Physical Fitness and Cognitive Function in Persons with Dementia and their Caregiver.

A cross-sectional design investigated the physical attributes of 15 dyads of people with dementia and their caregivers. Physical and cognitive markers determined deviations from clinical thresholds for loss of functional independence, where 100% of participants performed below criterion-referenced threshold values for aerobic endurance. Walking distance for people with dementia was associated with bath/shower activity (p = .007), transfers (p < .001), and mobility (p = .013). Less distance walked was associated with more assistance with self-care tasks. Physical deficits associated with low aerobic endurance and lower body strength compromised independence, placing dyads at risk for falls and mobility-related health issues.

Declines in grip strength may indicate early changes in cognition in healthy middle-aged adults.

Declining grip strength is an indicator of cognitive loss in older individuals but it has not been explored people younger than 65 years old. The purpose of this study was to investigate the relationship between grip strength and specific cognitive tests known to decline with mild cognitive impairment in young and middle-aged adults. Declines in cognitive performance in middle-aged adults may provide evidence that these changes occur earlier than previously reported. A cross sectional design was used to compare differences between young and middle-aged healthy adults and to investigate associations between cognitive and grip strength measures within groups. Healthy young (20-30 years old) and middle-aged (45-65 years old) adults completed five cognitive tests including the Stroop, California Verbal Learning Test, Symbol Digit Modalities Test, Trail Making Tests and the Controlled Oral Word Association Test. All participants completed right and left maximum grip strength measures. Middle-aged adults performed significantly worse on right and left grip strength and the Stroop test (p<0.05) when compared to the younger group. There were no significant relationships among grip strength and cognitive performance at the whole-group level or within the younger-age group; however, weaker grip strength was significantly associated with poorer Controlled Oral Word Association Test total cluster (r = 0.458; p < .05) and Stroop interference (r = 0.471; p < .05) scores in the middle-aged group. Findings from this study suggest that cognitive changes may occur earlier than previously thought (prior to age 65). Weaker grip strength was significantly associated with poorer function in two of the cognitive measures in the middle-age group, suggesting that some domains of cognition, specifically semantic categorization and executive function, may be particularly sensitive to age-related changes.

Asymmetries in force matching are related to side of stroke in right-handed individuals.

Asymmetries in grasp force matching extend beyond quantifying a single measure of maximum grip strength and advance our application of side-specific treatment interventions. A cross sectional study design investigated grasp-force matching performance in right-handed individuals with a stroke and age-matched healthy controls. A visual representation of the 20% Maximum Voluntary Contraction (MVC) was matched in three conditions in the absence of visual feedback with the same (Ipsilateral Remembered - IR) or opposite hand (Concurrent - CC and Contralateral Remembered - CR). Greater overall relative error (RE) was found in contralateral compared to ipsilateral matching tasks. In the CR condition, post hoc analysis revealed significant differences between control and right hemisphere damage (RHD) group (95% CI [16.41-88.59]; p < 0.01) as well as left hemisphere damage (LHD) group and RHD (95% CI [23.4-95.09]; p < 0.01). Right hand matching relative error was 2.49 times larger in the RHD compared to the LHD group. Within the RHD group, matching errors were greater for the right than left hand in both contralateral conditions (95% CI [34.25-101.07]; p < 0.001). Individuals with RHD showed greater asymmetries in contralateral matching tasks compared to LHD and controls. More specifically, the RHD group had the greatest difficulty matching tasks with their right (non-paretic) than left (paretic) hand. In order to elucidate this asymmetry in the clinic the use of complementary grasp measures may be considered.

Upper Limb Asymmetry in the Sense of Effort Is Dependent on Force Level.

Previous studies have shown that asymmetries in upper limb sensorimotor function are dependent on the source of sensory and motor information, hand preference and differences in hand strength. Further, the utilization of sensory and motor information and the mode of control of force may differ between the right hand/left hemisphere and left hand/right hemisphere systems. To more clearly understand the unique contribution of hand strength and intrinsic differences to the control of grasp force, we investigated hand/hemisphere differences when the source of force information was encoded at two different force levels corresponding to a 20 and 70% maximum voluntary contraction or the right and left hand of each participant. Eleven, adult males who demonstrated a stronger right than left maximum grasp force were requested to match a right or left hand 20 or 70% maximal voluntary contraction reference force with the opposite hand. During the matching task, visual feedback corresponding to the production of the reference force was available and then removed when the contralateral hand performed the match. The matching relative force error was significantly different between hands for the 70% MVC reference force but not for the 20% MVC reference force. Directional asymmetries, quantified as the matching force constant error, showed right hand overshoots and left undershoots were force dependent and primarily due to greater undershoots when matching with the left hand the right hand reference force. Findings further suggest that the interaction between internal sources of information, such as efferent copy and proprioception, as well as hand strength differences appear to be hand/hemisphere system dependent. Investigations of force matching tasks under conditions whereby force level is varied and visual feedback of the reference force is available provides critical baseline information for building effective interventions for asymmetric (stroke-related, Parkinson's Disease) and symmetric (Amyotrophic Lateral Sclerosis) upper limb recovery of neurological conditions where the various sources of sensory - motor information have been significantly altered by the disease process.

Handgrip strength as a means of monitoring progression of cognitive decline - A scoping review.

Cognitive decline in older adults contributes to reduced ability to perform daily tasks and continued disuse leads to muscle weakness and potentiates functional loss. Despite explicit links between the motor and cognitive systems, few health care providers assess motor function when addressing the needs of individuals with cognitive loss. Early and easy measurable biomarkers of cognitive decline have the potential to improve care for individuals with dementia and mild cognitive impairment. The aim of this study was to conduct a systematic search to determine the relationship among handgrip strength, as a measure of global muscle strength, and cognitive decline over time. Fifteen prospective, cohort, longitudinal studies of adults >60years old who were healthy or at risk of cognitive decline at study onset were included in the review. Studies that investigated changes in cognition relative to baseline grip strength and, those that investigated changes in grip strength relative to cognitive function were revealed. Findings here support the use of handgrip strength as a way to monitor cognitive changes and show that reduced handgrip strength over time may serve as a predictor of cognitive loss with advancing age.

Construct validity of the Modified Gait Efficacy Scale in older females.

There are few well-validated tools that focus on the assessment of walking confidence in older adults. The main objective of this study was to assess construct validity of the 10-item Modified Gait Efficacy Scale (mGES) as a measure of walking confidence in older adults. Twenty-four older females completed the mGES, the 16-item Activities-specific Balance Confidence (ABC-16) scale, and the Senior Fitness Test (SFT). Construct validity of the mGES was evaluated by quantifying relationships between the mGES and the ABC-16 and the SFT, and by examining the ability of the mGES to discriminate between known groups (no/lower fear of falling versus higher fear of falling). There was a strong correlation between mGES and the ABC-16 scale (rs = 0.85; p < 0.001). The mGES was significantly associated with SFT components that required lower extremity strength, stepping aerobic endurance, and walking agility and dynamic balance (rs = 0.45 to 0.61; p < 0.05). Relationships between the mGES and number of arm curls in 30 s, chair sit and reach test, and back scratch test were weak (rs = 0.13-0.25; p > 0.05). Mean mGES score was 91.5% in a no/lower fear of falling group, while it was 81.4% in a higher fear group (p = 0.22). There was a trend toward a significant difference in the unstandardized residuals derived from regression of ranked mGES scores on ranked covariate (age and 8 foot up and go) scores, between the no/lower versus higher fear of falling group (p = 0.095). These results support construct validity of the mGES as a measure of gait self-efficacy in community-dwelling older females.

Contribution of Head Position, Standing Surface, and Vision to Postural Control in Community-Dwelling Older Adults.

Postural control requires the integration of sensorimotor information to maintain balance and to properly position and orient the body in response to external stimuli. Age-related declines in peripheral and central sensory and motor function contribute to postural instability and falls. This study investigated the contribution of head position, standing surface, and vision on postural sway in 26 community-dwelling older adults. Participants were asked to maintain a stable posture under conditions that varied standing surface, head position, and the availability of visual information. Significant main and interaction effects were found for all three factors. Findings from this study suggest that postural sway responses require the integration of available sources of sensory information. These results have important implications for fall risks in older adults and suggest that when standing with the head extended and eyes closed, older adults may place themselves at risk for postural disequilibrium and loss of balance.

Reliability and validity of cervical position measurements in individuals with and without chronic neck pain.

OBJECTIVES: The cervical range of motion device (CROM) has been shown to provide reliable forward head position (FHP) measurement when the upper cervical angle (UCA) is controlled. However, measurement without UCA standardization is reflective of habitual patterns. Criterion validity has not been reported. The purposes of this study were to establish: (1) criterion validity of CROM FHP and UCA compared to Optotrak data, (2) relative reliability and minimal detectable change (MDC95) in patients with and without cervical pain, and (3) to compare UCA and FHP in patients with and without pain in habitual postures. METHODS: (1) Within-subjects single session concurrent criterion validity design. Simultaneous CROM and OP measurement was conducted in habitual sitting posture in 16 healthy young adults. (2) Reliability and MDC95 of UCA and FHP were calculated from three trials. (3) Values for adults over 35 years with cervical pain and age-matched healthy controls were compared. RESULTS: (1) Forward head position distances were moderately correlated and UCA angles were highly correlated. The mean (standard deviation) differences can be expected to vary between 1·48 cm (1·74) for FHP and -1·7 (2·46)° for UCA. (2) Reliability for CROM FHP measurements were good to excellent (no pain) and moderate (pain). Cervical range of motion FHP MDC95 was moderately low (no pain), and moderate (pain). Reliability for CROM UCA measurements was excellent and MDC95 low for both groups. There was no difference in FHP distances between the pain and no pain groups, UCA was significantly more extended in the pain group (P<0·05). DISCUSSION: Cervical range of motion FHP measurements were only moderately correlated with Optotrak data, and limits of agreement (LOA) and MDC95 were relatively large. There was also no difference in CROM FHP distance between older symptomatic and asymptomatic individuals. Cervical range of motion FHP measurement is therefore not recommended as a clinical outcome measure. Cervical range of motion UCA measurements showed good criterion validity, excellent test-retest reliability, and achievable MDC95 in asymptomatic and symptomatic participants. Differences of more than 6° are required to exceed error. Cervical range of motion UCA shows promise as a useful reliable and valid measurement, particularly as patients with cervical pain exhibited significantly more extended angles.

Age and task differences in functional fitness in older women: comparisons with Senior Fitness Test normative and criterion-referenced data.

Age-related changes in physical abilities, such as strength and flexibility, contribute to functional losses. However, older individuals may be unaware of what specific physical abilities compromise independent functioning. Three groups of women, aged 60 to 69, 70 to 79, and 80 to 92 years, were administered the Senior Fitness Test (SFT) to determine age differences in physical abilities and risk for functional losses. The oldest group showed significant differences in lower body strength, aerobic endurance, and agility and dynamic balance when compared with the other groups who performed similarly. Across all groups, a faster rate of decline was found for lower body strength (50.6%) and dynamic balance and agility (45.7%) than upper body strength (21.3%) and aerobic endurance (33.6%). Criterion-referenced (CR) fitness standards suggested that 45% of the individuals were at risk for loss of independent functioning. This study highlights age-related differences in physical abilities and the risk for the loss of independence in later life.

Grasp force matching and brain iron content estimated in vivo in older women.

Increased brain iron content has been linked to neural degeneration and to age-related decline of cognitive and motor functions. The basal ganglia (BG), which contain significant amount of iron, play an important role in establishing and modulating force requirements in hand grasp to meet specific task demands. However, it is unclear if increased BG iron content contributes to age differences in hand grasp performance. To investigate the relationship between BG iron content and hand grasp force matching in older (65.0 ± 8.9 years) healthy women, participants generated a 20% maximum voluntary exertion reference force that was matched with the opposite hand in the Contralateral Remembered (CR) and Contralateral Concurrent (CC) conditions and with the same hand in the Ipsilateral Remembered (IR) condition. T2* relaxation times calculated from MRI scans served to estimate iron content in the caudate nucleus (Cd), globus pallidus (GP), and putamen (Pt). Greater iron content in all BG was associated with relatively greater number of errors committed when matching force with the opposite hand in the CR and CC conditions than with the same hand in the IR condition. Younger women with greater estimated iron content committed more errors than their older counterparts with lesser estimated iron content in Cd and Pt. Greater iron content in the BG may contribute to sensorimotor declines in healthy women, and relative iron content quantified by MRI may be a promising biomarker of such.

Sense of effort revisited: relative contributions of sensory feedback and efferent copy.

Although controversial, muscular effort perception is frequently attributed to the efferent copy of the associated motor command. While peripheral/sensory information is thought to be necessary for force modulation/control, it is not involved in initial force production. We recently showed in right-handers, that perception of effort was asymmetric for grasp-force tasks. This asymmetry was related to individual differences in right and left hand strength and an intrinsic component. A difference in gain (input/output magnitude relationship) for each limb/hemisphere system was proposed as the mechanism explaining intrinsic asymmetries. To further investigate the relative contributions of efferent copy and sensory feedback to the sense of effort, vibration was used to distort sensory information from the muscles providing the reference force. Visual feedback (vision) of the reference hand force was also manipulated. The absolute error (AE) was generally larger in the vision than no-vision condition and the influence of reference hand vibration was significant for left hand matching of the right hand reference force. However, this effect was negligible when matching in the reverse condition. These two results may reflect an interaction between two phenomena: (1) visual feedback, which represents the total output force may not be congruent with the internal representation of effort associated with the efferent copy and eventually the proprioceptive feedback; and (2) a vibration-induced larger AE for left than right hand contralateral matching indicates that the contribution of proprioceptive feedback to force matching is significant for the left but not the right hand/hemisphere system. Overall, it may be suggested that in right-handers, the sense of effort associated with the right hand may be primarily based on the efferent copy while the left hand/hemisphere system may use a combination of efferent copy and proprioceptive feedback. However, the weight of each type of information may depend on the association between motor command and representation of the execution of the motor command (visual vs. internal).

The contribution of head position, standing surface and vision to postural control in young adults.

Postural control requires the integration of sensory information and is essential for performing every day movements and activities. Integrating sensory information from multiple sources may be challenging when competing sources of sensory information are affected. To further understand this complex relationship, this study investigated the contribution of varying sources of sensory information to postural control in healthy, young participants. Sixty young healthy adults (n=22 males; mean age, 24.6 ± 2.1 SD years and (n=38 females, mean age 24.0 ± 1.4 SD years) were asked to maintain a stable posture under conditions that varied standing surface, head position and the availability of visual information. Sway velocity was largest when standing on foam with eyes closed and head extended (2.07°/s) however, under the same visual-surface conditions with the head in a neutral position, sway velocity (1.59°/s) was smaller yet remained significant. Findings from this study suggest that postural sway responses are dependent on the combined integration of available sources of sensory information. It is anticipated that such baseline information will allow us to apply our findings to the clinical management of individuals suffering from balance and vestibular impairments.

Age differences in virtual environment and real world path integration.

Accurate path integration (PI) requires the integration of visual, proprioceptive, and vestibular self-motion cues and age effects associated with alterations in processing information from these systems may contribute to declines in PI abilities. The present study investigated age-related differences in PI in conditions that varied as a function of available sources of sensory information. Twenty-two healthy, young (23.8 ± 3.0 years) and 16 older (70.1 ± 6.4 years) adults participated in distance reproduction and triangle completion tasks (TCTs) performed in a virtual environment (VE) and two "real world" conditions: guided walking and wheelchair propulsion. For walking and wheelchair propulsion conditions, participants wore a blindfold and wore noise-blocking headphones and were guided through the workspace by the experimenter. For the VE condition, participants viewed self-motion information on a computer monitor and used a joystick to navigate through the environment. For TCTs, older compared to younger individuals showed greater errors in rotation estimations performed in the wheelchair condition, and for rotation and distance estimations in the VE condition. Distance reproduction tasks (DRTs), in contrast, did not show any age effects. These findings demonstrate that age differences in PI vary as a function of the available sources of information and by the complexity of outbound pathway.

Upper limb kinesthetic asymmetries: gender and handedness effects.

Proprioceptive and motor information contribute to movement representation; however, the equivalence of homologous contralateral sensorimotor processes as a function of gender and handedness has received little attention. The present work investigated asymmetry in contralateral reproductions of movements elicited by tendon vibration in right and left handed young adults of both genders. With eyes closed, illusions of elbow flexion movement elicited by a 100 Hz vibration applied to the distal tendon of the right or left triceps muscle were matched concurrently with the opposite limb. Overall, movement velocity was larger for females than males, asymmetric and handedness dependent in males. Conversely, consistent symmetry was found between left and right-handed females. These findings lead us to suggest that hand preference and gender contribute to differences in movement representation that may result from the combination of cortical structural differences and information processing specific to each hemisphere and gender.

Asymmetry in grasp force matching and sense of effort.

While asymmetries in upper limb force matching have been observed, the mechanisms underlying asymmetry in the sense of effort have not been conceptualized. The aim of this study was to investigate asymmetries in the perception and reproduction of grasp force. Forty-two young adults, 22 right-handed (RH) and 20 left-handed (LH), were, respectively, divided into three groups according to differences between their right and left-hand strength (left stronger than right, right stronger than left and right & left equivalent). A reference force, representing 20% of the maximal voluntary contraction (MVC) produced by the right or left hand, was matched with same hand (Ipsilateral Remembered--IR) or opposite (Contralateral Remembered--CR) hand. The matching relative error was 92% (for RH) and 46% (for LH) greater in the CR than IR condition. Asymmetries in matching were significant for RH participants only in the CR condition and were dependent on right/left differences in hand strength as shown by the constant error (CE). For this RH population, right-hand overshoot of the left-hand reference and left-hand undershoot of the right-hand reference were significant when the right hand was stronger than the left. Asymmetry remained significant when CE was normalized (%MVC). Asymmetry was reduced when the strength of each hand was equivalent or when the left hand was stronger than the right. These findings suggest that effort perception is asymmetric in RH but not in LH individuals. The hand x strength interaction indicates that asymmetry in force matching is a consequence of both a difference in the respective cortical representations and motor components, which confer a different "gain" (input-output relationship) to each system. The similarity with position sense asymmetry suggests that the gain concept may be generalized to describe some functional/performance differences between the two hand/hemisphere systems. The more symmetrical performance of the LH than RH group underlines that context specific influence of handedness, hemisphere dominance and hemispheric interactions modulate performance symmetries/asymmetries.

Age-related declines in the detection of passive wrist movement.

Age-related changes in proprioceptive ability and their contributions to postural instability have been well documented. In contrast, and despite the known importance of proprioceptive feedback in the control of coordinated arm and hand movement, studies focusing on upper limb proprioception in older populations are few and equivocal in their findings. This study focused on kinesthetic awareness about the wrist joint in healthy young and older adults. Passive movement detection thresholds (PMDTs) were twice as high in older compared to young participants. In contrast to previous findings demonstrating asymmetries in static position sense, PMDT did not differ between the dominant and non-dominant wrist joints nor did direction of joint displacement affect PMDT as has been reported for the lower limb. Preliminary analysis indicated that PMDT was significantly higher in older adults categorized as sedentary while active older adults were able to detect passive movement as well as young adults. These findings demonstrate that upper limb kinesthesia is impaired in older adults although the degree of impairment may be influenced by one's level of physical activity.

Establishing hand preference: why does it matter?

Hand preference has been associated with psychological and physical well-being, risk of injury, pathological irregularities, longevity, and cognitive function. To determine hand preference, individuals are often asked what hand they use to write with, or what hand is used more frequently in activities of daily living. However, relying only on one source of information may be misleading, given the strong evidence to support a disassociation between self-reported hand preference and outcomes of hand performance assessments. This brief communication is intended to highlight the various methods used to determine hand preference, to discuss the relationship between hand preference inventories and performance measures and to present some recent findings associated with hand preference and musculoskeletal disorders.

Contribution of sensory and motor components to motor control asymmetries: an analytical model approach.

Proprioceptive and motor information contribute to movement representation; however, the equivalence of homologous contralateral information has received little attention. In a recent study using the matching paradigm we showed that upper limb position sense, based on feedback control, is asymmetric and this asymmetry could be associated with a difference in gain between left (L) and right (R) sensorimotor systems. The current results also show that movement sense is asymmetric in males and this asymmetry is dependent on handedness. It is assumed that a difference in gain between each sensorimotor system may be associated with asymmetric kinesthetic representations in cortical areas. Outcomes of models representing position and velocity control respectively suggest that velocity matching may be primarily controlled in a feed forward mode. Furthermore, compatibility between the models representing position control and velocity control also indicate that i) a difference between the L and R motor gains alone is not possible and ii) there must be a difference between the L and R sensory gains. Hence, the results strongly suggest a difference in movement representation between the two hand/hemisphere systems.

The influence of age and physical activity on upper limb proprioceptive ability.

Our understanding of age-related declines in upper limb proprioceptive abilities is limited. Furthermore, the extent to which physical activity might ameliorate age-related changes in proprioception is not known. Upper limb proprioceptive acuity was examined in young and older (active and sedentary) right-handed adults using a wrist-position-matching task that varied in terms of processing demands. Older individuals were also classified according to their participation in tasks specific to the upper limb. Errors were greater for older than younger individuals. Older sedentary adults showed greater errors and performed movements less smoothly than older active adults. The nonspecific group showed greater errors and longer movement times than the upper-limb-specific group. In older adults, decreased ability to perceive limb position may be related to a sedentary lifestyle and declines associated with memory and transfer of proprioceptive information. Performing tasks specific to the upper limbs may reduce age-related declines in proprioception.

Position sense asymmetry.

Asymmetries in upper limb position sense have been explained in the context of a left limb advantage derived from differences in hemispheric specialization in the processing of kinesthetic information. However, it is not clearly understood how the comparison of perceptual information associated with passive limb displacement and the corresponding matching movement resulting from the execution of a motor command contributes to these differences. In the present study, upper limb position sense was investigated in 12 right-hand-dominant young adults performing wrist position matching tasks which varied in terms of interhemispheric transfer, memory retrieval and whether the reference position was provided by the same or opposite limb. Right and left hand absolute matching errors were similar when the reference and matching positions were produced by the same hand but were 36% greater when matching the reference position with the opposite hand. When examining the constant errors generated from matching movements made with the same hand that provided the reference, the right and left hand matching errors (approximately 3 degrees) were similar. However, when matching with the opposite limb, a large overshoot (P < 0.05) characterized the error when the right hand matched the left hand reference while a large undershoot (P < 0.05) characterized the error when the left hand matched the right hand reference. The overshoot and undershoot were of similar magnitude (approximately 4 degrees). Although asymmetries in the central processing of proprioceptive information such as interhemispheric transfer may exist, the present study suggests that asymmetries in position sense predominantly result from a difference in the "gain of the respective proprioceptive sensory-motor loops". This new hypothesis is strongly supported by a dual-linear model representing the right and left hand sensory-motor systems as well as morphological and physiological data.