Walking speed questionnaire used to estimate gait speed in older adults: Comparisons with testing protocols and diagnostic accuracy.

BACKGROUND: Walking speed is an important clinical tool in the physical therapy examination of older adults, but not always feasible to measure. Clinicians may be limited by space, a client's functional limitations, or use of telehealth. The Walking Speed Questionnaire (WSQ) can be used to estimate walking speed, but the effects of testing protocols on the accuracy and diagnostic capability of the WSQ have not yet been investigated. OBJECTIVES: The purposes of this study were to compare estimated with recorded walking speed and examine effects of start condition and instructions in healthy older adults. METHODS: One hundred community dwelling adults 60 years or older were tested. After completing the WSQ, participants performed two trials of six walking conditions that included standing and walking starts under instructions to "walk at a usual pace," "as if crossing a street," and "fast." RESULTS: Participants averaged 72.4 (9.6) years of age. The WSQ average walking speed was 1.22 (0.16) m/s and was slower than each condition, p-value = 0.001, except for those performed with instructions to walk at usual pace with both standing, 1.23 (0.29) m/s and walking starts, 1.26 (0.30) m/s. Compared to the usual pace walking start condition, the WSQ sensitivity and specificity were 31% and 94% respectively with an 82% accuracy. A modified cutoff of the WSQ to 1.17 m/s improves sensitivity. CONCLUSIONS: If walking testing cannot be performed, the WSQ is a reasonable alternative providing an accurate estimate of a client's walking speed when walking at a usual pace.

The impact of resistance training on body composition, muscle strength, and functional fitness in older women (45-80 years): A systematic review (2010-2020).

As women age, they typically experience a progressive decrease in skeletal muscle mass and strength, which can lead to a decline in functional fitness and quality of life. Resistance training (RT) has the potential to attenuate these losses. Although well established for men, evidence regarding the benefits of RT for women is sparse and inconsistent: prior reviews include too few studies with women and do not adequately examine the interactive or additive impacts of workload, modalities, and nutritional supplements on outcomes such as muscle mass (MM), body composition (BC), muscle strength (MS), and functional fitness (FF). The purpose of this review is to identify these gaps. Thirty-eight papers published between 2010 and 2020 (in English) represent 2519 subjects (mean age = 66.89 ± 4.91 years). Intervention averages include 2 to 3 × 50 min sessions across 15 weeks with 7 exercises per session and 11 repetitions per set. Twelve studies (32%) examined the impact of RT plus dietary manipulation. MM, MS, and FF showed positive changes after RT. Adding RT to fitness regimens for peri- to postmenopausal women is likely to have positive benefits.

Acute Effects of Assisted Cycling Therapy on Post-Stroke Motor Function: A Pilot Study.

BACKGROUND: Stroke is the most common cause of long-term disability in the United States (US). Assisted Cycling Therapy (ACT) at cadences of about 80 rpm has been associated with improvements in motor and clinical function in other clinical populations. The acute effects of ACT on motor function of persons with stroke have not been investigated. OBJECTIVES: The primary purpose of this cross-over trial was to compare the effects of ACT, voluntary cycling (VC), and no cycling (NC) on upper (Box and Blocks Test) and lower extremity motor function (Lower Extremity Motor Coordination Test) in adults with chronic stroke (age: 60 ± 16 years; months since stroke: 96 ± 85). The secondary purpose was to examine average cycling cadence and ratings of perceived exertion as predictors of change in motor function following the exercise session. METHODS: Twenty-two participants (female = 6, male = 16) completed one 20-min session each of ACT (mean cadence = 79.5 rpm, VC (mean cadence = 51.5 rpm), and NC on separate days in quasi-counterbalanced fashion). RESULTS: Main effects of intervention did not differ between ACT and VC. Within-intervention analyses revealed significant (p < 0.05) pre- to posttest changes in all outcome measures for ACT but only in the Lower Extremity Motor Coordination Test on the non-paretic side for VC. Trend analyses revealed a positive relationship between average ACT cadences and improvements in upper and lower extremity motor function (p < 0.05). A positive relationship between average VC cadences and lower extremity function was also revealed (p < 0.05). CONCLUSION: ACT and VC produced similar acute improvements in paretic and non-paretic lower extremity motor function whereas changes in upper extremity motor function were more limited. Faster cycling cadences seem to be associated with greater acute effects.

The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults.

Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001-2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5-6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation.

Balance and gait of adults with very mild Alzheimer disease.

BACKGROUND AND PURPOSE: Studies have shown that adults with Alzheimer disease (AD) have gait and balance deficits; however, the focus has been on those with mild to severe disease. The purpose of this study was to determine whether balance and gait deficits are present in those with very mild AD. METHODS: Thirteen adults (72.9±4.7 years old) with very mild AD and 13 age-matched (72.6±4.6 years old) and sex-matched (10 males and 3 females) participants in a control group without AD performed balance and gait tests. All participants were living in the community and independent in community ambulation. RESULTS: Participants with very mild AD had shorter times in tandem stance with eyes open (P<0.001) and with eyes closed (P=0.007) compared with participants in the control group. Those with AD also took longer to complete the Timed "Up & Go" Test (P<0.001). Gait deficits were found for those with AD as demonstrated by slower velocities in the 10-m walk at a comfortable pace (P=0.029) and on an instrumented walkway (P<0.001). Stance times were longer for those with AD (P<0.001) and step length was shorter (P=0.001). There were no group differences in the 10-m walk at a fast pace. The gait velocity of participants in the control group was faster on the instrumented walkway than in the 10-m walk at a comfortable pace (P=0.031). In contrast, the gait velocity of those with AD was significantly slower on the instrumented walkway than in the 10-m walk at a comfortable pace (P=0.024). DISCUSSION: Balance and gait deficits may be present in those in the very early stages of AD. Novel surfaces may affect gait speed in those with very mild AD. Identifying mobility deficits early in the progression of AD may provide an opportunity for early physical therapy intervention, thus promoting continued functional independence. CONCLUSIONS: Adults in the very early stages of AD may show signs of balance and gait deficits. Recognition of these problems early with subsequent physical therapy may slow the progression of further balance and gait dysfunction.

Feasibility and efficacy of intensive cognitive training in early-stage Alzheimer's disease.

Cognitive training may be beneficial for individuals with Alzheimer's disease (AD); however, the effects are modest with little evidence of carryover. Prior studies included limited hours and low intensity of training. The purpose of this study was to test the feasibility and efficacy of many hours of intensive cognitive training with adults in the early stages of AD. Twenty-one adults with very mild or mild AD participated in cognitive training for 10 days over 2 weeks with 4 to 5 hours of training each day. Participants significantly improved in practiced computer-based tasks including those involving working memory, sustained attention, and switching attention. Outcome measures that improved included the Mini-Mental State Examination, letter fluency, and 3 of 5 Trail-Making Tests. Gains in outcome measures were maintained at 2- and 4-month follow-up. Adults in early-stage AD can participate in intensive cognitive training and make modest gains in both practiced and unpracticed cognitive tasks.

The role of patient demographics and clinical presentation in predicting discharge placement after inpatient stroke rehabilitation: analysis of a large, US data base.

PURPOSE: To determine whether functional ability at admission and demographics predict discharge placement after inpatient rehabilitation for older adults recovering from stroke. METHOD: In this retrospective study, we examined records of 31,910 adults 65 years of age and older who were admitted for inpatient rehabilitation post-stroke. Binary logistic regression was used with the outcome of placement and potential predictors of the admission Functional Independence Measure (FIM) score, age, sex and marital status. RESULTS: The average admission FIM was 60.0 out of 126; the average FIM at discharge was 84.8. The mean age was 77.7 ± 7.3 years, 57% were female and 52.5% were not married. More than three quarters of the patients were discharged to home. Odds ratios (ORs) with 95% confidence intervals (CIs) showed that patients with a FIM score below the mean of our sample (OR = 5.8, CI = 5.5-6.2), older than the mean age of our sample (OR = 1.6, CI = 1.5-1.7), and who were not married (OR = 1.9, CI = 1.8-2.0) (p-values <0.001) were more likely to be discharged to residential care. Sex was not predictive of placement. CONCLUSION: The admission FIM was an important predictor of discharge placement after rehabilitation in older adults. Age and marital status were also significant predictors of discharge placement. Sex was not a significant predictor.

Diagnostic accuracy of fall risk assessment tools in people with diabetic peripheral neuropathy.

BACKGROUND: Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking. OBJECTIVE: The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent "fallers" and those who are not recurrent fallers. DESIGN: A cross-sectional study was conducted. SETTING: The study was conducted in a medical research university setting. PARTICIPANTS: The participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy. MEASUREMENTS: Fall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed "Up & Go" Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. RESULTS: Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed "Up & Go" Test demonstrated the highest diagnostic accuracy at 88.9%. LIMITATIONS: The small sample size and retrospective fall history assessment were limitations of the study. CONCLUSIONS: Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy.

Older adults with and without stroke reduce cadence to meet the demands of talking.

PURPOSE: Cognitive tasks performed while walking can be challenging for older adults, especially for those with stroke. Conversational speech requires attention and working memory. The purpose of this study was to examine how older adults with and without stroke meet the demands of walking while talking. METHODS: Community-dwelling older adults, 12 without stroke and 24 with, were videotaped walking an irregular elliptical pathway. Audio recordings were made as subjects discussed topics such as describing a memorable vacation. Each participant performed in single and dual task conditions: speaking, walking, and speaking while walking. Primary measures of interest included cadence and speech rate. Components of language including measures of fluency, grammatical complexity, and semantic content were analyzed to examine additional changes in speech. Paired t-tests were used to compare single and dual task performance for each group. Group differences for dual task effects were examined with independent sample t tests. RESULTS: Cadence decreased with the addition of talking for those without stroke, P < .007, and those with stroke, P < .001. Speech rates did not change with walking for either group; those without stroke did not alter the language components. Participants with stroke reduced the grammatical complexity and semantic content of speech when walking, P's < .013. Those without stroke spent more time doing both tasks at once than those with stroke, P < .023. CONCLUSION: Clinicians can expect older adults to reduce walking speed to meet the demands of walking and talking. Older adults with stroke may use additional strategies to walk and talk simultaneously.

Dual-task demands of hand movements for adults with stroke: a pilot study.

UNLABELLED: For adults with stroke, walking while performing a cognitive task can be challenging, resulting in slower walking, poorer cognitive performance, or decreased performance on both tasks. It is not known if dual-task deficits are also present for upper limb movements for adults with stroke. PURPOSE: To determine if unilateral movements of the affected and less affected hand are compromised when walking or talking. METHODS: Nineteen community-dwelling adults with stroke were video- and audiotaped while performing in single- and dual-task conditions. Tasks included repeated, rhythmic hand movements with the affected and less affected hand, walking a narrow pathway, and speaking. For dual-task conditions, movements of each hand were done while walking and while talking. The rate of hand movement, cadence, and speech rate were analyzed using repeated measures analyses of variance. RESULTS: Affected hand movement rate was the same for single- and dual-task conditions. The rate of less affected hand movement was affected by dual-task conditions; this was due to an increase in hand movement rate while talking. Examination of cadence and speech rates revealed that cadence was decreased when moving the affected hand. Speech rate increased when accompanied by hand movements, but post hoc analyses were not significant. CONCLUSION: For those with stroke, dual-task deficits are seen with slower walking while moving the affected hand. In contrast, hand movements while speaking may have a more complex relationship, with possible faster speech rates in dual-task conditions.

Single limb exercise: pilot study of physiological and functional responses to forced use of the hemiparetic lower extremity.

PURPOSE: Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. METHODS: Twelve participants (5 male) with a mean age of 60.6 +/- 14.5 years and 69.1 +/- 82.2 months post stroke participated in the training intervention. All participants performed SLE using the hemiparetic leg three times a week for 4 weeks. The nonhemiparetic limb served as the control limb and did not engage in SLE. Peak oxygen uptake (VO2 peak) and oxygen uptake (VO2) were measured at baseline and post intervention in all 12 participants. At pre and post intervention, gait velocity was assessed in a subset of participants (n = 7) using the 10-m fast-walk test. RESULTS: After the 4-week SLE training intervention, significant improvements were found for VO2 during submaximal work effort (P = .009) and gait velocity (n = 7) (P = .001). Peak oxygen uptake did not increase (P = .41) after the training intervention. CONCLUSION: These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.

Current clinical practices in stroke rehabilitation: regional pilot survey.

This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments.

Task switching after stroke.

BACKGROUND AND PURPOSE: Task switching is a cognitive skill that may be compromised after brain damage. The purposes of this study were to examine task-switching abilities in the subacute phase after stroke, to determine whether a switching task under endogenous or internal control is more difficult than a switching task under exogenous or cued control, and to determine whether deficits in switching attenuate in the first few months after stroke. SUBJECTS: The participants in this study were 46 adults with stroke and 38 adults without stroke. METHODS: Subjects performed 2 computer-based switching tasks, an alternating task that relied on endogenous control and a cued task that relied on exogenous control. Testing was done in subjects' homes at 1 and 3 months after stroke and at a 2-month interval for control subjects. Switch costs, or the difference between the no-switch condition and the switch condition, were calculated for accuracy and response time. RESULTS: Subjects in the stroke group had higher switch costs for accuracy than did subjects in the control group. The alternating task was more difficult than the cued task, with higher switch costs for accuracy and response time. The alternating task was particularly difficult for subjects in the stroke group, with high switch costs for accuracy. Both groups showed decreased response time switch costs at the second testing session. DISCUSSION AND CONCLUSION: Task switching, particularly if under endogenous control, is impaired in adults in the subacute phase after stroke. Clinicians should be aware of performance deficits that may relate to task switching.

Access to polling places in the 2004 Presidential election: the experience of one metropolitan midwestern city.

According to federal law, polling places must be accessible to persons with disabilities. The rate of compliance with these laws, however, is not known. Our purpose was to determine whether polling places in the Greater Kansas City area were physically accessible to persons with disabilities. Students, faculty, and staff members from four professional programs representing two universities completed surveys at 128 polling places on the day of the 2004 Presidential election. Over the 14 items of interest, compliance ranged from 75% to 99%. The highest rate of deficiencies was found in the lack of a ramp with a handrail to the entrance of the polling place. Only 43% of the polling places were compliant in all of the 14 survey items. Despite laws mandating that polling places be accessible to persons with disabilities, restrictions in access persist. Persons with disabilities may still find polling places inaccessible on Election Day.

Gains in distance walking in a 3-month follow-up poststroke: what changes?

STATEMENT OF PROBLEM: Distance walking remains compromised for many adults poststroke. The purpose of this study was to examine if the amelioration of stroke-related neuromuscular impairments, improved cardiovascular fitness, or better balance contributed to gains in distance walking. METHOD OF STUDY: The authors gathered baseline data of 92 adults at an average of 75 days poststroke and again 3 months later. Participants performed a bicycle ergometry stress test, a 6-min walk, and a Fugl-Meyer assessment for motor control, strength, and balance testing. The gain in walk distance was modeled using multiple regression with the variables of gains in peak VO2, lower limb control, plantar flexion strength, and balance. Separate analyses were done for poor performers, that is, participants who walked less than the median distance (213 m) at baseline and good performers, that is, participants who walked more than 213 m. RESULTS: For poor performers, the gain in balance was the only significant predictor of the gain in distance walking and accounted for 16% of the variance. For good performers, gains in peak VO2 and the lower limb Fugl-Meyer score were significant predictors and accounted for 28% of the variance. DISCUSSION: These results suggest that rehabilitation efforts to improve distance walking should focus on different factors depending on initial distance walked.

Effects of practice and unpredictable distractors on planning and executing aiming after stroke.

The primary purpose of this study was to examine practice effects on the planning and execution of an aiming movement after right versus left stroke. A secondary purpose was to investigate the effects of a distractor that appeared randomly on motor performance after stroke. Right-hand dominant individuals, 15 with right stroke (right-sided brain damage), 16 with left stroke, and 30 without stroke, performed aiming movements to targets. Those with stroke used the ipsilesional upper extremity (UE). Right and left comparison groups used the right and left UE, respectively. Reaction time (RT) and movement time (MT) were collected to represent movement planning and execution, respectively. Individuals with right stroke improved RT with practice. Individuals with left stroke did not improve RT with practice and made more errors than their comparison group. Those with left stroke achieved faster MT with practice, but MT remained slower than their comparison group. There were no effects of the distractor on RT or MT. Adults with left stroke have persistent deficits in movement planning and execution. Further studies are needed to determine how the performance of older adults, with or without stroke, is affected by an unpredictable visual distractor.

Ipsilateral deficits of targeted movements after stroke.

OBJECTIVE: To test the hypotheses that targeted movements of both the ipsilateral and the contralateral extremities of stroke survivors would be prolonged compared with those from a control group without stroke, and that the ipsilateral deficit would occur in movements toward small, but not large, targets. DESIGN: Descriptive study. SETTING: Motor performance laboratory. PARTICIPANTS: Convenience sample of right-handed individuals including 10 who were more than 6 months poststroke with Fugl-Meyer Motor Assessment scores greater than 75% for the upper (UEs) and lower (LEs) extremities, and a comparison group of 20 age-matched adults without stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The average time required for the stylus, held with the hand or strapped to the foot, to travel from leaving 1 target to contacting the second target (ie, movement time) and the average time the stylus rested on the target (ie, dwell time). RESULTS: Regardless of target size, movement and dwell times for both UEs of the stroke group were prolonged compared with those of the comparison group. Regardless of target size, dwell time for both LEs of the stroke group was prolonged compared with that of the comparison group. CONCLUSIONS: After stroke, the ipsilateral extremities may show subtle deficits in targeted movements.

Anticipatory postural adjustments and the latency of compensatory stepping reactions in humans.

A compensatory stepping response is a commonly used strategy in recovering balance control after a postural perturbation. Unlike gait initiation, the compensatory stepping often occurs without an anticipatory postural adjustment (APA), in which body weight is shifted to the swing leg first and then back to the stance leg prior to foot lifting. In postural perturbation studies using a moving platforms stepping responses without an APA were found to have shorter latency to foot lifting than trials with an APA. We studied stepping responses of healthy young adults under postural perturbation of a pulling force impulse on the subject's waist. In contrast to previous studies, the latency of foot lifting was found in the current study to be shorter in the trials with an APA than trials without an APA. Furthermore, greater amplitude of an APA was associated with a shorter latency of foot lifting. Response with an APA of large amplitude may indicate high level of determinant for foot lifting. A pause as to whether or not to initiate/complete a stepping response is suggested to be partially the cause of delayed foot lifting in trials without an APA or with small amplitude of the APA.

Attentional abilities and functional outcomes following stroke.

Although stroke affects cognitive functioning as well as motor functioning, research on cognitive consequences has lagged behind that focused on motor function. The evidence that is accruing suggests that cognitive function is importantly related to successful rehabilitation. The present study examined two aspects of attentional functioning (divided attention and switching attention) in older adult stroke survivors and healthy older adults. In addition, the authors investigated the relation between attention and functional outcomes following stroke. Results revealed stroke-related deficits in both of the types of attention as well as significant associations between attentional functioning and both physical and social outcome measures. Poorer attentional performance was associated with a more negative impact of stroke on daily functioning. These findings suggest an important role for attention in post-stroke function and provide information that can contribute to improving outcomes following stroke.