Diagnostic accuracy, reliability, and construct validity of the German quick mild cognitive impairment screen.

BACKGROUND: Early detection of cognitive impairment is among the top research priorities aimed at reducing the global burden of dementia. Currently used screening tools have high sensitivity but lack specificity at their original cut-off, while decreasing the cut-off was repeatedly shown to improve specificity, but at the cost of lower sensitivity. In 2012, a new screening tool was introduced that aims to overcome these limitations - the Quick mild cognitive impairment screen (Qmci). The original English Qmci has been rigorously validated and demonstrated high diagnostic accuracy with both good sensitivity and specificity. We aimed to determine the optimal cut-off value for the German Qmci, and evaluate its diagnostic accuracy, reliability (internal consistency) and construct validity. METHODS: We retrospectively analyzed data from healthy older adults (HOA; n = 43) and individuals who have a clinical diagnosis of 'mild neurocognitive disorder' (mNCD; n = 37) with a biomarker supported characterization of the etiology of mNCD of three studies of the 'Brain-IT' project. Using Youden's Index, we calculated the optimal cut-off score to distinguish between HOA and mNCD. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic accuracy based on the area under the curve (AUC). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Reliability (internal consistency) was analyzed by calculating Cronbach's α. Construct validity was assessed by analyzing convergent validity between Qmci-G subdomain scores and reference assessments measuring the same neurocognitive domain. RESULTS: The optimal cut-off score for the Qmci-G was ≤ 67 (AUC = 0.96). This provided a sensitivity of 91.9% and a specificity of 90.7%. The PPV and NPV were 89.5% and 92.9%, respectively. Cronbach's α of the Qmci-G was 0.71 (CI95% [0.65 to 0.78]). The Qmci-G demonstrated good construct validity for subtests measuring learning and memory. Subtests that measure executive functioning and/or visuo-spatial skills showed mixed findings and/or did not correlate as strongly as expected with reference assessments. CONCLUSION: Our findings corroborate the existing evidence of the Qmci's good diagnostic accuracy, reliability, and construct validity. Additionally, the Qmci shows potential in resolving the limitations of commonly used screening tools, such as the Montreal Cognitive Assessment. To verify these findings for the Qmci-G, testing in clinical environments and/or primary health care and direct comparisons with standard screening tools utilized in these settings are warranted.

"Brain-IT": Exergame training with biofeedback breathing in neurocognitive disorders.

INTRODUCTION: The combination of exergame-based motor-cognitive training with resonance breathing guided by heart-rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in mild neurocognitive disorders (mNCD). METHODS: This randomized controlled trial (RCT) investigated the effectiveness of adding this novel intervention approach to usual care in mNCD. The individualized intervention was delivered via the "Brain-IT" training concept, which was iteratively co-designed, tested, and refined with patient and public involvement. RESULTS: We observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. Fifty-five percent of participants showed a clinically relevant improvement in response to training. DISCUSSION: Confirmatory RCTs are warranted to investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia and test the implementation of the training in clinical practice. HIGHLIGHTS: We proposed a novel intervention approach for mild neurocognitive disorders. It combines exergame-based training with biofeedback-guided resonance breathing. Our results confirm the effectiveness of this approach. Fifty-five percent of participants showed a clinically relevant improvement in response to training.

Minding your steps: a cross-sectional pilot study using foot-worn inertial sensors and dual-task gait analysis to assess the cognitive status of older adults with mobility limitations.

BACKGROUND: Cognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments. METHODS: We analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance. RESULTS: The addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups. CONCLUSIONS: Our preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT04587895).

Gait disorders in CKD patients: muscle wasting or cognitive impairment? A cross-sectional pilot study to investigate gait signatures in Stage 1-5 CKD patients.

BACKGROUND: Instrumental gait analysis in nephrology is widely neglected, although patients with chronic kidney disease (CKD) show brain changes due to cerebrovascular disease and metabolic disorders that can potentially influence gait quality. Our study assesses the association between CKD stages and gait parameters, to understand the prevalent status of brain related gait parameters (i.e. variability) and of performance related parameters (i.e. gait speed, stride length). We hypothesize that gait changes are detectable already in early stages of CKD. METHODS: Forty-five participants distributed in 5 CKD severity groups underwent an instrumental gait analysis via a triaxial accelerometer affixed to the lower trunk under single- and dual-task conditions. In addition to spatio-temporal parameters, variability and dual-task cost of gait were extracted. A battery of clinical assessments was conducted with the aim of helping to better explain the findings of the gait analysis. A correlation analysis was made to investigate a linear relation between gait parameters and CKD severity. RESULTS: Statistically significant correlations (Pearson correlation coefficient) with CKD severity were found for gait speed (p < 0.01, r = -0.55, 95% CI [-0.73;-0.30]), stride length ( p < 0.01, r = -0.40, 95% CI [-0.62;-0.12]), step length (p < 0.01, r = -0.41, 95% CI [-0.63;-0.13], coefficient of variance (CV) of step length (p = 0.01, r = 0.36, 95% CI [0.08;0.59]), gait regularity (p < 0.01, r = -0.38, 95% CI [-0.61;-0.10]), dual-task cost of gait speed (p < 0.01, r = 0.40, 95% CI [0.13;0.62]) and dual-task cost of stride time (p = 0.03, r = 0.32, 95% CI [0.03;0.57]). Adjustment for age and gender confirmed all results except for gait regularity. With increasing severity of renal failure, Handgrip strength, Time for the Expanded Timed Get Up and Go test, executive functions, haemoglobin, and haematocrit, worsen. CONCLUSIONS: The correlation of CKD severity with spatio-temporal parameters (performance indices mainly relatable to peripheral functionality) and with variability of gait (related to central factors) supported by the results of the clinical assessments, suggests that gait disturbance in CKD patients is not only due to metabolic factors that lead to muscle wasting, but also to brain changes that affect motor control. This suggests that the treatment of renal disease should include cognitive aspects in addition to metabolic and functional factors.

Prevalence of probable sarcopenia in community-dwelling older Swiss people - a cross-sectional study.

BACKGROUND: The European Working Group on Sarcopenia in Older People has recently defined new criteria for identifying "(probable) sarcopenia" (EWGSOP2). However, the prevalence of probable sarcopenia, defined by these guidelines, has not been determined extensively, especially in the oldest old. This study aims to determine the prevalence of probable sarcopenia in older, community-living people and its association with strength-related determinants. METHODS: Handgrip strength and reported determinants (age, height, weight, osteoarthritis of hands, medications, fall history, physical activity, activities of daily living (ADL) and global cognitive function) were collected in a cross-sectional study of 219 community-living Swiss people (75 years and over). Probable sarcopenia was estimated based on cut-off values for handgrip strength as recommended by EWGSOP2. Spearman correlations, binary-regression analyses and contingency tables were used to explore relationships between variables. RESULTS: The prevalence of probable sarcopenia in women (n = 137, age 84.1 ± 5.7 years) and men (n = 82, age 82.6 ± 5.2 years) was 26.3 and 28.0%, respectively. In women, probable sarcopenia correlated positively with age and falls (rs range 0.332-0.195, p < .05), and negatively with weight, cognition, physical activity, using stairs regularly, participating in sports activities and ADL performance (rs range = - 0.141 - -0.409, p < .05). The only significant predictor of probable sarcopenia at the multivariate level was ADL performance (Wald(1) = 5.51, p = .019). In men, probable sarcopenia was positively correlated with age (rs = 0.33, p < .05) and negatively with physical activity, participation in sports and ADL performance (rs range - 0.221 - - 0.353, p < .05). ADL performance and age (Wald(1) = 4.46, p = .035 and Wald(1) = 6.30, p = .012) were the only significant predictors at the multivariate level. Men and women with probable sarcopenia were 2.8 times more likely to be dependent in ADL than those without. CONCLUSION: Probable sarcopenia affected one in every four community-living, oldest old people and was independently associated with impaired ADL performance in both sexes. This highlights the importance of detection of handgrip strength in this age group in clinical practice. Although prospective studies are required, independence in ADL might help to protect against probable sarcopenia.

Effects of exergame training combined with omega-3 fatty acids on the elderly brain: a randomized double-blind placebo-controlled trial.

BACKGROUND: Older adults often suffer from age- and behavior-related brain changes affecting neuronal functioning and, therefore, cognitive and motor functions. The improvement of these functions might decrease falls and improve mobility. Previous studies indicate that video game-based physical exercise, so-called exergames, or omega-3 fatty acids (FAs) improve motor and cognitive functioning through brain adaptations. The aim of this study was to assess the effects of exergame training combined with fish oil supplementation on neuronal system levels in the brain and behavioral measurements in older adults. We hypothesized that the combination would differently affect these factors compared to the sole administration of exergame. METHODS: Fifty-eight participants were randomly assigned to one of two groups (N = 29 each group) in a parallel, double-blind, randomized controlled trial lasting 26 weeks. The experimental group received daily fish oil, whereas the control group received daily olive oil. After 16 weeks, both groups started with an exergame training. Measurements were performed pre, during, and post intervention. Primary outcomes were recruitment curves using transcranial magnetic stimulation and response-locked potentials using electroencephalography. Secondary outcomes included executive functions and gait parameters. Blood samples were taken to control for FAs. RESULTS: Forty-three individuals (mean age 69.4 ± 4.6 years) completed the study (Nexperimental = 22, Ncontrol = 21). The results showed no significant time × group interaction effects for any parameters. Blood samples demonstrated significant time × group interaction effects. Post-hoc tests showed a significant increase of omega-3 FAs (p < .001) and a significant decrease of omega-6 FAs (p < .001) for the experimental group. CONCLUSION: The combination of exergame training and fish oil did not lead to additional beneficial effects. To trigger possible effects, future studies should carefully consider study design aspects; e.g. study duration, individual nutritional supplementation dose, omega-3 FAs supplementation composition, and placebo. Furthermore, studies should consider neuroimaging methods as these might be more sensitive to assess early brain adaptations. Thus, future studies should be aware of several aspects running a combinatory study that includes omega-3 FAs according to their expected effects. TRIAL REGISTRATION: Swiss National Clinical Trials SNCTP000001623 and ISRCTN12084831 registered 30 November 2015.

Gait characteristics of CKD patients: a systematic review.

BACKGROUND: People with Chronic Kidney Disease (CKD) often present with prevalent gait impairment and high fall rates, particularly in advanced CKD stages. Gait impairment and its consequences is associated with increased hospital admission, institutionalization, and greater need for health care. The objective of this systematic review was to evaluate the quality of studies investigating CKD patients' gait characteristics at different CKD stages, to highlight areas of agreement and contradiction between studies reporting aspects of gait in CKD, and to discuss and emphasize gait parameters associated with fall risk. METHODS: We performed a literature search of trials in CINAHL (EBSCO), Cochrane Library, EMBASE, Medline (EBSCO), PEDro, PubMed, and Scopus databases from their inception to June 30th 2018 using a two-stage process for the identification of studies. We retrieved English-, German-, Italian-, Spanish-, Portuguese and Dutch-language articles for review. Methodological quality of randomized and non-randomized studies was assessed with an adapted version of the Downs and Black checklist. RESULTS: Thirty-one studies (22 cross-sectional with 3901 participants) and 9 longitudinal intervention studies (1 randomized control trial, 5 controlled clinical trials and 3 one-group pre-post-test; with 659 participants) were considered. The studies revealed a primary emphasis on gait speed measures within clinical tests, and a neglect of spatiotemporal gait variables. Most of the studies showed that CKD progression is associated with slowing of walking speed. No studies analysed the relation between gait parameters and fall risk. CONCLUSIONS: There was a paucity of studies investigating aspects of gait quality in patients with CKD. In the majority of studies, only gait speed is analysed as a performance indicator. The relation between gait parameters and fall risk in CKD is not investigated. We formulate several recommendations to fill the current research gap, encourage the use of standardized gait analysis protocols that include assessment of spatiotemporal parameters in clinical care of patients with CKD, aimed at prevention of mobility decline and falls risk.

Handgrip strength in old and oldest old Swiss adults - a cross-sectional study.

BACKGROUND: Handgrip strength is indicative of overall physical health and mobility in the elderly. A reduction in strength below a certain threshold severely increases the risk of mobility limitations and is predictive for adverse outcomes such as dependence in daily activities and mortality. An overview of age- and geography- specific handgrip strength values in older adults provide a reference for further investigations and measures in clinical practice to identify people at risk for clinically meaningful weakness. The aim of this study was to evaluate handgrip strength in the Swiss-German population aged 75 and over. METHODS: In a cross-sectional study, maximal isometric handgrip strength of the dominant hand was evaluated in 244 Swiss people aged 75 years and over (62.7% women), with mean age (SD) of 84.5 (5.6) years in men and 83.1 (5.9) years in women. Demographic data and information about comorbidities, medication, fall history, global cognitive function, self-reported physical activity and dependence in activities of daily living were collected, and correlated with grip strength measures. Age- and gender specific grip strength values are reported as means, standard deviations and standard error of mean. RESULTS: Sex-stratified handgrip strength was significantly lower with advancing age in men (p < .01), from 37.7 (6.5) kg to 25.6 (7.6) kg and in women (p < .01) from 22.2 (4.0) kg to 16.5 (4.7) kg. Handgrip strength in our sample was significantly higher than in Southern European countries. Handgrip strength was independently associated with age, height and ADL dependence in men and women. Overall, 44% of men and 53% of women had handgrip strength measures that were below the clinically relevant threshold for mobility limitations. CONCLUSION: This study reports the age- and sex-stratified reference values for handgrip strength in a representative sample of the Swiss population, aged 75-99 years. Although grip strength decreased with advancing age in both sexes; the relative decline was greater in men than women. Nonetheless men had significantly higher grip strength in all age groups. While the Swiss population sampled had greater grip strength than that reported in other European countries, about 50% were still classified as at risk of mobility limitations.

Handgrip force steadiness in young and older adults: a reproducibility study.

BACKGROUND: Force steadiness is a quantitative measure of the ability to control muscle tonus. It is an independent predictor of functional performance and has shown to correlate well with different degrees of motor impairment following stroke. Despite being clinically relevant, few studies have assessed the validity of measuring force steadiness. The aim of this study was to explore the reproducibility of handgrip force steadiness, and to assess age difference in steadiness. METHOD: Intrarater reproducibility (the degree to which a rating gives consistent result on separate occasions) was investigated in a test-retest design with seven days between sessions. Ten young and thirty older adults were recruited and handgrip steadiness was tested at 5%, 10% and 25% of maximum voluntary contraction (MVC) using Nintendo Wii Balance Board (WBB). Coefficients of variation were calculated from the mean force produced (CVM) and the target force (CVT). Area between the force curve and the target force line (Area) was also calculated. For the older adults we explored reliability using intraclass correlation coefficient (ICC) and agreement using standard error of measurement (SEM), limits of agreement (LOA) and smallest real difference (SRD). RESULTS: A systematic improvement in handgrip steadiness was found between sessions for all measures (CVM, CVT, Area). CVM and CVT at 5% of MVC showed good to high reliability, while Area had poor reliability for all percentages of MVC. Averaged ICC for CVM, CVT and Area was 0.815, 0.806 and 0.464, respectively. Averaged ICC on 5%, 10%, and 25% of MVC was 0.751, 0.667 and 0.668, respectively. Measures of agreement showed similar trends with better results for CVM and CVT than for Area. Young adults had better handgrip steadiness than older adults across all measures. CONCLUSION: The CVM and CVT measures demonstrated good reproducibility at lower percentages of MVC using the WBB, and could become relevant measures in the clinical setting. The Area measure had poor reproducibility. Young adults have better handgrip steadiness than old adults.

Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games.

BACKGROUND: Multiplayer games have emerged as a promising approach to increase the motivation of patients involved in rehabilitation therapy. In this systematic review, we evaluated recent publications in health-related multiplayer games that involved patients with cognitive and/or motor impairments. The aim was to investigate the effect of multiplayer gaming on game experience and game performance in healthy and non-healthy populations in comparison to individual game play. We further discuss the publications within the context of the theory of flow and the challenge point framework. METHODS: A systematic search was conducted through EMBASE, Medline, PubMed, Cochrane, CINAHL and PsycINFO. The search was complemented by recent publications in robot-assisted multiplayer neurorehabilitation. The search was restricted to robot-assisted or virtual reality-based training. RESULTS: Thirteen articles met the inclusion criteria. Multiplayer modes used in health-related multiplayer games were: competitive, collaborative and co-active multiplayer modes. Multiplayer modes positively affected game experience in nine studies and game performance in six studies. Two articles reported increased game performance in single-player mode when compared to multiplayer mode. CONCLUSIONS: The multiplayer modes of training reviewed improved game experience and game performance compared to single-player modes. However, the methods reviewed were quite heterogeneous and not exhaustive. One important take-away is that adaptation of the game conditions can individualize the difficulty of a game to a player's skill level in competitive multiplayer games. Robotic assistance and virtual reality can enhance individualization by, for example, adapting the haptic conditions, e.g. by increasing haptic support or by providing haptic resistance. The flow theory and the challenge point framework support these results and are used in this review to frame the idea of adapting players' game conditions.

The Zürich Maxi Mental Status Inventory (ZüMAX): Test-Retest Reliability and Discriminant Validity in Stroke Survivors.

OBJECTIVE: To examine discriminant validity and test-retest reliability of the Zürich maxi mental status inventory (ZüMAX) in patients with stroke. BACKGROUND: The ZüMAX is a novel domain-specific cognitive assessment tool to screen for disturbances in neuropsychological function. The test can be used in stroke rehabilitation to estimate severity of cognitive impairment. Because evidence for validity and reliability is lacking, the tool's clinical use is limited. METHODS: We administered the ZüMAX in a test-retest design to 33 community-dwelling stroke survivors, and once to 35 healthy controls matched for age and sex. RESULTS: We found significant group differences in subscores for the cognitive domains of executive functions and language as well as total score (P=0.001 to 0.004); we did not find group differences for the domains of praxia (defined as the ability to perform purposeful actions), visual perception and construction, or learning and memory. Test-retest reliability of the total score was good (intraclass correlation coefficient=0.81), with the individual domain subscores ranging from poor to fair (0.59 to 0.79). The ZüMAX could detect changes in patients with low smallest detectable differences in executive functions, language, and praxia (0.05 to 1.49) and total score (0.09). CONCLUSION: The ZüMAX has moderate to good test-retest reliability. Furthermore, the tool might discriminate between healthy persons and chronic stroke survivors on three of five subscales. The ZüMAX shows promise in measuring neuropsychological disturbances in stroke survivors; however, further trials are required with larger samples.

Spatial physical activity patterns among primary school children living in neighbourhoods of varying socioeconomic status: a cross-sectional study using accelerometry and Global Positioning System.

BACKGROUND: Neighbourhood socioeconomic status (SES) has been shown to be related to health status and overweight independent of individual SES. However, results about the association between neighbourhood SES and physical activity among children are ambiguous. Particularly, it is unknown how socioeconomic factors influence the spatial context of children's moderate-vigorous physical activity (MVPA) and sedentary behaviour (SB). This study aimed to investigate by means of Global Positioning System (GPS) and accelerometry whether locations where children engage in MVPA and SB differ by neighbourhood SES. METHODS: Participants included 83 children aged 7-9 from nine public schools located in a low- and high-SES area in Zurich, Switzerland. Children wore an accelerometer and GPS sensor for seven consecutive days. Time-matched accelerometer and GPS data was mapped with a geographic information system and each data point assigned to one of eight activity settings. The amount and proportion of MVPA and SB were calculated for every setting. To investigate differences between the two SES groups, multilevel analyses accounting for the hierarchical structure of the data were conducted. RESULTS: Both SES groups achieved most minutes in MVPA at own school, on streets and at home and recorded the highest proportions of MVPA in recreational facilities, streets and other schools. The highest amounts and proportions of SB were found at home and own school. High-SES children accumulated significantly more minutes in MVPA and SB in parks, sport facilities, other schools and streets, while the low-SES group spent more time in both activities in other places. When taking the total time spent in a setting into account and using the proportion of MVPA or SB, the only differences between the two groups were found at other schools and outside, where the high-SES children showed a significantly higher activity level (p-values <0.001). CONCLUSIONS: Several differences in the spatial activity pattern between children from low- and high-SES neighbourhoods were found, independent of their individual SES. The findings seem to highlight the importance of providing safe streets and access to appropriate types of recreational facilities to reach recommended PA levels. Further policies to reduce SB within home and school environment are needed.

Concurrent validity and test-retest reliability of the Virtual Peg Insertion Test to quantify upper limb function in patients with chronic stroke.

BACKGROUND: Measuring arm and hand function of the affected side is vital in stroke rehabilitation. Therefore, the Virtual Peg Insertion Test (VPIT), an assessment combining virtual reality and haptic feedback during a goal-oriented task derived from the Nine Hole Peg Test (NHPT), was developed. This study aimed to evaluate (1) the concurrent validity of key outcome measures of the VPIT, namely the execution time and the number of dropped pegs, with the NHPT and Box and Block Test (BBT), and (2) the test-retest-reliability of these parameters together with the VPIT's additional kinetic and kinematic parameters in patients with chronic stroke. The three tests were administered on 31 chronic patients with stroke in one session (concurrent validity), and the VPIT was retested in a second session 3-7 days later (test-retest reliability). Spearman rank correlation coefficients (ρ) were calculated for assessing concurrent validity, and intraclass correlation coefficients (ICCs) were used to determine relative reliability. Bland-Altman plots were drawn and the smallest detectable difference (SDD) was calculated to examine absolute reliability. RESULTS: For the 31 included patients, 11 were able to perform the VPIT solely via use of their affected arm, whereas 20 patients also had to utilize support from their unaffected arm. For n = 31, the VPIT showed low correlations with the NHPT (ρ = 0.31 for time (Tex[s]); ρ = 0.21 for number of dropped pegs (Ndp)) and BBT (ρ = -0.23 for number of transported cubes (Ntc); ρ = -0.12 for number of dropped cubes (Ndc)). The test-retest reliability for the parameters Tex[s], mean grasping force (Fggo[N]), number of zero-crossings (Nzc[1/sgo/return) and mean collision force (Fcmean[N]) were good to high, with ICCs ranging from 0.83 to 0.94. Fair reliability could be found for Fgreturn (ICC = 0.75) and trajectory error (Etrajgo[cm]) (0.70). Poor reliability was measured for Etrajreturn[cm] (0.67) and Ndp (0.58). The SDDs were: Tex = 70.2 s, Ndp = 0.4 pegs; Fggo/return = 3.5/1.2 Newton; Nzc[1/s]go/return = 0.2/1.8 zero-crossings; Etrajgo/return = 0.5/0.8 cm; Fcmean = 0.7 Newton. CONCLUSIONS: The VPIT is a promising upper limb function assessment for patients with stroke requiring other components of upper limb motor performance than the NHPT and BBT. The high intra-subject variation indicated that it is a demanding test for this stroke sample, which necessitates a thorough introduction to this assessment. Once familiar, the VPIT provides more objective and comprehensive measurements of upper limb function than conventional, non-computerized hand assessments.

Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study.

BACKGROUND: Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. AIMS: The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. METHODS: Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. RESULTS: Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patient-reported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). CONCLUSION: A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs.

Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial.

BACKGROUND AND PURPOSE: Cardiovascular fitness is greatly reduced after stroke. Although individuals with mild to moderate impairments benefit from conventional cardiovascular exercise interventions, there is a lack of effective approaches for persons with severely impaired physical function. This randomized controlled pilot trial investigated efficacy and feasibility of feedback-controlled robotics-assisted treadmill exercise (FC-RATE) for cardiovascular rehabilitation in persons with severe impairments early after stroke. METHODS: Twenty individuals (age 61 ± 11 years; 52 ± 31 days poststroke) with severe motor limitations (Functional Ambulation Classification 0-2) were recruited for FC-RATE or conventional robotics-assisted treadmill exercise (RATE) (4 weeks, 3 × 30-minute sessions/wk). Outcome measures focused on peak cardiopulmonary performance parameters, training intensity, and feasibility, with examiners blinded to allocation. RESULTS: All 14 allocated participants (70% of recruited) completed the intervention (7/group, withdrawals unrelated to intervention), without serious adverse events occurring. Cardiovascular fitness increased significantly in both groups, with peak oxygen uptake increasing from 14.6 to 17.7 mL · kg · min (+17.8%) after 4 weeks (45.8%-55.7% of predicted maximal aerobic capacity; time effect P = 0.01; no group-time interaction). Training intensity (% heart rate reserve) was significantly higher for FC-RATE (40% ± 3%) than for conventional RATE (14% ± 2%) (P = 0.001). DISCUSSION AND CONCLUSIONS: Substantive overall increases in the main cardiopulmonary performance parameters were observed, but there were no significant between-group differences when comparing FC-RATE and conventional RATE. Feedback-controlled robotics-assisted treadmill exercise significantly increased exercise intensity, but recommended intensity levels for cardiovascular training were not consistently achieved. Future research should focus on appropriate algorithms within advanced robotic systems to promote optimal cardiovascular stress.Video abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A107).

Feasibility and effects of applying stochastic resonance whole-body vibration on untrained elderly: a randomized crossover pilot study.

BACKGROUND: Aging is associated with loss of balance and activity in daily life. It impacts postural control and increases the risk of falls. The current study was conducted to determine the feasibility and long-term impact of stochastic resonance whole-body vibration (SR-WBV) on static and dynamic balance and reaction time among elderly individuals. METHODS: A randomized crossover pilot study with blinding of the participants. Twenty elderly were divided into group A (SR-WBV 5 Hz, Noise 4/SR-WBV 1 Hz, Noise 1) or group B (SR-WBV 1 Hz, Noise 1/SR-WBV 5 Hz, Noise 1). Feasibility outcomes included recruitment, compliance and safety. Secondary outcomes were Semi-Tandem Stand (STS), Functional Reach Test (FRT), Expanded Timed Get Up-and-Go (ETGUG), walking under single (ST) & dual task (DT) conditions, hand and foot reaction time (RTH/RTF). Puri and Sen Rank-Order L Statistics were used to analyse carry-over effects. To analyse SR-WBV effects Wilcoxon signed-ranked tests were used. RESULTS: With good recruitment rate (55%) and compliance (attrition 15%; adherence 85%) rates the intervention was deemed feasible. Three participants dropped out, two due to knee pain and one for personal reasons. ETGUG 0 to 2 m (p = 0.143; ES: 0.36) and ETGUG total time (p = 0.097; ES: 0.40) showed medium effect sizes. CONCLUSIONS: Stochastic resonance training is feasible in untrained elderly resulting in good recruitment and compliance. Low volume SR-WBV exercises over 12 training sessions with 5 Hz, Noise 4 seems a sufficient stimulus to improve ETGUG total time. The stimulation did not elicit changes in other outcomes. TRIAL REGISTRATION: This trial has been registered at the U.S. National Institutes of Health under ClinicalTrials.gov: NCT01045746.

The relevance of applying exercise training principles when designing therapeutic interventions for patients with inflammatory myopathies: a systematic review.

Physical exercise seems to be a safe and effective intervention in patients with inflammatory myopathy (IM). However, the optimal training intervention is not clear. To achieve an optimum training effect, physical exercise training principles must be considered and to replicate research findings, FITT components (frequency, intensity, time, and type) of exercise training should be reported. This review aims to evaluate exercise interventions in studies with IM patients in relation to (1) the application of principles of exercise training, (2) the reporting of FITT components, (3) the adherence of participants to the intervention, and (4) to assess the methodological quality of the included studies. The literature was searched for exercise studies in IM patients. Data were extracted to evaluate the application of the training principles, the reporting of and the adherence to the exercise prescription. The Downs and Black checklist was used to assess methodological quality of the included studies. From the 14 included studies, four focused on resistance, two on endurance, and eight on combined training. In terms of principles of exercise training, 93 % reported specificity, 50 % progression and overload, and 79 % initial values. Reversibility and diminishing returns were never reported. Six articles reported all FITT components in the prescription of the training though no study described adherence to all of these components. Incomplete application of the exercise training principles and insufficient reporting of the exercise intervention prescribed and completed hamper the reproducibility of the intervention and the ability to determine the optimal dose of exercise.

Discriminant validity and test re-test reproducibility of a gait assessment in patients with vestibular dysfunction.

BACKGROUND: Gait function may be impaired in patients with vestibular disorders, making gait assessment in the clinical setting relevant for this patient population. The purpose of this study was to evaluate the discriminant validity of a gait assessment protocol between patients with vestibular disorders and healthy participants. Furthermore, test re-test reproducibility and the measurement error of gait performance measures in patients with vestibular lesions was performed under different walking conditions. METHODS: Gait parameters of thirty-five patients with vestibular disorders and twenty-seven healthy controls were assessed twice with the GAITRite® system. Discriminant validity, reproducibility (intra class correlation [ICC]) and the measurement error (standard error of measurement [SEM], smallest detectable change [SDC]) were determined for gait speed, cadence and step length. Bland-Altman plots were made to assess systematic bias between tests. RESULTS: A significant effect of grouping on gait performance indicates discriminant validity of gait assessment. All tests revealed differences between patients and healthy controls (p < 0.01). The ICCs for test re-test reproducibility were excellent (0.70-0.96) and measurement error showed acceptable SDC values for gait parameters derived from three walking conditions (9-19 %). Bland-Altman plots indicated no systematic bias. CONCLUSIONS: Good validity and reproducibility of GAITRite® system measurements suggest that this system could facilitate the study of gait in patients with vestibular disorders in clinical settings. The SDC values for gait are generally small enough to detect changes after a rehabilitation program for patients with vestibular disorders.

Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review.

BACKGROUND: There is increasing evidence for the beneficial effects of exercise training in stroke survivors. In order to reach the desired training effects, exercise training principles must be considered as this ensures the prescription of adequate exercises at an adequate dose. Moreover, exercise training interventions must be designed in a way that maximizes patients' adherence to the prescribed exercise regimen. The objectives of this systematic review were (1) to investigate whether training principles for physical exercise interventions are reported in RCTs for sub-acute and chronic stroke survivors, (2) to evaluate whether the RCTs reported the prescription of the FITT components of the exercise interventions as well as (3) patients' adherence to this prescription, and (4) to assess the risk of bias of the included studies. METHODS: We performed a systematic review of RCTs with exercise training as the primary intervention and muscular strength and/or endurance as primary outcomes. The Cochrane library's risk of bias (ROB) tool was used to judge the methodological quality of RCTs. RESULTS: Thirty-seven RCTs were included in this systematic review. Eighteen studies (48.7%) focused on aerobic, 8 (21.6%) on resistance and 11 (29.7%) on combined interventions of aerobic and resistive strength exercise. Twenty-nine studies (78.4%) included only chronic stroke survivors, 5 studies (13.5%) only sub-acute stroke survivors whilst 3 studies (8.1%) included both. In terms of principle of exercise training, 89% reported specificity, 75.7% progression, 48.7% overload, 37.8% initial values, 32.4% reversibility and 13.5% diminishing returns. One RCT described all principles of physical exercise training and 19 (51.4%) all FITT components. Patients' adherence to exercise prescription was accounted for in 3 studies (8.1%). Failure to report blinding in patients and participants and failure to report allocation concealment were the most prevalent methodological shortcomings. CONCLUSIONS: Incomplete and inconsistent reporting of (1) training components, (2) underlying exercise training principles and (3) patient adherence together with (4) a broad variation in the methodological quality of the included RCTs limit both the utility and reproducibility of physical exercise programs in stroke patients.

Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial.

BACKGROUND: Exercise interventions often do not combine physical and cognitive training. However, this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training. METHODS: A multicenter parallel randomized controlled trial was conducted to compare a motor to a cognitive-motor exercise program. A total of 182 eligible residents of homes-for-the-aged (n = 159) or elderly living in the vicinity of the homes (n = 23) were randomly assigned to either strength-balance (SB) or strength-balance-cognitive (SBC) training. Both groups conducted similar strength-balance training during 12 weeks. SBC additionally absolved computerized cognitive training. Outcomes were dual task costs of walking, physical performance, simple reaction time, executive functions, divided attention, fear of falling and fall rate. Participants were analysed with an intention to treat approach. RESULTS: The 182 participants (mean age ± SD: 81.5 ± 7.3 years) were allocated to either SB (n = 98) or SBC (n = 84). The attrition rate was 14.3%. Interaction effects were observed for dual task costs of step length (preferred walking speed: F(1,174) = 4.94, p = 0.028, η2 = 0.027, fast walking speed: F(1,166) = 6.14, p = 0.009, η2 = 0.040) and dual task costs of the standard deviation of step length (F(1,166) = 6.14, p = 0.014, η2 = 0.036), in favor of SBC. Significant interactions in favor of SBC revealed for in gait initiation (F(1,166) = 9.16, p = 0.003, η2 = 0.052), 'reaction time' (F(1,180) = 5.243, p = 0.023, η² = 0.028) & 'missed answers' (F(1,180) = 11.839, p = 0.001, η² = 0.062) as part of the test for divided attention. Within-group comparison revealed significant improvements in dual task costs of walking (preferred speed; velocity (p = 0.002), step time (p = 0.018), step length (p = 0.028), fast speed; velocity (p < 0.001), step time (p = 0.035), step length (p = 0.001)), simple reaction time (p < 0.001), executive functioning (Trail making test B; p < 0.001), divided attention (p < 0.001), fear of falling (p < 0.001), and fall rate (p < 0.001). CONCLUSIONS: Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking, gait initiation, and divided attention. The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls. TRIAL REGISTRATION: This trial has been registered under ISRCTN75134517.