Physical treatment (Hydrotherapy) by individuals with and without dementia. Aquatic exercising. Part 1.

It still today “not done”, aquatic exercising with people with an neurological disease and especially people with an form of dementia. Why not? Is it the amount of work to transport undress them and escort them in the water? Or is it the cost for all this work and the cost for the swimming pool? Or is there still an culture problem that elderly with or without an neurological disease cannot participate as others in an swimming pool? The interest of science in this kind of therapy is long standing on an low level. Mid years 50-60 of the foreign century all rehabilitation centre must have an swimming pool and often more than that. Even Nursing homes were built with an pool inside, but when the sciences has discovery other things as robotica with an higher amount of cost, the positive elements of exercising in water were lost and swimming pools were closed. The great performance of an J.MacMillan to train disable girls in an swimming pool according the rules of water was introduced in several countries but now this knowledge and especially the skills are decreasing, an pity. The content of people with an neurological disease and especially dementia that have learn to swim is increasing and the possibilities for an better live, better quality , by exercising is growing. From science there are more investigations that discover that exercising in water has great benefit and that this is better than exercising on land. Conclusion .The investment in training in water has an significant influence on the quality of people with neurological disease and also on people with dementia. The environment –water- makes movement normal, it push people to move and search for the best way to handle the up thrust. And it give an aerobe boost that is essential to decrease the speed of dementia, certainly when is combined with cognitive games. Furthermore is has all kinds of anaerobe elements that can use to increase the balance performance of this people. Therefore why we don’t do it !

Evaluation der Methoden und Effekte eines motorisch-kognitiven Dual-Task Trainings bei Menschen mit leichter bis mittelgradiger Demenz - eine randomisierte kontrollierte Studie

Derzeit existieren keine kausal wirksamen Therapieansätze, die eine Demenz heilen können. Aufgrund des geringen Wirkungsgrads medikamentöser Therapien, rücken nicht-pharmakologische Ansätze in den Fokus des Forschungsinteresses. Dabei zeigt sich insbesondere die körperliche Aktivität als vielversprechender Ansatz, um demenzspezifische Symptome positiv zu beeinflussen. Vor diesem Hintergrund war es ein erstes Ziel der vorliegenden Dissertationsarbeit, einen Überblick des aktuellen Forschungsstandes zum Einfluss körperlicher Aktivität und körperlichen Trainings auf Menschen mit Demenz zu erhalten, wobei die bisher wenig untersuchten Bereiche des psychischen Status (insbesondere Depressionen und Sturzangst) und der kognitive Status im Fokus standen. Schrift 1, in Form einer Übersichtsarbeit sowie Schrift 2 und 3, in Form von detail-lierten Buchbeiträgen, zeigen, dass Menschen mit Demenz in hohem Maße von körperlicher Aktivität profitieren können. Allerdings ist die Evidenzlage aufgrund der geringen Anzahl qualitativ hochwertiger randomisierter, kontrollierter Studien, die kausale Wirkmechanismen des Trainings auf Depressionen, Sturzangst und die kognitiven Leistungen nachweisen könnten, bei Menschen mit Demenz limitiert. Im Hinblick auf die Reduktion kognitiver Defizite stellen motorisch-kognitive Trainingsansätze eine vielversprechende Interventionsstrategie zum Erhalt und Verbesserung der aufmerksamkeitsabhängigen Dual-Task Leistungen (Doppelaufgaben) dar, die bei einer Demenz bereits im frühen Stadium erhebliche Defizite aufweisen und direkte Auswirkungen auf die mobilitätsabhängige Selbstständigkeit haben. Übergeordnetes Thema der vorliegenden Arbeit war daher die Weiterentwicklung und Evaluierung eines demenzspezifischen, motorisch-kognitiven Trainingsansatzes bei Menschen mit leichter bis mittelgradiger Demenz, wobei der Schwerpunkt der Dissertation auf den motorisch-kognitiven Dual-Task Leistungen lag. Zur Überprüfung der motorisch-kognitiven Trainingsinhalte werden spezifische Assessmentverfahren benötigt. Auch wenn teilweise geeignete Testverfahren zur Erfassung dieser kombinierten motorischen und kognitiven Leistungen vorliegen, sind diese hinsichtlich ihrer psychometrischen Testgütekriterien nur unzureichend oder nicht für Menschen mit Demenz untersucht. Zudem bedarf es der Entwicklung neuartiger, motorisch-kognitiver Assessmentverfahren, um die Vielzahl motorisch-kognitiver Leistungen abbilden zu können. Vor diesem Hintergrund wurden im ersten Teilprojekt der vorliegenden Forschungsarbeit geeignete Assessmentverfahren für Menschen mit Demenz entwickelt und umfassend validiert, mit denen im zweiten Teilprojekt die Evaluation der Wirksamkeit der motorisch-kognitiven Trainingsbausteine erfolgte. Schrift 4 umfasst die Validierung unterschiedlicher motorisch-kognitiver Testverfahren zur Erfassung der Dual-Task Leistung bei Menschen mit Demenz. Die Ergebnisse bestätigen moderate bis exzellente psychometrische Eigenschaften für die konvergente und Konstruktvalidität, die Test-Retest Reliabilität, die Verän-derungssensitivität und die Durchführbarkeit. Die Validierungsergebnisse bestätigen damit die Eignung der Dual-Task Testverfahren für den Einsatz als diagnostisches oder deskriptives Instrument zur Quantifizierung motorisch-kognitiver Leistungen genauso wie für die Anwendung als Studienendpunkt bei Interventionsstudien bei Menschen mit Demenz. Schrift 5 umfasst die Evaluation der Transfer- und Langzeiteffekte des motorisch-kognitiven Dual-Task Trainings. Die Interventionsgruppe zeigte signifikante Verbesserungen der trainierten Dual-Task Leistungen (p ≤ 0.001-0.047; ηp2 = 0.044-0.249). Signifikante Transfereffekte zeigten sich teilweise unter den semi-trainierten Dual-Task Bedingungen (p ≤ 0.001-0.041; ηp2 = 0.049-0.150), aber nicht bei den komplett untrainierten Dual-Tasks. Nach einer 3-monatigen Follow-up Phase zeigten sich signifikant erhaltene Effekte für die meisten der Outcomes unter der trainierten Dual-Tasks Anforderung (p ≤ 0.001-0.038; ηp2 = 0.058-0.187), aber nicht für die semi-trainierte Dual-Task Leistung. Insgesamt nahm mit ansteigender Distanz zwischen der trainierten und der untrainierten Dual-Task Anforderung die Übertragbarkeit der Trainingseffekte ab. Schrift 6 stellt die Validierungsergebnisse einer innovativen, computergestützten Assessmentstrategie dar, die direkt in das Bewegungsspiel Physiomat® zur Erfassung trainingsbezogener, motorisch-kognitiver Leistungen integriert wurde. Das Physiomat®-Assessment zeigt gute bis exzellente Testgütekriterien (Konstruktvalidität, Test-Retest Reliabilität, Veränderungssensitivität und Durchführbarkeit) bei Menschen mit Demenz und erfasst die motorisch-kognitiven Leistungen direkt während des Spielverlaufs. Schrift 7 umfasst die Überprüfung der Effekte des computergestützten, Spiele-basierten Physiomat®-Trainings auf motorisch-kognitive Leistungen, den Transfer der Trainingseffekte auf untrainierte Aufgaben sowie die Nachhaltigkeit der Trainingszugewinne bei Menschen mit Demenz. Das Physiomat®-Training erzielte in fast allen Komplexitätsniveaus eine signifikant Steigerung der Schnelligkeit und Genauigkeit innerhalb der trainierten (p ≤ 0.001–0.047, ηp2 = 0.065–0.589) und der untrainierten (p < 0.001–0.005, ηp2 = 0.073–0.459) Physiomat®-Aufgaben sowie eine Zunahme an erfolgreich durchgeführten Aufgaben (p < 0.001, ηp2 = 0.184–0.211). Der Trainingszugewinn blieb zum Teil auch nach dem Follow-up erhalten. Schrift 8 stellt die Entwicklung eines Beobachtungsinstruments zur Erfassung qualitativer Aspekte eines kompensatorischen Sitzen-Stehen-Transfers unter Berücksichtigung motorischer und kognitiver Aspekte (Assessment of Compensatory Sit-to-Stand Maneuvers in People With Dementia [ACSID]) sowie seine Validierung dar. Die Ergebnisse weisen gute bis sehr gute psychometrische Eigenschaften (konkurrente Validität, Intra- und Interrater-Reliabilität, Veränderungssensitivität und Durchführbarkeit) auf und belegen dadurch die Eignung der Anwendbarkeit des ACSID bei Menschen mit Demenz im klinischen Kontext. Schrift 9 umfasst die Überprüfung, ob ein demenzspezifisches motorisches Lernprogramm Menschen mit Demenz befähigt, eine kompensatorische Sitzen-Stehen Transferstrategie (Sit-to-Stand[STS]) zu erlernen, die häufig in der geriatrischen Rehabilitation genutzt wird, um die STS Fähigkeit der Patienten zu verbessern. Für die methodische Bewertung des Bewegungsablaufs wurde der ACSID angewendet. Die Ergebnisse zeigen, dass sich die Interventionsgruppe in allen ACSID-Scores gegenüber der Kontrollgruppe signifikant verbesserte (p < 0.001). Die erlernten motorisch-kognitiven Fähigkeiten blieben auch während der Follow-up Phase für die meisten Outcomes erhalten. Die Ergebnisse der vorliegenden Forschungsarbeit sind hochrelevant für den Einsatz geeigneter Assessmentverfahren zur Quantifizierung alltagsrelevanter, motorisch-kognitiver Leistungen sowie für die Konzipierung von Interventionsmaßnahmen zur Verbesserung motorisch-kognitiver Leistungen bei Menschen mit Demenz. Die Resultate bekräftigen sowohl die Notwendigkeit als auch den Nutzen, motorisch-kognitive Testverfahren in das bestehende geriatrische Assessment aufzunehmen sowie bestehende Rehabilitationsansätze dahingehend zu prüfen, die Inhalte um den Baustein des motorisch-kognitiven Trainings zu erweitern

State of the art of audio- and video based solutions for AAL

Working Group 3. Audio- and Video-based AAL ApplicationsIt is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living (AAL) technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters (e.g., heart rate, respiratory rate). Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals (e.g., speech recordings). Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary 4 debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely (i) lifelogging and self-monitoring, (ii) remote monitoring of vital signs, (iii) emotional state recognition, (iv) food intake monitoring, activity and behaviour recognition, (v) activity and personal assistance, (vi) gesture recognition, (vii) fall detection and prevention, (viii) mobility assessment and frailty recognition, and (ix) cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed.publishedVersio

State of the Art of Audio- and Video-Based Solutions for AAL

It is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters. Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals. Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely lifelogging and self-monitoring, remote monitoring of vital signs, emotional state recognition, food intake monitoring, activity and behaviour recognition, activity and personal assistance, gesture recognition, fall detection and prevention, mobility assessment and frailty recognition, and cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed

Quality of life and physical outcomes following an exercise intervention in individuals with a traumatic brain injury : a pilot study

Traumatic brain injuries (TBI) are becoming one of the leading causes of long-term disability worldwide, with more than 200,000 people attending emergency departments in the UK each year following a head injury. This creates immense strain on the individual’s life as well as the healthcare system. The long-term symptoms associated with TBI include depression, anxiety, headaches, dizziness, personality changes, increased aggression, and nausea. These symptoms can lead to job losses, relationship breakdowns and even homelessness. Traumatic brain injuries cannot always be avoided so evidence-based guidelines for suitable and effective rehabilitation interventions are important. The overall aim of this thesis was to pilot an original, multi-component exercise intervention on the mental and physical outcomes in individuals following a TBI. Secondly it aimed to identify disparities in the current rehabilitation guidelines and propose future changes. Finally it intended to lay foundations for a future larger RCT to be conducted across the UK with the implementation of exercise programmes within the community. A systematic review of the literature on the effects of exercise on the quality of life (QOL) in individuals with a TBI can be found in Chapter 3. It found limited conclusive data on the best exercise modality to illicit significant QOL improvements. Therefore, this highlighted the gap in the research and the need for more robust RCTs within this area.Sixteen healthy adults (non-TBI) took part in the first empirical study (Chapter 5) investigating the effects of a 4-week multi-component exercise intervention on physical and health-related quality of life outcomes. The intervention consisted of circuit-based sessions 1x/week working on balance, strength, coordination, and dual-tasking with the second session per week involving aerobic, reaction time and agility exercises. The findings indicated significant improvements in sit-to-stand tests (p = 0.04, g = 0.34) and reaction time on the Fitlight Trainer (p = 0.00, g = 2.94) in the exercise group. This was also the case during the 15-minute cycling time-trial, where the exercise group demonstrated significant improvements in the total distance cycled and average power over the four weeks (p = 0.008, g = 0.24 and p = 0.00, g = 0.28, respectively). These results revealed the opportunity for physical improvements in a TBI population and justified the second empirical study (Chapter 6). The first part of this chapter looked at the TBI admissions into the Hull Royal Infirmary A&E department highlighting trends in patient and injury characteristics. In addition it demonstrated a wide range of potential participants and emphasised the rationale for an exercise rehabilitation programme. The findings from the audit informed the second part of this chapter, where seven participants (with a TBI) were recruited, with four individuals allocated into the novel exercise programme and three into the standard treatment (control) group. The exercise group attended two session a week for twelve weeks. Participants in the exercise group demonstrated significant improvements (decreased scores) in anxiety (p = 0.05) and depression (p = 0.04) compared to the control group as measured using the Hospital Anxiety and Depression Scale (HADS). Health-related QOL score as measured with the SF- 36 revealed significant improvements for role-limited physical (p = 0.02) and vitality domains (p = 0.03) as a result of the exercise intervention. Significant improvements were also recorded for total distance covered during the cycling time trials (p = 0.03), number of sit-to-stands in 30 seconds (p = 0.02), resting heart rate (p = 0.03), and maximum workload during the aerobic fitness test (p = 0.001). An isokinetic dynamometer was used to measure lower limb average power at two angular speeds (60 deg/sec and 180 deg/sec). The exercise group demonstrated significant improvements during both leg extension (p = 0.04) and flexion (p = 0.05) at 180 deg/sec. In the final study (Chapter 7), a qualitative approach was used to understand the main facilitators to exercise following TBI. These included motivation, gaining an understanding of recovery, and improving physical fitness. The barriers to exercise were also explored, such as lack of confidence/ motivation and cost.Overall this thesis demonstrated the potential benefits of a 12-week multi-component exercise intervention on QOL and physical well-being outcomes in a cohort of TBI individuals. It also identified disparities in the current TBI rehabilitation guidelines and proposed future recommendations for long-term support for TBI individuals

Proceedings of the 11th International Conference on Kinanthropology

The 11th International Conference on Kinantropology was held on the Nov 29 – Dec 1, 2017 in Brno and was organized by the Faculty of Sports Studies, Masaryk University and the Faculty of Kinesiology, University of Zagreb. This year was divided into several themes: sports medicine, sport and social science, sport training, healthy lifestyle and healthy ageing, sports management, analysis of human movement. Part of the conference was also a symposium Atletika and Ortoreha that gathered specialists in physiotherapy