Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case-control study.

BACKGROUND: Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups. METHODS: Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables. RESULTS: There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking. CONCLUSIONS: Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.

Effect of progressive bridging exercise on weight-bearing during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke: A randomised controlled trial.

OBJECTIVE: To examine the effect of a progressive bridging exercise on force, time, and pressure during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke. DESIGN: A single-blinded randomised controlled trial. SETTING: Hospital. PARTICIPANTS: Forty-eight individuals with acute ischemic stroke, not at brainstem and cerebellum, randomly allocated to the intervention (n = 24) and control (n = 24) groups. Five participants dropped out during the 2-month follow-up, but they were in the intention-to-treat analysis. INTERVENTIONS: The intervention group undertook a 45-min conventional physiotherapy and a 30-min progressive bridging exercise. The control group received only the conventional exercise. MAIN MEASURES: Peak vertical ground reaction force, time to peak force, peak foot pressure, and regional peak foot pressure during the extension phase of sit-to-stand, and sitting-to-standing item of the Motor Assessment Scale were assessed before training, after 4-week training, and 2-month follow-up. RESULTS: The intervention group showed significantly (p < 0.001) less difference in peak vertical ground reaction force between feet during the extension phase of sit-to-stand than the control after 4-week training (mean ± standard deviation; intervention, 5.38 ± 3.99; control, 17.1 ± 10.3) and 2-month follow-up (intervention, 6.79 ± 3.84; control, 17.5 ± 9.89), and demonstrated significantly (p < 0.001) higher score in sit-to-stand than the control after training [mean (interquartile range); intervention, 5 (2-5); control, 2 (1-2)] and follow-up [intervention, 2 (2-5); control, 2 (1-2)]. Both groups demonstrated peak foot pressure on the medial and lateral heels, metatarsals, and hallux regions. CONCLUSION: Progressive bridging exercise improved symmetrical weight bearing during the extension phase of sit-to-stand, consequently enhanced sit-to-stand ability in individuals with stroke.

A Pilot Study of a 12-Week Leg Exercise and a 6- and 12-Month Follow-Up in Community-Dwelling Diabetic Elders: Effect on Dynamic Standing Balance.

OBJECTIVE: To determine the effects of 12-week leg exercise and follow-up on fasting blood glucose (FBG), blood pressure, static and dynamic standing balance time, leg muscle strength, and leg exercise behaviors in type 2 diabetic elderly. MATERIAL AND METHOD: Fourfemales, completing 12-week leg exercise group and 6- and 12-monthfollow-up were examined for FBG blood pressure, standing on firm and foam surfaces, single leg stance, Five-Times-Sit-to-Stand Test (FTSST), alternated stepping, and leg muscle strength at before leg exercise, week 12 of exercise, and months 6 and 12 follow-up after exercise. Friedman's ANOVA was used to compare these variables among 4 periods. Exercise behaviors were asked at months 6 and 12follow-up. RESULTS: Significant decreased time was observed in FTSST between before and at week 12, and alternated stepping between before and at month 6. For one year follow-up, two participants performed leg exercise regularly. According to patients' interviews, they continued leg exercise because ofreduced leg pain and stiffness, compliance to physiotherapist's suggestions, and exercise addiction. CONCLUSION: Leg exercise enhanced FTSST and alternated stepping produced good qualityfeeling in leg in diabetic elderly. Physiotherapists may be a keyfor continuing leg exercise in community-dwelling diabetic elderly.

Factors determining functional ability of individuals with stroke in community.

OBJECTIVE: The present study was conducted to assess the factors explaining functional ability in community-dwelling individuals with stroke. MATERIAL AND METHOD: In all, 758 persons with acute stroke who lived in the community and joined the home physical therapy program were recruited. The personal characteristics and clinical measures were recorded at the first home visit. Measures included Glasgow coma score, Stroke Rehabilitation Assessment of Movement (STREAM), Postural Assessment Scale for Stroke Patients (PASS) including PASS-maintaining position and PASS-changing position and Barthel index. RESULTS: Five variables: the PASS-maintain, PASS-change, STREAM, Glasgow coma score, and age were selected by stepwise multiple regression analysis to explain 85.6% of the variance of the Barthel Index score. The strongest predictor was the PASS-maintain, which explained 81.5% of functional score. CONCLUSION: The ability to maintain sitting and standing were the main contributors of activity daily living (ADL) ability. Physical therapists should emphasize treatment to improve these abilities in persons with acute stroke to promote independent ADL.

Postural balance, visual verticality perception, and its association in individuals with and without neck pain.

OBJECTIVE: To compare postural balance and visual verticality perception between neck pain and asymptomatic subjects; to determine its association within groups. MATERIAL AND METHOD: Fourteen neck pain and 14 asymptomatic subjects participated in the study. Subjects stood on a force platform to measure the displacement of the center of pressure in the medial-lateral and anterior-posterior directions, total path length, and sway velocity. Subjects performed 10 patterns of the rod and frame test in the sitting position to measure absolute errors of visual verticality perception. Postural balance variables between neck pain and asymptomatic participants were determined by Independent t-test. Two-way analysis of variance determined the effect of absolute errors of visual verticality perception, groups and its interaction. The association between postural balance variables and absolute errors of visual verticality perception was determined by Pearson's correlation. RESULTS: Neck pain patients showed greater total path length and sway velocity than asymptomatic subjects. Similar absolute errors of visual verticality perception between groups were shown. No correlation between postural balance variables and absolute errors of visual verticality perception within groups was demonstrated. CONCLUSION: Postural balance, not visual verticality perception was disturbed in individuals with neck pain. Postural balance was not associated with visual verticality perception in individuals with and without neck pain.

Learning of the bimanual cup-stacking task in individuals with chronic stroke improved with dyad training protocol.

OBJECTIVE: To compare the effects of dyad and individual training on the learning of bimanual cup-stacking in individuals with chronic stroke. MATERIAL AND METHOD: Twenty participants were divided into dyad and individual groups. The dyad group performed the task in pairs alternating between performing and observing, while the individual group performed individually. On the first day (acquisition phase: AP), allparticipants performed 20 trials. On the following day (retention phase: RP), they performed 10 trials; each participant individually performed five trials without verbal feedback followed by five trials with verbal feedback. The dependent measures were movement time (MT), which was a measure of motor execution, and reaction time (RT), a measure of motor planning. RESULTS: During the initial trials, the dyad group performed the task with longer MT. By the end of the AP their time was significantly shorter At the R, only the dyad group maintained the improved MT of cup stacking. Although the RT was not different between the two groups at the RE, only the RTof the dyad group reduced significantly at the RP compared with block l of the AP CONCLUSION: In individuals with chronic stroke, the dyad training protocol greatly enhanced the execution speed of the bimanual cup-stacking task when compared with the individual training protocol. Planning the task also improves dyad training.

Reach-to-grasp co-ordination in the paretic limbs of individuals with stroke: insight from a barrier paradigm.

OBJECTIVE: Reach and grasp components must be co-ordinated to preserve the optimal reach-to-grasp performance. However conflicting results regarding the deficit in reach-to-grasp co-ordination has been reported in the paretic hand of individuals after stroke. Additionally, investigations have not been undertaken to study more challenging task constraints to induce the impairment of reach-to-grasp co-ordination. This study aimed to compare reach-to-grasp co-ordination while avoiding an obstacle in the paretic hand of individuals after stroke with matched non-disabled adults. MATERIAL AND METHOD: Twenty-four participants having mild severity of upper extremity impairment were recruited with an equal number of non-disabled adults. Kinematic reach-to-grasp movements with obstacle avoidance were analyzed. Reach-to-grasp co-ordination was quantified using cross-correlation analysis: maximum correlation coefficient represented the spatial aspect and the time lag represented the temporal aspects. RESULTS: Individuals after stroke showed a significant disturbance in the temporal aspect of reach-to-grasp co-ordination, but not the spatial aspect as compared with non-disabled adults. CONCLUSION: Among participants, after stroke reach-to-grasp co-ordination was delayed in the temporal aspect of reach-to-grasp with obstacle avoidance but preserved in the spatial aspect. Specific methods to assess reach-to-grasp co-ordination and to treat the time delay to improve co-ordination should be considered in individuals after stroke.

A comparison of home-based exercise programs with and without self-manual therapy in individuals with knee osteoarthritis in community.

OBJECTIVE: The present study aimed to compare the effectiveness of the treatment programs of home-based exercise with and without self-manual therapy in individuals with knee osteoarthritis (knee OA) in community. MATERIAL AND METHOD: Forty-three participants with knee OA were randomly assigned in groups. All participants received the same home-based exercise program with or without self-manual therapy over 12 weeks. Outcome measures were pain intensity, range of motions, six-minute walk test distance, the knee injury and osteoarthritis outcome score (KOOS), short-form 36 (SF-36) and satisfaction. RESULTS: The results showed that the self-manual therapy program significantly decreased pain at 4 weeks, increased flexion and extension at 4 and 12 weeks, and improved the KOOS in pain item and SF-36 in physical function and mental health items. The home-based exercise group showed significant increase of the six-minute walk distance at 4 and 12 weeks, improvements in the KOOS in pain and symptom items and SF-36 in the physical function and role-emotional items. CONCLUSION: Overall, the results favored a combination of self-manual therapy and home-based exercise for patients with knee OA, which apparently showed superior benefits in decreasing pain and improving active knee range of motions.

Balance performance, falls-efficacy and social participation in patients with type 2 diabetes mellitus with and without vestibular dysfunction.

Background: The performance of balance is an important factor to perform activities. The complications of type 2 diabetes mellitus (T2DM), especially vestibular dysfunction (VD), could decrease balance performance and falls-efficacy (FE) which consequently impacts social participation and quality of life (QoL). Purpose: This study aimed to compare balance performance, FE, social participation and QoL between individuals with T2DM with and without VD. Methods: The participants comprised 161 T2DM with VD and 161 without VD. Three clinical tests used for confirming VD included the Head Impulse Test (HIT), the Dix Hallpike Test (DHT) and the Supine Roll Test (SRT). The scores of static and dynamic balances, FE, social participation and QoL were compared between groups. Results: The balance performance, FE, social participation and QoL were lower in the group with VD. The number of patients who had severe social restriction was higher in T2DM with VD than without VD (58.4% vs 48.4%). Moreover, all domains of QoL (physical, psychological, social relationships and environmental) were lower in T2DM with VD than without VD. Conclusion: The presence of VD in T2DM patients was associated with decreased physical balance performances and increased social and QoL disengagement. Comprehensive management related to balance and FE, as well as the monitoring to support social participation and QoL, should be emphasized in patients with T2DM with VD.

Non-linear dose response effect of cathodal transcranial direct current stimulation on muscle strength in young healthy adults: a randomized controlled study.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a technique that modulates brain excitability in humans. Increasing the stimulation intensity or duration within certain limits could enhance tDCS efficacy with a polarity-dependent effect; anodal stimulation increases cortical excitability, whereas cathodal stimulation decreases excitability. However, recent studies have reported a non-linear effect of cathodal tDCS on neuronal excitability in humans, and there is no conclusive result regarding the effect of cathodal tDCS on muscle performance. METHODS: Our study aimed to investigate the immediate effects of different intensities (i.e., 1, 1.5, and 2 mA and sham tDCS) of cathodal tDCS on muscle strength in healthy participants. All participants [mean age 23.17 (3.90) years] were recruited and randomly allocated into four groups (1, 1.5, and 2 mA cathodal tDCS and sham tDCS). Muscle strength in bilateral upper and lower extremities was measured before and immediately after tDCS using a handheld dynamometer. RESULTS: Our results showed that cathodal tDCS at 1 and 1.5 mA reduced muscle strength bilaterally in upper and lower extremity muscles, whereas stimulation at 2 mA tended to increase muscle strength on the dominant limb. CONCLUSION: These findings support the non-linear effects of cathodal tDCS on muscle strength, which should be considered for the clinical use of tDCS in motor rehabilitation. TRIAL REGISTRATION: NCT04672122, date of first registration 17/12/2020.

Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone.

OBJECTIVE: To determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC(95)) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone. DESIGN: Test-retest study. Data were collected on 2 occasions, about 6 days apart. SETTING: Outpatient physical therapy clinics. PARTICIPANTS: Volunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Reliability and absolute and relative MDC(95) of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed "Up & Go" test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT). RESULTS: Excellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC(95) in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC(95) of the subgroups were varied based on ankle plantarflexor tone. CONCLUSIONS: The BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC(95) of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC(95) seems more useful than the absolute MDC(95) because the relative value can be used for a single individual.

The Adaptation of Participation Scale Short Simplified Questionnaire into Indonesian Language and the Psychometric Properties in Individuals with Type 2 Diabetes Mellitus with Vestibular Dysfunction.

Background: Type 2 diabetes mellitus (T2DM) has been reported to affect the vestibular system resulting in dizziness and vertigo complaints. This complication is known to disable the social participation. The Participation Scale Short Simplified (PSSS) has been developed to quantify the severity of social participation restrictions. The aim of this study was to translate and cross-culturally adapt the PSSS into Indonesian Bahasa (PSSS-Ina). The measurement properties of the translated version and the factors contributing to the severe participation restriction were determined. Methods: The participants comprised 55 T2DM with vestibular dysfunction (VD) in the community center for diabetes mellitus in Central Java, Indonesia. The signs of VD were confirmed by head impulse test, Dix Hallpike Test, and supine roll test. The PSSS-Ina was administered twice with a four-week interval. The physical examination was also performed to identify the contributing factors. Results: The test-retest reliability of the PSSS Indonesian Bahasa version (PSSS-Ina) between two measurement sessions was excellent (ICC of 0.93, p < 0.001, and 95% CI: 0.88-0.95). The correlation coefficient between two administrations was high (r = 0.88). Based on the demonstrated content validity, the values of the corrected item and total correlation were greater than 0.3. No floor and ceiling effects were observed. The good internal consistency was confirmed with Cronbach's alpha of 0.84. The factor analysis produced three factors of activity participation, social engagement, and work-related participation. The multiple logistic regression revealed that the balance performance of mCTSIB was the main factor contributing to the severe participation restriction reflected by the PSSS-Ina score. Conclusion: The Indonesian version of the PSSS-Ina demonstrated excellent comprehensibility and reliability in individuals suffering T2DM with VD. This tool is therefore helpful in identifying the participation limitation in individuals with VD.

Effectiveness of Motor Imagery Combined with Structured Progressive Circuit Class Training on Functional Mobility in Post-Stroke Individuals: A Randomized Controlled Trial.

OBJECTIVE: To compare the effect of motor imagery combined with structured progressive circuit class therapy vs health education combined with structured progressive circuit class therapy on dynamic balance, endurance, and functional mobility in post-stroke individuals. DESIGN: Randomized controlled trial. METHODS: A total of 40 post-stroke individuals were randomly assigned to experimental and control groups. The experimental group was trained using motor imagery combined with structured progressive circuit class therapy, while the control group received health education combined with structured progressive circuit class therapy, 3 times a week for 4 weeks with an overall of 12 sessions. Outcomes included the step test for affected and unaffected limbs, the 6-Minute Walk Test, and the Timed Up and Go test. Assessments were performed at baseline, 2 weeks, and 4 weeks after the intervention Results: There were significant effects (p < 0.05) of: group on the step test for unaffected limb; of time on all outcomes; and of their interaction effect on the step test for affected limb, 6-Minute Walk Test, and Timed Up and Go test. Inter-group comparison showed significant differences (p < 0.05) in the step test for unaffected limb at 2 weeks after the intervention. At 4 weeks after the intervention, significant differences (p < 0.05) were found in the step test for affected and unaffected limbs and in the Timed Up and Go test. CONCLUSION: Motor imagery combined with structured progressive circuit class therapy was more effective on the step test, 6-Minute Walk Test, and Timed Up and Go test than training with structured progressive circuit class therapy alone. This suggest that that motor imagery should be incorporated into training programmes for restoring dynamic balance, endurance, and functional mobility in post-stroke individuals.

Effects of home-based dual-hemispheric transcranial direct current stimulation combined with exercise on upper and lower limb motor performance in patients with chronic stroke.

PURPOSE: This study aimed to determine the effects of home-based dual-hemispheric transcranial direct current stimulation (dual-tDCS) combined with exercise on motor performance in patients with chronic stroke. MATERIALS AND METHODS: We allocated 24 participants to the active or sham group. They completed 1-h home-based exercise after 20-min dual-tDCS at 2-mA, thrice a week for 4 weeks. The patients were assessed using the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test, Timed Up and Go test, Five Times Sit-to-Stand Test, Six-meter Walk Test, and muscle strength assessment. RESULTS: Compared with the sham group, the active group showed improved FMA scores, which were sustained for at least 1 month. There was no between-group difference in the outcomes of the functional tasks. CONCLUSION: Home-based dual-tDCS could facilitate motor recovery in patients with chronic stroke with its effect lasting for at least 1 month. However, its effects on functional tasks remain unclear. tDCS is safe and easy for home-based self-administration for patients who can use their paretic arms. This could benefit patients without access to health care centres or in situations requiring physical distancing. This home-based tDCS combined with exercise has the potential to be incorporated into telemedicine in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONTwelve sessions of home-based dual-tDCS combined with exercises (3 days/week for 4 weeks) facilitated upper and lower limb motor recovery in patients with chronic stroke compared with exercise alone, with a post-effect for at least 1 month.Home-based tDCS could be safe and easily self-administrable by patients who can use their paretic arms.This intervention could be beneficial for patients living in the community without easy access to a health care centre or in situations where physical distancing is required.

Effects of Different Montages of Transcranial Direct Current Stimulation on Haemodynamic Responses and Motor Performance in Acute Stroke: A Randomized Controlled Trial.

OBJECTIVE: Transcranial direct current stimulation (tDCS) has shown positive results in neurorehabilitation. However, there is limited evidence on its use in acute stroke, and unclear evidence regarding the best tDCS montage (anodal-, cathodal-, or dualtDCS) for stroke recovery. This study investigated the effects of these montages combined with physical therapy on haemodynamic response and motor performance. METHODS: Eighty-two eligible acute stroke participants were allocated randomly into anodal, cathodal, dual, and sham groups. They received 5 consecutive sessions of tDCS combined with physical therapy for 5 days. Cerebral mean blood flow velocity (MFV) and motor outcomes were assessed pre and post-intervention and at a 1-month follow-up. RESULTS: None of the groups showed significant changes in the MFV in the lesioned or non-lesioned hemispheres immediately post-intervention or at a 1-month follow-up. For motor performance, all outcomes improved over time for all groups; between-group comparisons showed that the dual-tDCS group had significantly greater improvement than the other groups for most of the lower-limb performance measures. All 5-day tDCS montages were safe. CONCLUSION: MFV was not modulated following active or sham groups. However, dual-tDCS was more efficient in improving motor performance than other groups, especially for lower-limb performance, with after-effects lasting at least 1 month.

Gait symmetrical indexes and their relationships to muscle tone, lower extremity function, and postural balance in mild to moderate stroke.

OBJECTIVE: To investigate asymmetrical gait characteristics and degree of associations between gait symmetrical indexes and clinical measures in a stroke population. MATERIAL AND METHOD: Thirty patients with stroke participated in the present study. Clinical measures included muscle tone of affected hip adductors (HA), hip extensors (HE), knee extensors (KE), ankle plantar flexors (AP) and ankle invertors (AI), lower extremity function and postural balance. Symmetrical indexes of gait biomechanics included braking peak force (Y1), propulsive peak force (Y2), first peak vertical force (Z1) and second peak vertical force (Z2), step length, single support time (SST), step time, stance time and swing time were determined. RESULTS: The symmetrical index of force was significantly related with muscle tone and lower extremity function. Temporospatial variables significantly related to muscle tone and lower extremity function, but not to postural balance. CONCLUSION: Muscle tone and lower extremity function were important for walking efficiency as the presented relationships with symmetrical gait characteristic in patients with a stroke.

A structural equation model of falls at home in individuals with chronic stroke, based on the international classification of function, disability, and health.

PURPOSE: To use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF). MATERIALS AND METHODS: A cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home. RESULTS: FMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model. CONCLUSIONS: A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.

Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial.

Owing to advancement of medical technology and current knowledge, the population has a longer life expectancy, leading to an increase in the proportion of elderly. OBJECTIVE: The study aimed to investigate the effect of action observation (AO) combined with gait training on gait and cognition in elderly with mild cognitive impairment (MCI). METHODS: Thirty-three participants were randomly allocated to action observation with gait training (AOGT), gait training (GT), and control (CT) groups. The AOGT and GT groups received a program of observation and gait training protocol with the same total duration of 65 min for 12 sessions. For the observation, the AGOT group watched a video of normal gait movement, while the GT group watched an abstract picture and the CT group received no training program. All participants were assessed for gait parameters during single- and dual-tasks using an electronic gait mat system and were assessed for cognitive level using the Montreal Cognitive Assessment (MoCA) at baseline, after training and at 1-month follow-up. RESULTS: The results showed that the AOGT group had significant improvements in gait speeds during single- and dual-tasks, as well as better MoCA score, while the GT group had significant improvement only in gait speed. CONCLUSION: The adjunct treatment of AO with gait training provides greater benefits for both gait and cognitive performances in elderly with MCI.

Com o avanço da tecnologia médica e do conhecimento atual, a população tem uma expectativa de vida mais longa, levando a um aumento na proporção de idosos. OBJETIVO: O estudo teve como objetivo investigar o efeito da observação de ação (AO) combinada com o treinamento da marcha na marcha e cognição em idosos com comprometimento cognitivo leve (CCL). MÉTODOS: Trinta e três participantes foram alocados aleatoriamente para observação de ação com grupos de treinamento de marcha (AOGT), treinamento de marcha (GT) e controle (CT). Os grupos AOGT e GT receberam um programa de observação e protocolo de treinamento de marcha com a mesma duração total de 65 minutos por 12 sessões. Na observação, o grupo AGOT assistiu a um vídeo de movimento normal da marcha, enquanto o grupo GT assistiu a uma figura abstrata e o grupo CT não recebeu nenhum programa de treinamento. Todos os participantes foram avaliados quanto aos parâmetros da marcha durante tarefas simples e duplas, utilizando um sistema eletrônico de esteira da marcha e avaliados quanto ao nível cognitivo, utilizando a Avaliação Cognitiva de Montreal (MoCA) na linha de base, após o treinamento e 1 mês de acompanhamento. RESULTADOS: Os resultados mostraram que o grupo AOGT apresentou melhorias significativas nas velocidades da marcha durante tarefas simples e duplas, além do escore MoCA, enquanto o grupo GT teve melhora significativa apenas na velocidade da marcha. CONCLUSÃO: O tratamento adjunto da AO com o treinamento da marcha proporciona maiores benefícios tanto do desempenho da marcha quanto do desempenho cognitivo em idosos com CCL.

Fear of Falling, Lower Extremity Strength, and Physical and Balance Performance in Older Adults with Diabetes Mellitus.

Fear of falling (FoF) is known to affect the physical activities and quality of life of older adults with type 2 diabetes mellitus (DM). Many complications of DM, especially ones distressing lower extremity (LE), could lead to increased fall risk and FoF. This study aimed to explore the relationship between FoF, LE muscle strength, and physical performance in older adults without diabetes mellitus (ONDM) and with DM (ODM) with varying degrees of balance impairment. The participants comprised 20 ONDM and 110 ODM. The ODM was grouped by the number of failed performances of the modified clinical test of sensory interaction and balance (mCTSIB). The scores of FoF, balance performance of mCTSIB, physical performance of TUG, and LE muscle strength were compared between groups. The results showed that FoF was present in 30% and 60% of the ONDM and ODM, respectively. Forty percent of the ODM failed one condition of the mCTSIB, while 18% and 16% failed two and three conditions, respectively. As the number of failed performances on the mCTSIB increased, the proportions of participants with FoF significantly increased. The psychosocial domain of FoF, LE muscle strength, and TUG score was significantly different between groups and more affected in the ODM with a greater number of failed performances on the mCTSIB. In conclusion, the mCTSIB can differentiate the varying degrees of balance impairment among ODM. FoF, LE muscle strength, and physical performance are more affected as the degree of balance impairment increases. Comprehensive management related to balance and falls in the ODM should include a regular evaluation and monitoring of standing balance, LE muscle strength, physical performance, and FoF.

A randomized controlled trial of motor imagery combined with structured progressive circuit class therapy on gait in stroke survivors.

Structured Progressive Circuit Class Therapy (SPCCT) was developed based on task-oriented therapy, providing benefits to patients' motivation and motor function. Training with Motor Imagery (MI) alone can improve gait performance in stroke survivors, but a greater effect may be observed when combined with SPCCT. Health education (HE) is a basic component of stroke rehabilitation and can reduce depression and emotional distress. Thus, this study aimed to investigate the effect of MI with SPCCT against HE with SPCCT on gait in stroke survivors. Two hundred and ninety stroke survivors from 3 hospitals in Yangon, Myanmar enrolled in the study. Of these, 40 stroke survivors who passed the selection criteria were randomized into an experimental (n = 20) or control (n = 20) group. The experimental group received MI training whereas the control group received HE for 25 minutes prior to having the same 65 minutes SPCCT program, with both groups receiving training 3 times a week over 4 weeks. Temporo-spatial gait variables and lower limb muscle strength of the affected side were assessed at baseline, 2 weeks, and 4 weeks after intervention. After 4 weeks of training, the experimental group showed greater improvement than the control group in all temporospatial gait variables, except for the unaffected step length and step time symmetry which showed no difference. In addition, greater improvements of the affected hip flexor and knee extensor muscle strength were found in the experimental group. In conclusion, a combination of MI with SPCCT provided a greater therapeutic effect on gait and lower limb muscle strengths in stroke survivors.