderly gait patterns. Falls were shown to result from the interaction of many risk factors. Within these, gender, functional fitness level and health parameters were found to be the strongest fall determinants. Interestingly, age was not a determinant factor for falling, even within very old individuals (≥75 years or ≥80 years). Therefore, in the subsequent studies, the gait patterns of a subgroup of older adults, who had participated in the epidemiological studies, were characterized according with their functional fitness levels. The results showed that older subjects with a lower functional fitness level score, consistently re-distribute lower limb joint moments while performing different locomotor tasks (walking, stair ascent and stair descent). Because the success of physical activity interventions aiming at falls and disability prevention is dependent on subgroup characterization, these biomechanical gait pattern changes may yield important information for the health and exercise professionals working with the elderly.RESUMO: A presente dissertação objetiva o aprofundamento do conhecimento sobre os determinantes das quedas na população idosa portuguesa, com especial enfoque nas alterações biomecânicas nos padrões de marcha associadas ao declínio funcional característico desta população. A abordagem metodológica preconizada para a análise do problema compreende duas fases complementares: uma primeira fase, que englobou dois estudos epidemiológicos com o objetivo de estabelecer os fatores determinantes de quedas na população idosa portuguesa; uma segunda fase, onde foram considerados três estudos experimentais (laboratoriais), com o propósito de determinar a influência de diferentes níveis de aptidão funcional nos padrões de marcha desta população. Os resultados demonstraram que as quedas resultam da interação de diversos fatores de risco, destacando-se os seguintes: género, parâmetros de aptidão funcional e de saúde. De relevar que o fenómeno de queda se revelou independente da idade, mesmo quando analisada a sua associação com os fatores determinantes em grupos etários mais avançados (≥75 e ≥80 anos). Neste sentido, nos estudos subsequentes, foram analisados os padrões de marcha de subgrupos de idosos recrutados do grupo de participantes dos estudos anteriores e estratificados em função do seu nível de aptidão funcional. Observou-se então que os idosos com baixos níveis de aptidão funcional adotavam estratégias consistentes de redistribuição dos momentos de força articulares dos membros inferiores, aquando da execução de diferentes tarefas locomotoras (marcha, subir e descer escadas). Considerando o sucesso demonstrado das intervenções sustentadas em programas de atividade física para a prevenção de quedas e incapacidade, as alterações biomecânicas dos padrões de marcha observadas poderão constituir um importante suporte informacional para os profissionais de saúde e exercício que trabalham com a população idosa.FCT - Fundação para a Ciência e a Tecnologi

Is the timed-up and go test feasible in mobile devices? A systematic review

The number of older adults is increasing worldwide, and it is expected that by 2050 over 2 billion individuals will be more than 60 years old. Older adults are exposed to numerous pathological problems such as Parkinson’s disease, amyotrophic lateral sclerosis, post-stroke, and orthopedic disturbances. Several physiotherapy methods that involve measurement of movements, such as the Timed-Up and Go test, can be done to support efficient and effective evaluation of pathological symptoms and promotion of health and well-being. In this systematic review, the authors aim to determine how the inertial sensors embedded in mobile devices are employed for the measurement of the different parameters involved in the Timed-Up and Go test. The main contribution of this paper consists of the identification of the different studies that utilize the sensors available in mobile devices for the measurement of the results of the Timed-Up and Go test. The results show that mobile devices embedded motion sensors can be used for these types of studies and the most commonly used sensors are the magnetometer, accelerometer, and gyroscope available in off-the-shelf smartphones. The features analyzed in this paper are categorized as quantitative, quantitative + statistic, dynamic balance, gait properties, state transitions, and raw statistics. These features utilize the accelerometer and gyroscope sensors and facilitate recognition of daily activities, accidents such as falling, some diseases, as well as the measurement of the subject's performance during the test execution.info:eu-repo/semantics/publishedVersio

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

A comprehensive review of health benefits of Qigong and Tai Chi

Objective. Research examining psychological and physiological benefits of Qigong and Tai Chi is growing rapidly. The many practices described as Qigong or Tai Chi have similar theoretical roots, proposed mechanisms of action, and expected benefits. Research trials and reviews, however, treat them as separate targets of examination. This review examines the evidence for achieving outcomes from randomized controlled trials (RCTs) of both. Data Sources. The key words Tai Chi, Taiji, Tai Chi Chuan, and Qigong were entered into electronic search engines for the Cumulative Index for Allied Health and Nursing (CINAHL), psychological literature (PsycINFO), PubMed, Cochrane database, and Google Scholar. Study Inclusion Criteria. RCTs reporting on the results of Qigong or Tai Chi interventions and published in peer-reviewed journals from 1993 to 2007. Data Extraction. Country, type and duration of activity, number/type of subjects, control conditions, and reported outcomes were recorded for each study. Synthesis. Outcomes related to Qigong and Tai Chi practice were identified and evaluated. Results. Seventy-seven articles met the inclusion criteria. The nine outcome category groupings that emerged were bone density (n = 4), cardiopulmonary effects (n = 19), physical function (n = 16), falls and related risk factors (n = 23), quality of life (n = 17), self-efficacy (n = 8), patient-reported outcomes (n = 13), psychological symptoms (n = 27), and immune function (n = 6). Conclusions. Research has demonstrated consistent, significant results for a number of health benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence of Qigong and Tai Chi

Movement Interventions for Children with Autism and Developmental Disabilities: An Evidence-Based Practice Project

This review explored the following question: Are the comprehensive treatment models Makoto Therapy, Brain Gym, and Interactive Metronome effective interventions for improving occupational performance including improving executive function, academic performance, and physical coordination in children and adolescents with Autism Spectrum Disorder (ASD)? Because current research on Interactive Metronome, Brain Gym®, and Makoto Therapy fails to address children and adolescents with autism spectrum disorder, presents multiple flaws in research design, and does not measure occupational outcomes such as occupational performance, we recommend that these interventions should not be used as comprehensive treatment models in occupational therapy. We recommend that more occupational-based, methodologically-sound research involving youth with ASD be conducted before implementing these interventions in occupational therapy practice

The Feasibility of Square-Stepping Exercise as a Universal Intervention for Older Adults with Chronic Disease to Improve Cognitive and Physical Function

Square-stepping exercise (SSE) is a cognitive training program with a physical component. An instructor demonstrates a stepping pattern across a gridded mat and participants are required to memorize and repeat the patterns on their own. In community-dwelling older adults, SSE has demonstrated some benefits on global cognitive functioning (GCF), balance, functional fitness, and social interaction. Aims: to investigate the feasibility and efficacy of SSE in varied populations and settings to improve mobility and cognition. Populations included older adults with: knee osteoarthritis (OA), type 2 diabetes mellitus (T2DM) and self-reported cognitive complaints (sCC), and those living in long-term care (LTC) and continuum care (CC) homes. Methods: We conducted 3 pilot randomized controlled trials ranging from 12- to 24-weeks of SSE. Feasibility was determined through recruitment and attendance. Participants were assessed on a host of cognitive, functional, and gait outcomes before and after SSE. Results: We found that SSE was not feasible in older adults with knee OA and results were inconclusive whether it effected mobility in this population. SSE demonstrated improvements in the planning domain in older adults with T2DM and sCC. However, attendance remained a challenge in this group due to high disease burden (i.e. appointments and illness), and therefore it was not feasible. In LTC and CC homes, SSE was not feasible because recruitment and attendance were low. However, we showed that adults living with dementia improved on mood and behaviour symptom scores. Conclusions: Square-stepping exercise is not a feasible program as implemented in this thesis and SSE showed limited benefit to cognitive and mobility outcomes. These pilot studies demonstrated the challenges of feasibility in adults with diverse cognitive and mobility impairments. Future studies should focus on addressing recruitment and adherence strategies for chronic disease populations

Can Virtual Reality Help Improve Motor and Cognitive Function in Active Aging in Older Adults? A Scoping Review

Background: Active aging is considered one of the most effective methods for a healthy aging process. There are numerous clinical practice guidelines that address this model and propose multiple strategies for its achievement through the improvement of motor and cognitive function. Virtual reality is emerging as a potential tool, with various modalities focused on promoting good health maintenance in older adults. The objectives of this review were to map the potential benefits of virtual reality for active aging and delve into adaptability and adherence in older individuals. Methods: A scoping review was conducted on studies published between 2013 and 2023 in English, Spanish, or Catalan, examining virtual reality interventions in older adults. The search was performed using the Medline, CINAHL, Scopus, and Web of Science databases. The methodological quality was assessed using CASPe and FLC 3.0 critical appraisal guidelines. The graphical data were reported narratively, grouping results based on the study characteristics and the impact of virtual reality. Results: The review process resulted in the inclusion of 22 articles out of the initial 459 following the application of the selection criteria. Most articles were randomized controlled trials (45.4%; n = 10), systematic reviews (40.9%; n = 9), observational studies (9%; n = 2), and pilot studies (4.5%; n = 1). The information was organized based on the virtual reality modality (immersive, non-immersive, and 360) and application area (motor, cognitive, and mental health). Conclusions: Virtual reality (both immersive and non-immersive) is a valuable tool for promoting physical exercise in older adults, helping to prevent recurrent accidental falls. It also yields positive results for cognitive stimulation in healthy older individuals, improving memory, depression, and mental health in those with cognitive impairment. Virtual reality is generally well-received by older adults, achieving high adherence rates