Tango-therapy vs physical exercise in older people with dementia; a randomized controlled trial.

BACKGROUND: Dementia is a growing health concern that affects millions of people worldwide. Gait and mobility disorders are often present and represent a major risk factor for falls. The purpose of this study was to investigate the effectiveness of tango-therapy in gait speed, functional mobility, balance, falls, ability to perform activities of daily living and quality of life. METHODS: A randomised controlled trial with 31 participants living in a specialised dementia unit, aged 65 to 93 years old, who were randomly assigned to tango group (IG) or physical exercise group (CG). The primary outcome was gait speed and Timed Up and Go test. The secondary outcomes include the Short Physical Performance Battery, the ability to perform activities of daily living (Katz Index) and quality of life (Quality of life in Alzheimer Disease). Measurements were performed at baseline, and after one and three months of training. RESULTS: After 3 months, IG improved gait speed (p = 0.016), implying a statistically significant difference between groups in favour of IG (p = 0.003). CG significantly worsened the time to complete the TUG (p = 0.039). Both groups declined in their ability to perform activities of daily living, being statistically significant only in the CG (p < 0.001). CONCLUSION: Tango interventions showed efficacy in improving gait speed and in mitigating the decline in functional mobility and ADL skill capacities. Allowing older people with dementia access to non-pharmacological interventions may be a successful strategy to prevent functional decline. TRIAL REGISTRATION: Registered at ClinicalTrials.gov (ID: NCT05744011).

Muscle effort is best minimized by the right-dominant arm in the gravity field.

The central nervous system (CNS) develops motor strategies that minimize various hidden criteria, such as end-point variance or effort. A large body of literature suggests that the dominant (D) arm is specialized for such open-loop optimization-like processes, whereas the nondominant (ND) arm is specialized for closed-loop postural control. Building on recent results suggesting that the brain plans arm movements that take advantage of gravity effects to minimize muscle effort, the present study tests the hypothesized superiority of the dominant arm motor system for effort minimization. Thirty participants (22.5 ± 2.1 yr old; all right-handed) performed vertical arm movements between two targets (40° amplitude), in two directions (upward and downward) with their two arms (dominant and nondominant). We recorded the arm kinematics and electromyographic activities of the anterior and posterior deltoid to compare two motor signatures of the gravity-related optimization process; i.e., directional asymmetries and negative epochs on phasic muscular activity. We found that these motor signatures were still present during movements performed with the nondominant arm, indicating that the effort-minimization process also occurs for the nondominant motor system. However, these markers were reduced compared with movements performed with the dominant arm. This difference was especially prominent during downward movements, where the optimization of gravity effects occurs early in the movement. Assuming that the dominant arm is optimal to minimize muscle effort, as demonstrated by previous studies, the present results support the hypothesized superiority of the dominant arm motor system for effort minimization.NEW & NOTEWORTHY The hypothesis of hemispheric specialization for feedforward and feedback control has been developed and is still debated. Here, taking advantage of recent knowledge on optimal planning and control of arm movements in the gravity field, we recorded kinematics and electromyographic activities during vertical arm movements performed with the dominant and nondominant arms. Our results reveal that the nondominant arm takes advantage of gravity effects to minimize muscle effort, but less than the dominant arm.

[Physical activity in the elderly with other major neurocognitive disorders]. / Activité physique chez le sujet âgé atteint d'un trouble neurocognitif majeur.

For decades, the literature was skeptical about the feasibility of motor rehabilitation and its impact, as well as that of physical activity (PA), in subjects with major neurocognitive disorders (MNCD), including Alzheimer's disease. Now, authors report several benefits of PA, both physical and cognitive, by promoting brain perfusion, neurogenesis and synaptic plasticity, as well as decreasing oxidative stress and inflammation. PA should be recommended in cases of TNCM.

[Physical activity in the elderly with a major neurocognitive disorder]. / Activité physique chez le sujet âgé atteint d'un trouble neurocognitif majeur (2/2).

A better knowledge of major neurocognitive disorders and motor learning allows us to propose motor rehabilitation (MR) adapted to subjects with Alzheimer's disease. Recent neuroscientific data on motor functions and cognition allow the construction of physical activity and MR programs, for which the dose-response relationship, content and instructions are determining factors. Further studies are needed to confirm the effectiveness of the methods used.

[Description of psychomotor disadaptation syndrome or frontal-subcortical dysfunction syndrome]. / Description du syndrome de désadaptation psychomotrice.

The psychomotor disadaptation syndrome (PDS) was first described 34 years ago by the geriatric research team from Dijon, France. This syndrome was initially called "psychomotor regression syndrome". It was renamed PDS in the 1990s following considerable advances in the understanding of its pathophysiology and management. Since the 2000s, a condition known as sub-cortical-frontal dysfunction (syndrome sous-cortico-frontal) has become synonymous with PDS. Effective management of PDS requires a multidisciplinary approach that includes physicians, physiotherapists, psychologists and the entire geriatrics healthcare team.

The use of motor imagery training to retain the performance improvement following physical practice in the elderly.

With physiological aging, appears a deterioration of the ability to retain motor skills newly acquired. In this study, we tested the beneficial role of motor imagery training to compensate this deterioration. We tested four groups: young control group (n = 10), elderly control group (n = 10), young mental-training group (n = 13) and elderly mental-training group (n = 13). In pre- and post-tests, the participants performed three trials on a dexterity manual task (the Nine Hole Peg Test), commonly used in clinic. We recorded the movement duration as a factor of performance. Each trial, including 36 arm movements, consisted in manipulating sticks as fast as possible. The control groups watched a non-emotional documentary for 30 min and the mental-training groups imagined the task (50 trials). First, we observed a speed improvement during the pre-test session for all groups. Immediately after viewing the movie (post-test 1), the young control group showed a preservation of motor performance in comparison to the performance measured before the break (pret-test 3), while the young mental-training group improved performance after motor imagery practice. For the elderly, the control group showed a deterioration of motor performance at post-test 1, attesting a deterioration of the ability to retain motor skills with aging. Interestingly, the elderly mental-training group showed a preservation of motor performance between the pre-test 3 and the post-test 1. The present findings demonstrate the beneficial role of mental training with motor imagery to retain the performance improvement following physical practice in the elderly. This method could be an alternative to prevent the deterioration of motor skills.

[Evaluation of the animal-assisted therapy in Alzheimer's disease]. / Évaluation de l'effet thérapeutique de la médiation animale dans la maladie d'Alzheimer.

Animal-assisted therapy sessions have been set up in a protected unit for patients with a dementia-related syndrome. The aim is to measure the effects of animal-assisted therapy on behavioural disorders in daily life and care. The results obtained provided some interesting areas to explore and recommendations with a view to optimising the implementation of such a system.

Balance control in aging: improvements in anticipatory postural adjustments and updating of internal models.

Postural stability of older subjects can be estimated during orthostatic equilibrium. However, dynamic equilibrium is also important to investigate risks of fall. It implies different interpretations of measures given by force plates. Same dependant variables (e.g. center of pressure displacement) cannot be interpreted the same ways depending of the type of equilibrium that is investigated. In particular, sways increases during dynamic equilibrium and before movement execution may reflect an improvement of feedforward control.

Tango-Therapy Intervention for Older Adults with Cognitive Impairment Living in Nursing Homes: Effects on Quality of Life, Physical Abilities and Gait.

Cognitive impairment in older adults is associated with poor gait performance, physical decline, falls and poor quality of life. This paper analyzes the feasibility and efficacy of tango-based intervention in older people living in nursing homes with and without cognitive impairment. A multicenter study, with pre- and post-test, was carried out. Intervention attendance, well-being, physical abilities (short physical performance battery), walking performance, functional capacities (Katz Index) and quality of life (quality of life in Alzheimer's disease) were assessed. Fifty-four participants (84.9 ± 6.7 years, mini mental state examination 14.5 ± 7.4) completed the protocol. Intervention attendance was 92%, and the mean subjective well-being after each session was 4.5 ± 0.5 (on a five-point scale). A statistically significant improvement was found in the quality of life (p = 0.030). Non-statistically significant changes were found in walking performance (p = 0.159), physical abilities (p = 0.876) and in functional capacities (p = 0.253). This study shows feasibility and suggests evidence for the effects of tango therapy on well-being and quality of life. Further studies are necessary to contrast these findings and to support the role of tango interventions as a holistic approach to prevent functional decline in older people with cognitive impairment.

Motor Imagery Training Is Beneficial for Motor Memory of Upper and Lower Limb Tasks in Very Old Adults.

Human aging is associated with a decline in the capacity to memorize recently acquired motor skills. Motor imagery training is a beneficial method to compensate for this deterioration in old adults. It is not yet known whether these beneficial effects are maintained in very old adults (>80 years), who are more affected by the degeneration processes. The aim of this study was to evaluate the effectiveness of a mental training session of motor imagery on the memorization of new motor skills acquired through physical practice in very old adults. Thus, 30 very old adults performed 3 actual trials of a manual dexterity task (session 1) or a sequential footstep task (session 2) as fast as they could before and after a 20 min motor imagery training (mental-training group) or watching a documentary for 20 min (control group). Performance was improved after three actual trials for both tasks and both groups. For the control group, performance decreased in the manual dexterity task after the 20 min break and remained stable in the sequential footstep task. For the mental-training group, performance was maintained in the manual dexterity task after the 20 min motor imagery training and increased in the sequential footstep task. These results extended the benefits of motor imagery training to the very old population, showing that even a short motor imagery training session improved their performance and favored the motor memory process. These results confirmed that motor imagery training is an effective method to complement traditional rehabilitation protocols.

[Conducting a multimodal exercise program in primary and secondary prevention of mobility disabilty in older adults at risk: guidelines and practical applications]. / Conduite d'un programme d'exercice multimodal en prévention primaire et secondaire de la perte de mobilité chez le senior à risque : recommandations et applications pratiques.

The implementation of strategies to prevent mobility disability in seniors at-risk with a strong focus on exercise is a public health imperative. These strategies must follow a pragmatic, structured and personalized approach. In order to obtain short, medium and long-term benefits, it is essential to consider the coordination of adapted physical exercise programs and to harmonize good practices. In support of national policies for the prevention of loss of autonomy, it is important to define clear guidelines to conduct effective programs. These programs should have a strong emphasis on evidence-based literature and should be validated by a consensus of multi-professional experts. The aim of this consensus is to outline the steps implementing these programs, to present their constituent elements and their practical application. Conception and elaboration of these programs should include frequency, intensity, duration, type of work, volume and individual progressiveness. Programs should also be focused on a personalised approach to develop participant health education, self-efficacy and empowerment for physical activity to ensure long-term health related behaviours. Moreover, trained professionals must supervise these programs in order to assure participants safety and program effectiveness. These guidelines will support policies for the prevention of loss of autonomy and mobility, throughout their development over the national territory.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review.

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

Do equilibrium constraints modulate postural reaction when viewing imbalance?

Action observation and action execution are tightly coupled on a neurophysiological and a behavioral level, such that visually perceiving an action can contaminate simultaneous and subsequent action execution. More specifically, observing a model in postural disequilibrium was shown to induce an increase in observers' body sway. Here we reciprocally questioned the role of observers' motor system in the contagion process by comparing participants' body sway when watching displays of antero-posterior vs. lateral imbalance. Indeed, during upright standing, biomechanical constraints differ along the antero-posterior (A-P) and medio-lateral (M-L) axes; hence an impact of observers' postural constraints on the contagion response would result in different reactions to both types of stimuli. In response to the displays, we recorded greater area of center of pressure (CoP) displacement when watching forward/backward compared to left/right imbalance. In addition, after normalizing A-P and M-L CoP displacements by a control condition (fixation cross), A-P CoP path length when viewing forward imbalance tended to be higher than M-L CoP path length when viewing imbalance to the left or right. These results indicate that postural contagion is promoted when the display is compatible with observers' motor stabilization strategy which is mainly oriented along the A-P axis. In terms of clinical application, this study brings new indications for adaptation of observational training devices in rehabilitation programs.

Cognition Impairment and Gait Disorders in Older Adults.

Thanks to the increase in life expectancy linked to scientific and medical progress and improvements in hygiene conditions, the population of people aged 75 years and over continues to grow worldwide, particularly in industrialized countries [...].

Use of Digital Tools, Social Isolation, and Lockdown in People 80 Years and Older Living at Home.

The COVID-19 crisis and associated lockdowns have exposed the extent of social isolation among older adults (OAs). Currently, the French government and medical, social, and charitable organizations are working to find means of limiting the multiple psychological and physical consequences of social isolation on the health of OAs. One proposal is to help the elderly become more comfortable using digital tools (DTs). However, the ability of DTs to reduce social isolation is disputed in the literature. This study aimed to collect the views of OAs on social isolation; to identify the determinants of the use or not of DTs, in particular in the context of a lockdown; and the role of DTs in the strategy to reduce social isolation. This qualitative study was based on 27 semi-structured individual interviews with OAs ≥ 80 years, in Côte-d'Or and Haute-Marne (French departments), from March to May 2021. A total of 96.3% of participants had already owned one or more DTs (mobile phone, tablet, or computer) for several years. The lockdown had not prompted the population to equip themselves more. The most common reason for using DTs was to maintain contact with relatives, and 63% of the participants said that DTs have a positive impact in reducing social isolation. However, there is a significant need for assistance and training in their use, especially since many services are now offered online. The participants suggested that the key to minimizing social isolation remained the maintenance of social contacts. In conclusion, DTs appear to be useful for helping the elderly maintain social links with relatives and, therefore, have a strategic place in the reduction of social isolation. However, these tools should not replace in-person interactions.

Sensory reweighting in frail aged adults: Are the balance deficiencies mainly compensated by visual or podal dependences?

BACKGROUND: Postural control is based on the integration of different sensory inputs. The process of scaling the relative importance of these sensory cues (visual, vestibular and proprioceptive) depends on individuals and creates sensory preferences, leading to sensory dependences when one particular source is preponderant. In this context, the literature showed a frequent visual dependence (visual inputs weighting) in aged adults. However, the somaesthetic inputs can also be prioritised in a podal-dependent profile. In the frail aged adults, none study has shown the distribution of these two dependences. RESEARCH QUESTION: Which sensory orientation profile is preferentially adopted by frail aged males and females? METHODS: In this cross-sectional study, we compared 33 frail aged adults to 16 non frail aged adults during a static postural control task in three conditions on a force platform: i) a standard condition, ii) a no-vision condition and iii) a foam condition. An analysis with the factor sex was also performed in each group of participants. RESULTS: The analysis of stabilometric parameters (mean velocity and mean velocity variance) highlighted a significant difference in no-vision or foam conditions when compared to the standard condition in frail aged males and only in the foam condition when compared to the standard condition for females in the frail group. No significant difference was observed between conditions in the control group. SIGNIFICANCE: Our study showed the predominance of both visual and podal information in frail aged adults when controlling their posture. Considering the sex factor, frail males were more dependents to their visual cues than frail females. This result should be used when designing the rehabilitation programs in this population.

Deterioration, Compensation and Motor Control Processes in Healthy Aging, Mild Cognitive Impairment and Alzheimer's Disease.

Aging is associated with modifications of several brain structures and functions. These modifications then manifest as modified behaviors. It has been proposed that some brain function modifications may compensate for some other deteriorated ones, thus maintaining behavioral performance. Through the concept of compensation versus deterioration, this article reviews the literature on motor function in healthy and pathological aging. We first highlight mechanistic studies that used paradigms, allowing us to identify precise compensation mechanisms in healthy aging. Subsequently, we review studies investigating motor function in two often-associated neurological conditions, i.e., mild cognitive impairment and Alzheimer's disease. We point out the need to expand the knowledge gained from descriptive studies with studies targeting specific motor control processes. Teasing apart deteriorated versus compensating processes represents precious knowledge that could significantly improve the prevention and rehabilitation of age-related loss of mobility.

Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial.

BACKGROUND: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. METHODS: Frail older adults (n = 37) were included in this study who were randomized and divided into a VR exercises group (VR group) or a control group using the Nintendo Wii system (CTRL group). Finally, 22 patients were included in the data treatment. APA were studied through muscular activation timings measured with electromyographic activities. The functional reach test, the gait speed, and the time up and go were also evaluated before and after a 3-week training phase. RESULTS AND DISCUSSION: As the main results, the training phase with VR improved the APA and the functional reach test score along the antero-posterior axis. Together, these results highlight the ability of a VR training phase to induce neuromuscular adaptations during the APA period in frail older adults. Then, it underlines the effective transfer from learning carried out during the VR training movements to control balance abilities in a more daily life context.

Postural Adjustments and Kinematic Index Finger Features in Frail Older Adults under Different Equilibrium Constraints.

Background: Anticipatory postural adjustments (APAs) are significantly affected by age and may represent restrictions on functional independence. Previous studies in young adults have already highlighted that changing postural stability (i.e., seated vs. upright posture) affects the motor planning and APAs. In frail older adults (FOAs), the effect of these different conditions of postural stability have not yet been established, and the present study aimed to disentangle this issue. Methods: Participants executed an arm-pointing task to reach a diode immediately after it turned on, under different conditions of stability (seated with and without foot support and in an upright posture). A kinematic profile of the index finger and postural electromyographic data were registered in their dominant-side leg muscles: tibialis anterior, soleus, rectus femoris, and semitendinosus. Results: The main finding of this study was that the adopted posture and body stabilization in FOAs did not reflect differences in APAs or kinematic features. In addition, they did not present an optimal APA, since postural muscles are recruited simultaneously with the deltoid. Conclusion: Thus, FOAs seem to use a single non-optimal motor plan to assist with task performance and counterbalance perturbation forces in which they present similar APAs and do not modify their kinematics features under different equilibrium constraints.

[Walking and ageing]. / Marche et vieillissement.

As we get older, our gait changes insidiously with a tendency for us to walk more slowly, to take shorter strides and to increase the time when both feet are on the ground. Four major factors are most often found interlinked in walking problems in the elderly. Being more aware of them enables healthcare teams to adapt the care provided to elderly patients.