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

3D KINEMATICS OF GAIT PATTERN IN ACTIVE ELDERLY MEN

Gait is one of the most important means for the maintenance of an independent life and gait pattern (GP) seems to be associated with falls and, therefore, with the quality of life in the elderly. On the other side, exercise is associated with the maintenance of the physical function and quality of life. Therefore, the purpose of our study was to determine if moderate/vigorous exercise could retain GP with aging. The sample had two groups of subjects: one of five young males (21.8 (0.45) y) and the other of three old males (69.3 (8.4) y). Kinematics data were determined and compared between groups. No significant differences were found between the groups and therefore exercise practise seems to maintain GP trough aging. However, these results should be seen in a conservative way due to the small number of participants of this study

DYNAMICS OF GAIT IN ACTIVE ELDERLY MEN

The purpose of this study was to identify if, on very active elderly male, the undesirables effects of age in gait dynamic variables where minimized. The gait cycle of 3 healthy and active elderly males (ages: 69.30±1.41 years) and 5 health and active young males (ages: 21.80±0.45 years) was compared in order to verify if the differences (between young and older adults) usually reported in the literature were present. The following kinetics variables were studied: ground reaction force (vertical and anterior-posterior components), joint torques and joint power (ankle, knee and hip joints). The dynamic variables were collected using the inverse dynamics technique. The results show no significant differences between the two groups in ground reaction force, joint torques and joint power. Our results seem to indicate that elderly functional decline is minimized with exercise

RELATIVE JOINT MOMENT CONTRIBUTION TO THE POWER GENERATED IN A MARTIAL ARTS KICK – INFLUENCE OF SKILL LEVEL

The purpose of this study was to analyse whether athletes of different skill level present different relative joint moment contributions to the power generated in a martial arts kick. This investigation was carried out using the induced power analysis, a method based on the dynamic coupling inherent to ultiarticulated systems. The comparison was done among three male karatekas, considered to be experienced, intermediate and novice. The results show that the hip extension moment was the major contributor in the production of mechanical energy in the kicking foot at impact. Similarly the hip internal rotation and ankle dorsiflexion moments worked to build up the foot’s energy for most of movement. The experienced athlete seems to benefit more from these by potentiating the moments produced in these joints

Using a multifactorial approach to determine fall risk profiles in portuguese older adults

The aim of this study was to use a multifactorial approach to characterize episodic and recurrent fallers risk profiles in Portuguese older adults.info:eu-repo/semantics/publishedVersio

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Reliability of a Global Gait Symmetry Index Based on Linear Joint Displacements

Gait symmetry is commonly used as an informal measure to assess functional gait recovery. As other outcome measures used for the evaluation of clinical change over time, gait symmetry indices must be reliable. However, studies assessing the reliability of symmetry indices are scarce and focused on discrete and local indices (i.e., peak joint angle, step length), which fail to assess overall gait symmetry. On the other hand, the repeatability of global symmetry indices (using multiple continuous waveforms) based on joint angles may be hampered by the sensitivity of these variables to marker placement imprecision. The aim of this study is to evaluate the test–retest intra-rater reliability and measurement error of an alternative global symmetry index. Two 3D gait analyses were performed on separate days (a week interval) on twenty-three healthy adults. Reliability and measurement error were assessed by calculating the intraclass correlation coefficient and the 95% limits of agreement, standard error of measurement and smallest detectable change, respectively. The new symmetry index presented acceptable results in terms of reliability (ICC = 0.71, 95% CI 0.33–0.88) and measurement error (95% LOA between −30.2% and 29.1%, SEM = 10.7% and SDC = 29.7%), thus being a more promising tool to assess overall gait symmetry

Predictive Factors of Short-Term Related Musculoskeletal Pain in the Automotive Industry

To determine the short-term associations between biomechanical risk factors and musculoskeletal symptoms in the upper limbs and low back in an automotive company, a longitudinal study with a follow-up of 4 days was conducted in a sample of 228 workers of the assembly and paint areas. Data were analyzed using generalized estimating equations, calculating the crude and adjusted model for age, sex, seniority, and intensity of pain at baseline. The interactions found were the same for both models. Workers were divided in low-risk and high-risk group for posture, force, exposure, percentage of cycle time with the arm at/above shoulder level, and with the trunk flexed or/and strongly flexed. The predictive factors showed by time × group effect were found between pain intensity on the left shoulder for posture (β = 0.221, p < 0.001), percentage of time with the trunk flexed (β = 0.136, p = 0.030) and overall exposure (β = 0.140, p = 0.013). A time × group interactions were observed, namely between neck pain and posture (β = 0.218, p = 0.005) and right wrist and force (β = 0.107, p = 0.044). Workers in the high-risk group were more prone to report unfavorable effects on their self-reported musculoskeletal pain, across a workweek when exposed to specific risk factor, being posture important to neck, right wrist and left shoulder pain