Balance performance and grip strength as predictors of cognitive function among community-dwelling older adults in the USA.

Objectives: To investigate how balance and grip strength predicts the probability of cognitive function impairment (i.e., executive function: mild and mild-to-moderate impairment, and delayed recall) over eight years in community-dwelling older adults in the US, controlling for sex and race/ethnicity. Methods: The National Health and Aging Trends Study dataset (2011 - 2018) was employed. Dependent variables included the Clock Drawing Test (Executive Function) and Delayed Word Recall Test. Longitudinal ordered logistic regression examined the association between cognitive function and predictors (i.e., balance and grip strength) over eight waves (n=9800, 1,225 per wave). Results: Those who could complete side-by-side standing and semi-tandem tasks were 33% and 38% less likely to have mild or mild-to-moderate executive function impairment, respectively, relative to those who could not complete these tests. One score decrease in grip strength increased the executive function impairment risk by 13% (Odds Ratio: 0.87, CI: 0.79-0.95). Those who completed the side-by-side tasks were 35% (Odds Ratio: 0.65, CI: 0.44-0.95) less likely to experience delayed recall impairments than those who could not complete this test. With one score decrease in grip strength, the risk of delayed recall impairment was increased by 11% (OR: 0.89, CI: 0.80-1.00). Conclusions: A combination of these two simple tests (i.e., semi-tandem stance and grip strength) can screen for cognitive impairment among community-dwelling older adults to identify people with mild and mild-to-moderate cognitive impairment in clinical settings.

Examining the effects of an experiential interprofessional education activity with older adults.

The need for experienced healthcare professionals to work with older adults is great, yet educational training is limited. In this interprofessional education (IPE) study, 861 students from five professions made 293 visits in the homes or preferred community settings of 208 older adults. Surveys with quantitative and open-text feedback assessed attitudes towards older adults, IPE team functioning, and the value of home visits. Survey results showed strongly positive attitudes towards ageing and older adults. Students from all professions expressed surprise and admiration for the active lives led by these healthier older adults, lives clearly in contrast to stereotypes of ageing. They further acknowledged the value of collaborative team functioning in meeting older adult needs, learned more about the roles and responsibilities of other professions, and identified strengths of the home as a site for care. Students positively valued the experience as part of their professional training, with 82% of all students stating they would welcome additional IPE opportunities. Results suggest that an experiential IPE activity can positively shape student attitudes towards older adults, IPE, and interprofessional collaboration.

Voice-Activated Lightweight Reacher to Assist with Upper Extremity Movement Limitations: A Case Study.

The focus of this research was to design a functional and user-friendly reacher for people with spinal cord injuries (SCIs). Engineering advancements have taken assistive robotics to new dimensions. Technologies such as wheelchair robotics and myo-electronically controlled systems have opened up a wide range of new applications to assist people with physical disabilities. Similarly, exo-skeletal limbs and body suits have provided new foundations from which technologies can aid function. Unfortunately, these devices have issues of usability, weight, and discomfort with donning. The Smart Assistive Reacher Arm (SARA) system, developed in this research, is a voice-activated, lightweight, mobile device that can be used when needed. SARA was built to help overcome daily reach challenges faced by individuals with limited arm and hand movement capability, such as people with cervical level 5-6 (C5-6) SCI. This article shows that a functional reacher arm with voice control can be beneficial for this population. Comparison study with healthy participants and an SCI participant shows that, when using SARA, a person with SCI can perform simple reach and grasp tasks independently, without someone else's help. This suggests that the interface is intuitive and can be easily used to a high level of proficiency by a SCI individual.

Deficits in stepping response time are associated with impairments in balance and mobility in people with Huntington disease.

Huntington disease (HD) is a disorder characterized by chorea, dystonia, bradykinesia, cognitive decline and psychiatric comorbidities. Balance and gait impairments, as well as falls, are common manifestations of the disease. The importance of compensatory rapid stepping to maintain equilibrium in older adults is established, yet little is known of the role of stepping response times (SRTs) in balance control in people with HD. SRTs and commonly-used clinical measures of balance and mobility were evaluated in fourteen symptomatic participants with HD, and nine controls at a university mobility research laboratory. Relative and absolute reliability, as well as minimal detectable change in SRT were quantified in the HD participants. HD participants exhibited slower SRTs and poorer dynamic balance, mobility and motor performance than controls. HD participants also reported lower balance confidence than controls. Deficits in SRT were associated with low balance confidence and impairments on clinical measures of balance, mobility, and motor performance in HD participants. Measures of relative and absolute reliability indicate that SRT is reliable and reproducible across trials in people with HD. A moderately low percent minimal detectable change suggests that SRT appears sensitive to detecting real change in people with HD. SRT is impaired in people with HD and may be a valid and objective marker of disease progression.

Changes in hemiplegic grasp following distributed repetitive intervention: a case series.

The purpose of this pilot study was to investigate the efficacy of a distributed model of repetitive and focused intervention on grasp force, and clinical and functional hand measures in persons with chronic hemiplegia and limited hand recovery from self-reported stroke. A case series design was used. Focused repetitive unilateral and bilateral interventions were provided in a distributed manner (three times a week for 6 weeks) to three persons with upper limb hemiplegia of more than 1 year. Data from instrumented grasp force, and clinical and functional measures were obtained at weeks 0, 3, 6 and 9. Each participant improved in at least one measure of grasp force, as well as in clinical skill and function. All participants improved in the quality of handwriting. Improved outcomes remained above baseline levels following 3 weeks of non-intervention. The findings are compatible with current evidence of adaptive cortical plasticity following increased repetition. The findings show that, for these three persons, distributed repetitive practice was sufficient to effect change. Localization by cerebral area affected is not possible, nor is it possible to parse the effectiveness of any component of the intervention. A larger group study is warranted to determine whether similar results may be found for other persons with chronic hemiplegia. Future studies should incorporate kinematic handwriting analysis and a greater range of functional tasks.

Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection.

OBJECTIVE: To examine the longitudinal effects of botulinum toxin injection on movement characteristics of the spastic upper extremity in children by using motor control testing (MCT) techniques and standard clinical measures. DESIGN: Open-label clinical trial. SETTING: Motor control laboratory at an academic medical center. PARTICIPANTS: A convenience sample of 9 subjects (5 boys, 4 girls; age range, 7-16 y) with cerebral injury (stroke or cerebral palsy) and asymmetric upper-extremity function because of spasticity. Eight subjects had right-sided involvement. INTERVENTIONS: Botulinum toxin injection to the involved upper extremity, involving elbow, wrist, and finger flexors, depending on clinical presentation. MAIN OUTCOME MEASURES: Clinical measures included range of motion (ROM), the Ashworth Scale, FIM trade mark instrument, Pediatric Evaluation of Disability Inventory, portions of the Bruininks-Oseretsky Test of Motor Proficiency, and the Purdue pegboard. MCT consisted of visually guided reaching, bilateral finger-to-nose movements, hand tapping, and isometric pinch force tasks. Kinematic assessments were made before and at 2, 4, 6, 12, 18, and 24 weeks after botulinum toxin injection. RESULTS: All subjects had increased ROM and decreased Ashworth values throughout the testing period. In motor control tasks, improvement typically occurred earlier in the least complex movements, such as hand tapping, with 6 of 9 subjects showing a maximum, although transient, unilateral tapping speed by 6 weeks. A similar time course was observed for pinch force tasks. Improvement in more complex, forward-reaching tasks occurred much later (week 12 or later) or did not occur at all. As with the hand tasks, improved reach performance declined toward the end of the testing period. All subject showed minimal or no improvement in bilateral finger-to-nose movements. Neither maximum changes in ROM or Ashworth values correlated with improvements in functional elbow extension during sit and reach tasks, with 3 subjects with normal active ROM showing late onset or no change in reach. CONCLUSIONS: Although botulinum toxin reduced tone and increased ROM of the spastic upper extremity, the time course and degree of motor improvement appears to depend on the complexity of the task. Future research should focus on the value of adjunct therapy, such as task-specific training, in addition to botulinum toxin treatments to facilitate functional improvement of the spastic upper extremity.