Characterization of the Kinetyx SI Wireless Pressure-Measuring Insole during Benchtop Testing and Running Gait.

This study characterized the absolute pressure measurement error and reliability of a new fully integrated (Kinetyx, SI) plantar-pressure measurement system (PPMS) versus an industry-standard PPMS (F-Scan, Tekscan) during an established benchtop testing protocol as well as via a research-grade, instrumented treadmill (Bertec) during a running protocol. Benchtop testing results showed that both SI and F-Scan had strong positive linearity (Pearson's correlation coefficient, PCC = 0.86-0.97, PCC = 0.87-0.92; RMSE = 15.96 ± 9.49) and mean root mean squared error RMSE (9.17 ± 2.02) compared to the F-Scan on a progressive loading step test. The SI and F-Scan had comparable results for linearity and hysteresis on a sinusoidal loading test (PCC = 0.92-0.99; 5.04 ± 1.41; PCC = 0.94-0.99; 6.15 ± 1.39, respectively). SI had less mean RMSE (6.19 ± 1.38) than the F-Scan (8.66 ±2.31) on the sinusoidal test and less absolute error (4.08 ± 3.26) than the F-Scan (16.38 ± 12.43) on a static test. Both the SI and F-Scan had near-perfect between-day reliability interclass correlation coefficient, ICC = 0.97-1.00) to the F-Scan (ICC = 0.96-1.00). During running, the SI pressure output had a near-perfect linearity and low RMSE compared to the force measurement from the Bertec treadmill. However, the SI pressure output had a mean hysteresis of 7.67% with a 28.47% maximum hysteresis, which may have implications for the accurate quantification of kinetic gait measures during running.

Evaluation of Different Pressure-Based Foot Contact Event Detection Algorithms across Different Slopes and Speeds.

If validated, in-shoe pressure measuring technology allows for the field-based quantification of running gait, including kinematic and kinetic measures. Different algorithmic methods have been proposed to determine foot contact events from in-shoe pressure insole systems, however, these methods have not been evaluated for accuracy, reliability against a gold standard using running data across different slopes, and speeds. Using data from a plantar pressure measurement system, seven different foot contact event detection algorithms based on pressure signals (pressure sum) were compared to vertical ground reaction force data collected from a force instrumented treadmill. Subjects ran on level ground at 2.6, 3.0, 3.4, and 3.8 m/s, six degrees (10.5%) inclined at 2.6, 2.8, and 3.0 m/s, and six degrees declined at 2.6, 2.8, 3.0, and 3.4 m/s. The best performing foot contact event detection algorithm showed maximal mean absolute errors of only 1.0 ms and 5.2 ms for foot contact and foot off, respectively, on level grade, when compared to a 40 N ascending and descending force threshold from the force treadmill data. Additionally, this algorithm was unaffected by grade and had similar levels of errors across all grades.

A socially-engaged lifestyle moderates the association between gait velocity and cognitive impairment.

Objective: Cognitive status has been linked to impaired gait velocity, and diminished social and physical engagement. To date, the potential moderating influence of lifestyle engagement on gait-cognitive status associations has not been systematically explored. The present investigation examines whether a socially- or physically-engaged lifestyle moderates the association between diminished gait velocity and likelihood of amnestic mild cognitive impairment (a-MCI) classification.Methods: Participants (aged 65+, Mage=73 years) were classified as either healthy controls (n = 30) or a-MCI (n = 24), using neuropsychological test scores and clinical judgement. Gait velocity was indexed using a GAITRite computerized walkway, engaged lifestyle (social and physical subdomains) were measured using a well-validated self-report measure, the revised Activity Lifestyle Questionnaire.Results: Logistic regression, evaluating likelihood of a-MCI classification, yielded a significant interaction between a socially-engaged lifestyle and gait velocity (b=.01, SE=.003, p=.015). Follow-up simple effects were derived for two levels (+/-1SD) of social engagement; for individuals 1 SD below the mean, the association between gait velocity and increased likelihood of a-MCI classification was exacerbated (probability of a-MCI classification for those with slower gait velocity was 60% higher for individuals 1 SD below vs 1 SD above the mean of social engagement). Physically-engaged lifestyle did not significantly moderate the gait-cognitive status association.Conclusions: The significant moderating influence of social engagement has several implications, including the likelihood that distinct mechanisms underlie the relationships of social engagement and gait velocity to cognitive function, the value of social variables for well-being, and the potential utility of socially-based interventions that may prevent/delay a-MCI onset.

Age-related erosion of obstacle avoidance reflexes evoked with electrical stimulation of tibial nerve during walking.

In young healthy adults, characteristic obstacle avoidance reflexes have been demonstrated in response to electrical stimulation of cutaneous afferents of the foot during walking. It is unknown whether there is an age-related erosion of this obstacle avoidance reflex evoked with stimulation to the tibial nerve innervating the sole of the foot. The purpose of this study was to identify age-dependent differences in obstacle avoidance reflexes evoked with electrical stimulation of the tibial nerve at the ankle during walking in healthy young and older (70 yr and older) adults with no history of falls. Toe clearance, ankle and knee joint displacement and angular velocity, and electromyograms (EMG) of the tibialis anterior, medial gastrocnemius, biceps femoris, and vastus lateralis were measured. A significant erosion of kinematic and EMG obstacle avoidance reflexes was seen in the older adults compared with the young. Specifically, during swing phase, there was reduced toe clearance, ankle dorsiflexion, and knee flexion angular displacement in older adults compared with the young as well as changes in muscle activation. These degraded reflexes were superimposed on altered kinematics seen during unperturbed walking in the older adults including reduced toe clearance and knee flexion and increased ankle dorsiflexion compared with the young. Notably, during mid-swing the toe clearance was reduced in the older adults compared with the young by 2 cm overall, resulting from a combination of 1-cm reduced reflex response in the older adults superimposed on 1-cm less toe clearance during unperturbed walking. Together, these age-related differences could represent the prodromal phase of fall risk. NEW & NOTEWORTHY This study demonstrated age-dependent erosion of obstacle avoidance reflexes evoked with electrical stimulation of the tibial nerve at the ankle during walking. There was significant reduction in toe clearance, ankle dorsiflexion, and knee flexion reflexes as well as changes in muscle activation during swing phase in older adults with no history of falls compared with the young. These degraded reflexes, superimposed on altered kinematics seen during unperturbed walking, likely represent the prodromal phase of fall risk.

Neuromechanical interactions between the limbs during human locomotion: an evolutionary perspective with translation to rehabilitation.

During bipedal locomotor activities, humans use elements of quadrupedal neuronal limb control. Evolutionary constraints can help inform the historical ancestry for preservation of these core control elements support transfer of the huge body of quadrupedal non-human animal literature to human rehabilitation. In particular, this has translational applications for neurological rehabilitation after neurotrauma where interlimb coordination is lost or compromised. The present state of the field supports including arm activity in addition to leg activity as a component of gait retraining after neurotrauma.

Erosion of Stumble Correction Evoked with Superficial Peroneal Nerve Stimulation in Older Adults during Walking.

In healthy young adults, electrical stimulation of the superficial peroneal cutaneous nerve (SPn) innervating the dorsum of the foot has been shown to elicit functionally relevant reflexes during walking that are similar to those evoked by mechanical perturbation to the dorsum of the foot during walking and are referred to as stumble corrective (obstacle avoidance) responses. Though age-related differences in reflexes induced by mechanical perturbation have been studied, toe clearance has not been measured. Further, age-related differences in reflexes evoked by electrical stimulation of SPn have yet to be determined. Thus, the purpose of this study was to characterize age-related differences between healthy young adults and older adults with no history of falls in stumble correction responses evoked by electrical stimulation of the SPn at the ankle during walking. Toe clearance relative to the walking surface along with joint displacement and angular velocity at the ankle and knee and EMG of the tibialis anterior, medial gastrocnemius, biceps femoris and vastus lateralis were measured. The combined background and reflex toe clearance was reduced in the older adults compared with the young in mid-early swing (p = 0.011). These age-related differences likely increase fall risk in the older adult cohort. Further, age-related changes were seen in joint kinematics and EMG in older adults compared with the young such as decreased amplitude of the plantarflexion reflex in early swing in older adults (p < 0.05). These altered reflexes reflect the degradation of the stumble corrective response in older adults.

A Comparison of Bioelectric and Biomechanical EMG Normalization Techniques in Healthy Older and Young Adults during Walking Gait.

This study compares biomechanical and bioelectric electromyography (EMG) normalization techniques across disparate age cohorts during walking to assess the impact of normalization methods on the functional interpretation of EMG data. The biomechanical method involved scaling EMG to a target absolute torque (EMGTS) from a joint-specific task and the chosen bioelectric methods were peak and mean normalization taken from the EMG signal during gait, referred to as dynamic mean and dynamic peak normalization (EMGMean and EMGPeak). The effects of normalization on EMG amplitude, activation pattern, and inter-subject variability were compared between disparate cohorts, including OLD (76.6 yrs N = 12) and YOUNG (26.6 yrs N = 12), in five lower-limb muscles. EMGPeak normalization resulted in differences between YOUNG and OLD cohorts in Biceps Femoris (BF) and Medial Gastrocnemius (MG) that were not observed with EMGMean or EMGTS normalization. EMGPeak and EMGMean normalization also demonstrated interactions between age and the phase of gait in BF that were not seen with EMGTS. Correlations showed that activation patterns across the gait cycle were similar between all methods for both age groups and the coefficient of variation comparisons found that EMGTS produced the greatest inter-subject variability. We have shown that the normalization technique can influence the interpretation of findings when comparing disparate populations, highlighting the need to carefully interpret functional differences in EMG between disparate cohorts.

Electrophysiological variability during tests of executive functioning: A comparison of athletes with and without concussion and sedentary control participants.

OBJECTIVE: Sport participation may benefit executive functioning (EF), but EF can also be adversely affected by concussion, which can occur during sport participation. Neural variability is an emerging proxy of brain health that indexes the brain's range of possible responses to incoming stimuli (i.e., dynamic range) and interconnectedness, but has yet to be characterized following concussion among athletes. This study examined whether neural variability was enhanced by athletic participation and attenuated by concussion. METHOD: Seventy-seven participants (18-25 years-old) were classified as sedentary controls (n = 33), athletes with positive concussion history (n = 21), or athletes without concussion (n = 23). Participants completed tests of attention switching, response inhibition, and updating working memory while undergoing electroencephalography recordings to index neural variability. RESULTS: Compared to sedentary controls and athletes without concussion, athletes with concussion exhibited a restricted whole-brain dynamic range of neural variability when completing a test of inhibitory control. There were no group differences observed for either the switching or working memory tasks. CONCLUSIONS: A history of concussion was related to reduced dynamic range of neural activity during a task of response inhibition in young adult athletes. Neural variability may have value for evaluating brain health following concussion.

Neural control of rhythmic arm cycling after stroke.

Disordered reflex activity and alterations in the neural control of walking have been observed after stroke. In addition to impairments in leg movement that affect locomotor ability after stroke, significant impairments are also seen in the arms. Altered neural control in the upper limb can often lead to altered tone and spasticity resulting in impaired coordination and flexion contractures. We sought to address the extent to which the neural control of movement is disordered after stroke by examining the modulation pattern of cutaneous reflexes in arm muscles during arm cycling. Twenty-five stroke participants who were at least 6 mo postinfarction and clinically stable, performed rhythmic arm cycling while cutaneous reflexes were evoked with trains (5 × 1.0-ms pulses at 300 Hz) of constant-current electrical stimulation to the superficial radial (SR) nerve at the wrist. Both the more (MA) and less affected (LA) arms were stimulated in separate trials. Bilateral electromyography (EMG) activity was recorded from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on averaged reflexes in 12 equidistant phases of the movement cycle. Phase-modulated cutaneous reflexes were present, but altered, in both MA and LA arms after stroke. Notably, the pattern was "blunted" in the MA arm in stroke compared with control participants. Differences between stroke and control were progressively more evident moving from shoulder to wrist. The results suggest that a reduced pattern of cutaneous reflex modulation persists during rhythmic arm movement after stroke. The overall implication of this result is that the putative spinal contributions to rhythmic human arm movement remain accessible after stroke, which has translational implications for rehabilitation.

Detecting differences in gait initiation between older adult fallers and non-fallers through multivariate functional principal component analysis.

Gait initiation (GI) is an important locomotor transition task that includes anticipatory postural adjustments and the joint propulsion necessary for the first step of walking. Discrete variable analysis between GI of fallers and non-fallers has shown important between-group differences. More complex time series analysis, such as functional principal component analysis (FPCA) may highlight group differences not detectable using discrete comparisons alone. This study aims to characterize the differences between fallers and non-fallers by examining the kinematics and kinetics of gait initiation using multivariate FPCA (mFPCA). A sample of 56 community-dwelling older adults completed five walking trials where GI was measured by force platforms. mFPCA of center of pressure kinematics and kinetics was conducted and functional principal component scores were compared between groups. Overall mFPCA provided a comprehensive assessment of GI that supports and enhances previous findings with respect to differences between faller and non-faller cohorts. During weight transfer and forward progress, fallers demonstrate a greater range of mediolateral movement and lower lateral force than non-fallers. During the first step, fallers have a more gradual rise in vertical force, as well as a greater lateral movement toward the edge of their base of support. Fallers also demonstrate a shorter step length, indicating an altered approach to GI, where mediolateral and anteroposterior stability may be prioritized over forward advancement.

Robotic-assisted stepping modulates monosynaptic reflexes in forearm muscles in the human.

Although the amplitude of the Hoffmann (H)-reflex in the forelimb muscles is known to be suppressed during rhythmic leg movement, it is unknown which factor plays a more important role in generating this suppression-movement-related afferent feedback or feedback related to body loading. To specifically explore the movement- and load-related afferent feedback, we investigated the modulation of the H-reflex in the flexor carpi radialis (FCR) muscle during robotic-assisted passive leg stepping. Passive stepping and standing were performed using a robotic gait-trainer system (Lokomat). The H-reflex in the FCR, elicited by electrical stimulation to the median nerve, was recorded at 10 different phases of the stepping cycle, as well as during quiet standing. We confirmed that the magnitude of the FCR H-reflex was suppressed significantly during passive stepping compared with during standing. The suppressive effect on the FCR H-reflex amplitude was seen at all phases of stepping, irrespective of whether the stepping was conducted with body weight loaded or unloaded. These results suggest that movement-related afferent feedback, rather than load-related afferent feedback, plays an important role in suppressing the FCR H-reflex amplitude.

Rhythmic arm cycling differentially modulates stretch and H-reflex amplitudes in soleus muscle.

During rhythmic arm cycling, soleus H-reflex amplitudes are reduced by modulation of group Ia presynaptic inhibition. This suppression of reflex amplitude is graded to the frequency of arm cycling with a threshold of 0.8 Hz. Despite the data on modulation of the soleus H-reflex amplitude induced by rhythmic arm cycling, comparatively little is known about the modulation of stretch reflexes due to remote limb movement. Therefore, the present study was intended to explore the effect of arm cycling on stretch and H-reflex amplitudes in the soleus muscle. In so doing, additional information on the mechanism of action during rhythmic arm cycling would be revealed. Although both reflexes share the same afferent pathway, we hypothesized that stretch reflex amplitudes would be less suppressed by arm cycling because they are less inhibited by presynaptic inhibition. Failure to reject this hypothesis would add additional strength to the argument that Ia presynaptic inhibition is the mechanism modulating soleus H-reflex amplitude during rhythmic arm cycling. Participants were seated in a customized chair with feet strapped to footplates. Three motor tasks were performed: static control trials and arm cycling at 1 and 2 Hz. Soleus H-reflexes were evoked using single 1 ms pulses of electrical stimulation delivered to the tibial nerve at the popliteal fossa. A constant M-wave and ~6% MVC activation of soleus were maintained across conditions. Stretch reflexes were evoked using a single sinusoidal pulse at 100 Hz given by a vibratory shaker placed over the triceps surae tendon and controlled by a custom-written LabView program. Results demonstrated that rhythmic arm cycling that was effective for conditioning soleus H-reflexes did not show a suppressive effect on the amplitude of the soleus stretch reflex. We suggest this indicates that stretch reflexes are less sensitive to conditioning by rhythmic arm movement, as compared to H-reflexes, due to the relative insensitivity to Ia presynaptic inhibition.

Interlimb coupling from the arms to legs is differentially specified for populations of motor units comprising the compound H-reflex during "reduced" human locomotion.

Recent experiments have identified neuromechanical interactions between the arms and legs during human locomotor movement. Previous work reported that during the rhythmic movement of all four limbs, the influence of the arms on reflex expression in the legs was superimposed on the dominant effect of the legs. This evidence was based upon studies using cutaneous and H-reflex modulation as indices of neuronal activity related to locomotion. The earlier H-reflex study was restricted to one phase of movement and to only a fixed H-reflex amplitude. Also, all four limbs were actively engaged in locomotor movement, and this led to the speculation that the effect from the arms could be underestimated by "swamping" of the conditioning during movement of the test limb. Work from the cat suggests that descending locomotor drive may be differentially specified for different motor unit populations in the hindlimb. Accordingly, details of interlimb coordination between the arms and legs in humans require further characterization and an examination of different populations of motor units as can be obtained from H-reflex recruitment curve (RC) parameters. Using modulation of H-reflex amplitudes across the entire ascending limb as neural probes for interlimb coupling, the present study evaluated the separated influences of rhythmic activity of the arms and leg on neuronal excitability of a stationary "test leg". This three-limb "reduced" locomotion approach was applied using a stepping ergometer during the performance of three rhythmic movement tasks: arms (A); contralateral leg (L); and arms and contralateral leg (AL). Data were sampled at four different phases of the stepping cycle (using the moving leg as reference): start power (SP); end power (EP); start recovery (SR); and end recovery (ER). The main result was a large and significant influence of rhythmic AL activity on RC parameters of the H-reflex at EP and SP phases. However, the parameters (and thus motor unit populations) were differentially affected at each phase and task. For instance, a significant contribution of arms movement was noticed for H (max) (largest motor units) at EP phase (P < 0.05), but no changes was observed for other parameters related to lower reflex amplitude (e.g., H-reflex evoked with an input that elicited 50% of maximum reflex response during static condition; H@50%). On the other hand, at SR phase, the parameter H@50% was significantly affected during AL compared to L. It is suggested that the remote effect from arms rhythmic activity has been differentially manifested across motor unit populations for each phase of movement. These findings provide definitive evidence for interlimb coupling between cervical and lumbar oscillators in gating the excitability of reflex pathways to a leg muscle for different populations of motorneurons within the pool. This further supports the contention of similar functional organization for locomotor networks in the human when compared to other animals. Additionally, these data provide additional confirmation of the significant role of the output of neural control for rhythmic arm movement in modulating reflex excitability of the legs that is specifically adjusted according to the phase and task.

Intraindividual variability in executive and motor control tasks in children with attention deficit hyperactivity disorder.

OBJECTIVE: Emerging evidence highlights intraindividual variability (IIV) during executive function (EF) tasks as a reliable endophenotype of Attention Deficit/Hyperactivity Disorder (ADHD) and as contributing to motor dysregulation and hyperactive-impulsive behaviors. This study examined the relationship between EF and motor control in children with and without ADHD. METHOD: Ninety-seven children (6-13 years) completed standardized and experimental tasks of executive and motor control. Primary caregivers completed a semi-structured interview, and behavioral rating forms for ADHD symptoms and EF. RESULTS: Children with ADHD demonstrated lower performance on motor dexterity and sequencing tasks, and greater IIV during EF tasks with lower cognitive demand. IIV accounted for ADHD symptoms of hyperactivity, beyond age and motor dexterity. IIV from EF measures with lower cognitive demand was also sensitive to ADHD symptoms. CONCLUSION: IIV metrics may tap into the motor regulation challenges associated with ADHD, as well as attentional lapsing at lower levels of cognitive demand.

The quadrupedal nature of human bipedal locomotion.

During rhythmic movement, arm activity contributes to the neural excitation of leg muscles. These observations are consistent with the emergence of human bipedalism and nonhuman primate arboreal quadrupedal walking. These neural and biomechanical linkages could be exploited in rehabilitation after neurotrauma to allow the arms to give the legs a helping hand during gait rehabilitation.

Suppression of soleus H-reflex amplitude is graded with frequency of rhythmic arm cycling.

In humans, rhythmic arm cycling has been shown to significantly suppress the soleus H-reflex amplitude in stationary legs. The specific nature of the relationship between frequency of arm cycling and H-reflex modulation in the legs has not been explored. We speculated that the effect of arm cycling on reflexes in leg muscles is related to the neural control of arm movement; therefore, we hypothesized that a graded increase in arm cycling frequency would produce a graded suppression of the soleus H-reflex amplitude. We also hypothesized that a threshold frequency of arm cycling would be identified at which the H-reflex amplitude significantly differed from static control trials (i.e., the arms were stationary). Soleus H-reflexes were evoked in stationary legs with tibial nerve stimulation during both control and rhythmic arm cycling (0.03-2.0 Hz) trials. The results show a significant inverse linear relation between arm cycling frequency and soleus H-reflex amplitude (P<0.05). Soleus H-reflex amplitude significantly differed from control at an average threshold cycling frequency of 0.8 Hz. The results demonstrate that increased frequency of upper limb movement increases the intensity of interlimb influences on the neural activity in stationary legs. Further, a minimum threshold frequency of arm cycling is required to produce a significant effect. This suggests that achieving a threshold frequency of rhythmic arm movement may be important to incorporate in rehabilitation strategies to engage the appropriate interlimb neural pathways.

Mean and variability in functional brain activations differentially predict executive function in older adults: an investigation employing functional near-infrared spectroscopy.

OBJECTIVE: although the preponderance of research on functional brain activity investigates mean group differences, mounting evidence suggests that variability in neural activity is beneficial for optimal central nervous system (CNS) function. Independent of mean signal estimates, recent findings have shown that neural variability diminishes with age and is positively associated with cognitive performance, underscoring its adaptive nature. The present investigation sought to employ functional near infrared spectroscopy (fNIRS) to derive two operationalizations of cerebral oxygenation, representing mean and variability [using standard deviation (SD)] in neural activity, and to specifically contrast these mean- and SD-oxyhemoglobin (HbO) estimates as predictors of cognitive function. METHOD: a total of 25 older adults (71 to 81 years of age) completed a test of cognitive interference (Multisource Interference Task) while undergoing fNIRS recording using a multichannel continuous-wave optical imaging system (TechEn CW6) over bilateral prefrontal cortex (PFC). Time-varying covariation models were employed to simultaneously estimate the within- and between-person effects of cerebral oxygenation on behavioral performance fluctuations. RESULTS: mean effects were predominantly observed at the between-person level and suggest that greater concentrations of HbO are associated with slower and less accurate performance. Greater HbO variability at the between-person level was associated with slower performance, but was associated with faster performance at the within-person level. CONCLUSIONS: these findings are in keeping with assertions that mean and variability confer complementary (as opposed to redundant) sources of information regarding the effective functioning of a neural system and suggest that fNIRS is a viable methodology for capturing meaningful variance in the hemodynamic response that is characteristic of adaptive CNS function.

Comparing executive function, evoked hemodynamic response, and gait as predictors of variations in mobility for older adults.

OBJECTIVE: Falls represent a major concern for older adults and may serve as clinically salient index events for those presenting in the prodromal stages of mild cognitive impairment. Declines in executive function performance and in gait consistency have shown promise in predicting fall risk; however, associated neurophysiological underpinnings have received less attention. In this study, we used a multimodal approach to assess fall risk in a group of older adults with and without a previous fall history. METHOD: Processing speed, inductive reasoning, verbal fluency, crystallized ability, episodic memory, and executive functioning were assessed using standardized neuropsychological tests. Cognitive interference was assessed using the Multi-Source Interference Task. Spatiotemporal gait parameters were assessed with and without cognitive load using a 6.4-m instrumented walkway. Hemodynamic responses were measured using functional near-infrared spectroscopy. RESULTS: Whereas no group differences were observed in cognitive behavioral performance, during a cognitive interference task fallers displayed more oxygenated hemoglobin across the prefrontal cortex than nonfallers, suggesting that engaging in the cognitive task was more effortful for them overall, therefore eliciting greater cortical activation. Between-group differences in spatial as well as temporal gait parameters were also observed. CONCLUSIONS: These results are in keeping with assertions that diminished executive control is related to fall risk. Notably, the group differences observed in prefrontal cortical activation and in gait parameters may ultimately precede those observed in cognitive behavioral performance, with implications for measurement sensitivity and early identification.

Concurrent Indicators of Gait Velocity and Variability Are Associated with 25-Year Cognitive Change: A Retrospective Longitudinal Investigation.

Background/Objectives: Physical function indicators, including gait velocity, stride time and step length, are linked to neural and cognitive function, morbidity and mortality. Whereas cross-sectional associations are well documented, far less is known about long-term patterns of cognitive change as related to objective indicators of mobility-related physical function. Methods: Using data from the Victoria Longitudinal Study, a long-term investigation of biological and health aspects of aging and cognition, we examined three aspects of cognition-physical function linkages in 121 older adults. First, we examined a simple marker of physical function (3 m timed-walk) as a predictor of cross-sectional differences and up to 25-year change for four indicators of cognitive function. Second, we tested associations between two markers of gait function derived from the GAITRite system (velocity and stride-time variability) and differences and change in cognition. Finally, we evaluated how increasing cognitive load during GAITRite assessment influenced the associations between gait and cognition. Results: The simple timed-walk measure, commonly used in clinical and research settings, was a minor predictor of change in cognitive function. In contrast, the objectively measured indicator of walking speed significantly moderated long-term cognitive change. Under increasing cognitive load, the moderating influence of velocity on cognitive change increased, with increasing variability in stride time also emerging as a predictor of age-related cognitive decline. Conclusion: These findings: (a) underscore the utility of gait as a proxy for biological vitality and for indexing long-term cognitive change; and (b) inform potential mechanisms underlying age-related linkages in physical and cognitive function.

Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity.

Purpose Given the importance of physical activity in maintaining health and wellness, an improved understanding of physical activity patterns across different clinical populations is required. This study examines the facilitators for, and barriers to, participation in physical activity across multiple contexts for three clinical groups with chronic lower limb spasticity (individuals with stroke, multiple sclerosis and incomplete spinal cord injury). Method This cross-sectional study employed quantitative measures for spasticity, ankle range of motion, pain, falls, cognition, mobility, and physical activity as well as qualitative semi-structured interviews. Results There were similar impairments in body functions and structures and limitations in activities across the clinical groups. These impairments and limitations negatively impacted participation in physical activity, which was low. Environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life. Conclusions In this population, participation in physical activity includes activities such as housework which are different than what is typically considered as physical activity. Further, the presence of similar barriers and facilitators across the groups suggests that support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. Implications for rehabilitation Physical activity is of utmost importance in maintaining health and wellness in clinical populations. This research highlights the desired and actual physical activity for these populations can look different than what may traditionally be considered as physical activity (e.g. housework is not typically considered participation physical activity). Therefore, rehabilitation interventions need to be directly designed to enhance clients' ability to perform these activities and these activities should be an integral focus of ongoing physical activity programs. Individuals who have lower limb spasticity shared similar impairments in body structures and functions and limitations in activities across the clinical groups and these impairments and limitations negatively impacted participation in physical in a similar way in all groups. Further, the environmental and personal factors exacerbated or mitigated the limiting effects of body functions and structures and activities on physical activity in many areas of life in a similar way in all groups. The presence of similar barriers and facilitators across the clinical groups suggests that rehabilitation assessment and treatment as well as support and services to promote valued forms of physical activity could be organised and delivered based on limitations in mobility and functioning rather than clinical diagnosis. This work affirms that a mixed methods research approach is critical for completely understanding the complexities of the barriers and facilitators engaging in physical activity across clinical groups, including multiple sclerosis, stroke, and incomplete spinal cord injury who have chronic lower limb spasticity.