Association between measures of cognitive function on physical function in novice users of a lower limb prosthesis

BACKGROUND: Cognitive impairment is prevalent in people with lower limb amputations (PLLA) and is associated with adverse outcomes, such as falls and worse rehabilitation outcomes. Physical function tests are essential to examine abilities; however, no research in PLLA has clarified the magnitude of cognitive demands amongst available tests in users novice at walking with a prosthesis. METHODS: People from inpatient prosthetic rehabilitation were recruited. Inclusion criteria were: age ≥ 50 years, unilateral transtibial amputation and able to walk independently. Gait velocity and the L Test under single-task (usual) and dual-task (walking while counting backwards) conditions assessed functional mobility. The Four Square Step Test (FSST) examined dynamic balance. The Montreal Cognitive Assessment (MoCA) and the Trail Making Test (TMT-B) assessed global cognitive status and executive function, respectively. Multivariable linear regressions evaluated the association of cognition on physical function. RESULTS: Twenty-two people participated (age: 62.3 ± 8.9 years, male: 68.18%). The mean MoCA score was 26.23 ± 2.90. A 1-point MoCA increase was independently associated with faster gait velocity (cm/s) [single-task: 5.45 (95%CI: 2.35-8.54, AdjR2 =0.46), dual-task: 5.04 (95%CI: 1.33-8.75, AdjR2 =0.20) and a quicker L Test (s) [single-task: - 4.75 (95%CI: 7.22-2.28, AdjR2 =0.45), dual-task: - 5.27 (95%CI: 8.74-1.80, AdjR2 =0.38)]. A 1-second TMT-B increase was also independently associated with worse L Test performance [single-task: 0.21 s (95%CI: 0.03-0.39, AdjR2 =0.20), dual-task: 0.29 s (95%CI: 0.06-0.51, AdjR2 =0.30)]. No association was observed between MoCA or TMT-B on the FSST (p \u3e 0.13). SIGNIFICANCE: Better global cognitive function and executive function were independently associated with faster gait velocity and improved functional mobility, but not dynamic balance. The present study demonstrates a unique relationship between cognition and physical function that warrants further research on the cognitive demands among clinical tests of physical function in PLLA

Association Between Changes in Subjective and Objective Measures of Mobility in People With Lower Limb Amputations After Inpatient Rehabilitation

Functional recovery for people with lower limb amputations is quantified using objective or subjective measures of performance. In this brief report, the prospective relationship between objective and subjective mobility after rehabilitation was evaluated in people with lower limb amputations. Adults undergoing inpatient prosthetic rehabilitation for a first unilateral transtibial or transfemoral level lower limb amputation were recruited. Assessment times: discharge and 4-mo follow-up. Gait velocity and the L Test under single- and dual-task conditions measured objective mobility. The Prosthetic Evaluation Questionnaire (section 4 and question 5b) measured subjective mobility. Paired t tests and Pearson correlation analysis evaluated change over time and the association between mobility types, respectively. Twenty-one people with lower limb amputations (61.6 ± 8.2 yrs) participated. Gait velocity significantly improved (single- and dual-task: P \u3c 0.001). L Test significantly improved for single-task (P = 0.002) but not dual-task conditions. No statistically significant Prosthetic Evaluation Questionnaire changes were observed. One subjective mobility question (sidewalk walking) correlated with objective mobility at follow-up (L Test single- and dual-task: r = -0.77; P \u3c 0.001). Objective mobility improved after discharge; however, subjective reporting had no change. Lack of association may represent a mismatch between quantitative outcomes and subjective self-assessment. Both subjective and objective measures of mobility should be collected to provide a holistic picture of clinical and patient-relevant outcomes in people with lower limb amputations

The Effect of Dual-Task Testing on Balance and Gait Performance in Adults with Type 1 or Type 2 Diabetes Mellitus: A Systematic Review

BACKGROUND: Individuals with diabetes mellitus (DM) are susceptible to balance, gait and cognitive impairments. Importantly, diabetes affects executive function, a set of cognitive processes critical to everyday cortical function and mobility. Reduced executive function is a risk factor for falls in people with DM. Dual-task testing, the completion of two tasks at once, enables the examination of the cognitive-mobility relationship. A synthesis of the literature on the effects of dual- task testing on the balance and gait of individuals with DM has not been performed. OBJECTIVE: To systematically review the literature on the effect of dual-task testing on balance and gait in people with DM. METHODS: Databases EMBASE, CINAHL, MEDLINE, PsycINFO, Scopus and Web of Science were searched (inception-April 2020). INCLUSION CRITERIA: participants were adults with a diagnosis of DM, instrumented dual-task balance and/or gait was assessed, and articles were published in English. RESULTS: Ten articles met inclusion criteria- three examined dual-task balance and seven dual-task gait. In people with DM with or without peripheral neuropathy, dual-task resulted in larger sway velocities during standing tests. Individuals with DM and peripheral neuropathy had impaired dual-- task gait; specifically, and more consistently, reduced pace and rhythm compared to controls or people with DM without peripheral neuropathy. CONCLUSION: The findings support a compromise in the cognitive-mobility relationship of people with DM, and especially in those with peripheral neuropathy. Future research should continue to examine the cognitive-mobility relationship in order to understand the increased prevalence of falls in this population

Prof-in-a-Box: using internet-videoconferencing to assist students in the gross anatomy laboratory

BACKGROUND: The optimal learning environment for gross anatomy is the dissection laboratory. The Prof-in-a-Box (PiB) system has been developed where an anatomist using distance-learning technologies 'helps' students in a dissection laboratory at a different site. METHODS: The PiB system consists of: (1) an anatomist in his/her office with a computer and video camera; (2) a computer and 2 video cameras in the lab; (3) iChat AV software; (4) a secure server to host the PiB-student 'consultation'. The PiB system allows the students and faculty to interact via audio and video providing an environment where questions can be asked and answered and anatomical structures can be identified 'at a distance' in real-time. The PiB system was set up at a prosected cadaver and made available for student use during 'office hours'. RESULTS: 25–30% of the students used the PiB system. Anatomical structures were identified, questions answered and demonstrations given 'at a distance' using the system. Students completed an optional questionnaire about the PiB system at the end of the semester. Results of the questionnaire indicate that the students were enthusiastic about the PiB system and wanted its use to be expanded in the future. CONCLUSION: Many of the functions of a faculty member in the gross anatomy dissection laboratory can be performed 'at a distance' using the PiB system. This suggests that a geographically dispersed faculty could assist in providing instruction in the dissection labs at multiple medical schools without needing to be physically present

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer\u27s Disease: Part I - Cane

BACKGROUND: People with Alzheimer\u27s disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD. OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking. METHODS: Seventeen participants with AD (age 82.1±5.6 years) and 25 healthy controls (age 70.8±14.1 years) walked using a single-point cane in a straight (6 meter) and a complex (Figure of 8) path under three conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). Velocity and stride time variability were recorded with accelerometers. RESULTS: Gait velocity significantly slowed for both groups in all conditions and stride time variability was greater in the AD group. Overall, multi-tasking produced a decrease in gait and cognitive demands for both groups, with more people with AD self-prioritizing the cognitive task over the gait task. CONCLUSION: Learning to use a cane demands cognitive resources that lead to detrimental changes in velocity and stride time variability. This was most pronounced in people with mild to moderate AD. Future research needs to investigate the effects of mobility aid training on gait performance

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer\u27s Disease: Part II - 4-Wheeled Walker.

BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer\u27s disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk. OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults. METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). RESULTS: Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values CONCLUSION: Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance

Effect of learning to use a mobility aid on gait and cognitive demands in people with mild to moderate Alzheimer’s dementia: Part I - Cane

Background: People with Alzheimer’s dementia (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD. Objectives: In people with AD and healthy adult controls: 1) to examine changes in gait while using a cane under various walking conditions; and 2) to determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking. Methods: Seventeen participants with AD (age 82.1±5.6 years) and 25 healthy controls (age 70.8±14.1 years) walked using a single-point cane in a straight (6 meter) and a complex (Figure of 8) path under three conditions: single-task (no aid), dual-task (walking with aid), and multitask (walking with aid while counting backwards by ones). Velocity and stride time variability were recorded with accelerometers. Results: Gait velocity significantly slowed for both groups in all conditions and stride time variability was greater in the AD group. Overall, multi-tasking produced a decrease in gait and cognitive demands for both groups, with more people with AD self-prioritizing the cognitive task over the gait task. Conclusion: Learning to use a cane demands cognitive resources that lead to detrimental changes in velocity and stride time variability. This was most pronounced in people with mild to moderate AD. Future research needs to investigate the effects of mobility aid training on gait performance

Effect of dual-tasking on walking and cognitive demands in adults with Alzheimer’s dementia experienced in using a 4-wheeled walker

Background Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer’s dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations. Research question What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker? Methods Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience participated. Three walking configurations: 1) straight path (SP), 2) Groningen Meander Walking Test (GMWT), and 3) Figure of 8 path (F8) were tested under two walking conditions: 1) single-task (walking with aid) and 2) dual-task (walking with aid and completing a cognitive task). Tri-axial accelerometers collected velocity, cadence and stride time variability (STV). Gait and cognitive task cost were the percentage difference between single-task and dual-task conditions. Two-way repeated measures ANOVAs were used to answer the study question. Results A significant interaction between walking configuration and condition was found for velocity (p = 0.002, ω2 = 0.36), cadence (p = 0.04, ω2 = 0.15) and STV (p < 0.001, ω2 = 0.53). Velocity and cadence decreased and STV increased with increasing walking configuration complexity and upon dual-tasking. Dual-task gait and cognitive task cost deteriorated in all walking configurations, but gait was prioritized in the GMWT and F8 configurations. Despite familiarity, experienced walker users with AD exhibit impaired gait when walking in complex situations which increases falls risk. Upon dual-task, individuals with AD self-prioritized a posture-first strategy in complex configurations. Significance Dual-task testing in experienced users results in slower walking, fewer steps and increased STV, which increases falls risk in people with mild to moderate AD and becomes most pronounced in complex environments