Enhanced Rehabilitation Outcomes of Robotic-Assisted Gait Training with EksoNR Lower Extremity Exoskeleton in 19 Stroke Patients.

BACKGROUND Stroke is a leading cause of long-term disability, often resulting in impaired mobility and gait abnormalities, necessitating effective rehabilitation approaches. Robotic-assisted gait training (RAGT) offers precise control and intensive, task-specific training. The EksoNR exoskeleton shows potential in facilitating gait recovery. This study assesses the efficacy and tolerability of RAGT using EksoNR in the rehabilitation of 19 stroke patients. MATERIAL AND METHODS A prospective nonrandomized, observational study design was employed with a single group convenience sample. The study included 19 individuals post-stroke, who underwent a 4-week rehabilitation program. Baseline and post-rehabilitation assessments were conducted using selected International Classification of Functioning, Disability and Health (ICF) codes, gait exoskeleton parameters (number of steps, walking time, time of verticalization) obtained during the exoskeleton sessions, and the Timed Up and Go Test (TUG). RESULTS The study revealed statistically significant improvements in all analyzed ICF categories, except for D530 Toileting, indicating enhanced functioning. The most notable improvements in activity and participation were observed in the categories of D410 Changing basic body position (-0.84±0.60) and D450 Walking (-0.84±0.60). Additionally, gait analysis demonstrated significant enhancements in the number of steps (difference of 506.79±252.49), walking time (13.02±7.91), and time of verticalization (11.82±9.21) (p>0.001). The TUG test also showed a statistically significant improvement in mobility (p=0.005). CONCLUSIONS This study supports previous findings, demonstrating that RAGT using the EksoNR lower extremity exoskeleton improves gait and functional status in stroke patients, while being well tolerated. The results highlight the potential of this approach for improved rehabilitation outcomes.

The Impact of Physical Exercises with Elements of Dance Movement Therapy on Anthropometric Parameters and Physical Fitness among Functionally Limited Older Nursing Home Residents.

Changes in the composition of the body mass of functionally limited older patients may contribute to a decrease in functional fitness and the development of chronic diseases. This research aimed to assess the differences in anthropometric parameters and physical fitness of older patients, over the age of 65, in a 12-week clinical intervention study. Method: The study participants were nursing home inhabitants aged 65-85 who were functionally limited. Persons meeting the inclusion criteria were assigned to one of the three groups: Group 1-basic exercises/BE group (n = 56); Group 2-physical exercises with elements of dancing/PED group (n = 57); Group 3-control group/CO group (n = 56) routine care. The data were collected at the beginning of the study and at the 12-week mark. The outcome was observed for hand grip strength (HGS), arm curl test (ACT), Barthel Index (BI), Berg Balance Scale (BBS), triceps skin fold (TSF), waist-to-hip-ratio (WHR), and arm muscle area (AMA). Results: The study included 98 women and 71 men. The average age of the participants was 74.40 years. The analysis of the effects of the 12-week exercise program showed the greatest changes in HGS, ACT, and BI in the exercise groups, especially in the PED group compared to the BE group. Statistically significant differences in the examined parameters of the PED vs. BE vs. CO groups were demonstrated in favour of the exercising groups. In conclusion, a 12-week program of group physical exercises, both PED and BE, improves physical fitness indicators and anthropometric indicators.

The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes - a randomized control trial.

INTRODUCTION: Over the last few decades, the quality of care and the quality of life of nursing home (NH) residents have significantly improved, but insufficient physical activity and social involvement still represent substantial challenges in modern nursing facilities. The main aim of this research was to assess the influence of physical exercises with dance movement therapy (DMT) elements on strength and other fitness components of the upper limbs and the overall functional performance of NH residents in wheelchairs compared to standard exercise programmes and usual care. METHOD: The study participants were persons aged 68-85 who lived in NH and used manual wheelchairs as a primary means of mobility. Individuals meeting the inclusion criteria were assigned to one of the three groups: Group 1, basic exercise/BE group (n = 55); group 2, physical exercises with elements of dance movement therapy/PED group (n = 55); and group 3, control group, usual care/CO group (n = 55). The intervention for both exercising groups consisted of a 30-min session, two times a week, for 12 weeks in total. Outcome assessments were performed at baseline, 12 weeks after baseline (immediately after the intervention) and 24 weeks after baseline (12 weeks after the intervention). The main outcome was observed for hand grip strength (HGS), while secondary outcomes for box and block test (BBT), arm curl test (ACT), back scratch test (BS), chair sit-and-reach (CSR), peak expiratory flow (PEF), Barthel Index (BI), Berg Balance Scale (BBS) and the range of motion of the shoulder. RESULTS: Prior to the start of the exercise programmes, all the tested groups were homogeneous. After 12 weeks the PED group presented higher statistically significant scores in HGSL, BBT, ACT, BS, CSR, BI, BBS: p < 0.001 and HGSR: p = 0.01, compared to the BE group. After 24 weeks from the beginning of the intervention the comparison between the PED group and the BE group showed statistically significant differences (p < 0.001) in favour of PED group in almost all areas: HGSR, HGSL, BBT: ACT, PEF, BS, CSR, BI. After 12 and 24 weeks both intervention groups performed better than the CO in all measures except for Katz ADL and shoulder extension. CONCLUSION: Twelve weeks of physical exercises had beneficial effects on the strength and fitness of the upper limbs and overall functional performance in both exercise groups. This study demonstrated that group performing physical exercises with elements of DMT obtained statistically better scores in the majority of analysed domains than other groups. TRIAL REGISTRATION: The study was registered in the Sri Lanka Clinical Trials Registry (Registration Number - SLCTR/2018/014 - Date of Registration 16/05/2018. Accessed on https://slctr.lk/trials/1045 ).

Reference values and factors associated with hand grip strength among older adults living in southeastern Poland.

Handgrip strength (HGS) is used as a biomarker for the state of health of older people, but the number of research publications containing the normative values of HGS in older adult populations is limited. The aim of the study was to define reference values and factors associated with HGS in older adults living in southeastern Poland. A cross-sectional study including 405 participants aged 65 and older was conducted. Handgrip strength for the dominant hand was assessed by the average of three trials using a JAMAR dynamometer. The sample was categorized into the following age groups: 65-69 years, 70-74 years, 75-79 years, 80-84 years, 85 and over. The average HGS was 19.98 kg (16.91 kg for women and 26.19 kg for men). There was a decrease in handgrip strength across the age range in both sexes. The average handgrip strength of the older people was 17.97 kg (14.47 kg for women and 25.66 kg for men) for those aged 80-85 and 16.68 kg (13.51 kg for women and 21.77 kg for men) in the group over 85 years old. In both sexes, marital status was an independent factor associated with reduced handgrip strength. In conclusion, this study described, for the first time, handgrip strength values for the southeastern Polish population aged ≥ 65 years according to age and gender.

Cultural adaptation and validation of the Polish version of the physical activity scale for older people living in a community: a cross-sectional study.

BACKGROUND: Polish clinicians and researchers face challenges in selecting physical activity tools appropriate and validated for older people. The aim of this study is to provide cultural adaptation and validation of the Polish version of the Physical Activity Scale for Elderly (PASE-P). METHODS: This cross-sectional study was carried out among 115 older adults living in south-eastern Poland. The original version of the scale has been translated into the Polish language following standardized translation procedures. Validation was evaluated by Pearson's rank correlation coefficients between PASE-P, the normal Timed Up and Go test and that with a cognitive task (TUG and TUG cog, respectively), grip strength, basic and instrumental activities of daily living (ADL and IADL, respectively), Five Times Sit to Stand (5x STS), 10-m Walk Test (10MWT), the Berg Balance Scale (BBS) and the International Physical Activity Questionnaire (IPAQ). RESULTS: The mean PASE-P was 91.54 (SD 71.15). Sufficient reliability of the test-retest of the PASE-P questionnaire components was found between the trials. The ICC test was strong and ranged from 0.988 to 0.778 for both major domains and the total scale score. A significant correlation was found between the total PASE-P score and the shorter TUG, TUG cog (r = - 0.514, p < 0.001; r = - 0.481, p < 0.001) and 10MWT (r = 0.472, p < 0.001). The total PASE-P score was also positively correlated with ADL and IADL (r = 0.337, p < 0.001; r = 0.415 p < 0.001), BBS (r = 0.537, p < 0.001) and 5xSTS (r = 0.558, p < 0.001). CONCLUSIONS: The results obtained in the study confirm that the Polish version of the PASE scale is a valid and reliable tool for assessing the level of physical activity in older adults living in a community.

Extraction and characterization of phytochemical compounds from araçazeiro (Psidium cattleianum) leaf: Putative antioxidant and antimicrobial properties.

Underexplored species have phytochemical potential for pharmacological and nutraceutical applications. The fruits of such species, including aracá (Psidium cattleianum Sabine), are rich in specialized metabolites with putative antioxidant and antimicrobial activity; therefore, the leaves of these species are also a potential source of bioactive compounds. In this study, araçazeiro leaves were extracted using an aqueous infusion (Al) and a pressurized liquid extraction system with water (PLE-W), ethanol (PLE-E), and 1:1 water:ethanol ratio combination (PLE-W:E). PLE-W:E yielded a greater diversity of extracted compounds. Nonetheless, all extracts showed inhibitory activity against pathogenic Gram-positive and Gram-negative bacteria and antioxidant activity in the in vitro thiobarbituric acid reactive substances (TBARS) and reactive oxygen species (ROS) assays with rat brain and yeast model systems. Thus, araçazeiro leaves can be exploited as a promising source of bioactive compounds.

Psychophysical Health Factors and Its Correlations in Elderly Wheelchair Users Who Live in Nursing Homes.

Background: The aging is a multi-faceted process comprising both-the physical and mental alterations. Thus, the aim of the study was to evaluate the variables affecting the psychophysical state of the elderly people using wheelchairs and living in nursing homes (NH). Methods: 165 older wheelchair users were included in the study after meeting the inclusion criteria and expressing written consent. The assessment involved cognitive functioning, depression, body balance and flexibility, lung capacity and upper limbs dexterity, strenght and endurance. The results showed negative correlation between depression and balance, upper limb dexterity and endurance and shoulder flexion. A positive correlation between cognitive functioning and balance, upper limb dexterity, strenght and endurance, lung capacity and joint mobility was determined. Also, the study proved positive correlation between daily functioning and functional fitness, muscle strength and endurance, body flexibility, joint mobility. The regression analysis showed that better scores in balance test and joint mobility implied with higher scores in cognitive functioning. The most important determinants of functional fitness were balance, hand grip strenght and joint mobility. Conclusion: The future study should be focused on developing interventions aimed at senior wheelchair users living in NHs to prevent the deterioration of their mental and physical fitness.

Effects of Physical Exercises and Verbal Stimulation on the Functional Efficiency and Use of Free Time in an Older Population under Institutional Care: A Randomized Controlled Trial.

Older people in institutional care are, for the most part, physically inactive and do not interact with each other or medical staff. Therefore, reducing sedentary behaviour is a new, important, and modifiable lifestyle variable that can improve the health of elderly people. The aim of the project was to assess the degree of improvement in functional performance and the possibility of changing habitual, free time behaviour among elderly people under institutional care by applying physical training with verbal stimulation. The study covered older people, aged 65-85 years, who are living a sedentary lifestyle in care homes in Southeastern Poland. Those who met the eligibility criteria were enrolled in the study and were assigned, at random, to one of four parallel groups: basic exercises (n = 51), basic exercises combined with verbal stimulation (n = 51), functional exercise training (n = 51), and functional exercise training with verbal stimulation (n = 51). No statistically significant differences in baseline characteristics were observed across the groups. Data were collected at baseline and at 12 and 24-weeks following the completion of the intervention. In the group with functional exercise training with verbal stimulation, in comparison to the group with basic exercises, the greatest positive short-term impact of intervention was demonstrated in terms of functional fitness (increased by 1.31 points; 95% confidence interval (CI) = 0.93-1.70), gait speed (improved by 0.17 m/s, 95% CI = 0.13-0.22), hand grip strength (by over 4 kg; 95% CI = 2.51-4.95), and upper-limb flexibility (by 10 cm; 95% CI = 5.82-12.65). There was also a significant increase in the level of free-time physical activity and an improvement in the quality of life, especially as expressed in the domain of overall physical functioning. Our study showed that a functional exercise program, combined with verbal stimulation, is effective at improving physical fitness and raising the level of free-time physical activity.

Gender differences in postural stability in elderly people under institutional care.

PURPOSE: The aim of the research was to assess the postural stability indicators of older women and men receiving i nstitutional care. METHODS: The study involved 123 people aged 65-85, living in residential care homes in Rzeszów district. The main research tool was the CQ-Stab 2P 2-platform posturograph. RESULTS: There were statistically significant differences between women and men in the total statokinesiogram path length, the statokinesiogram path length in the anteroposterior direction, the mean COP displacement in the anteroposterior direction as well as the mean velocity of the COP point in the anteroposterior direction under eye control (p = 0.04). In the case of absence of visual control, men were characterized by significantly worse parameters in the area of mean COP displacement in the anteroposterior and lateral directions as well as the maximal COP displacement in the anteroposterior and lateral directions. It indicated that without visual control, body balance parameters in men significantly worsened along with increasing age. A statistically significant difference was found between both genders in terms of the statokinesiogram path length, the mean COP displacement and the mean COP velocity (p < 0.05). CONCLUSIONS: Gender differences in postural stability of older people under institutional care were noticed. Men were characterized by a lower level of postural stability compared to women. Elimination of visual control significantly worsened the balance of the body. The results obtained indicate the necessity of introducing therapeutic programs in nursing homes, taking proprioceptive exercises and exercises without visual input into account.

Association between Handgrip Strength, Mobility, Leg Strength, Flexibility, and Postural Balance in Older Adults under Long-Term Care Facilities.

INTRODUCTION: Low muscle strength is common and important in geriatric syndromes including frailty and sarcopenia. The epidemiology of grip strength of older people under long-term care facilities has been little explored. PURPOSE: The aim of this study was to assess handgrip strength of older women and men covered by institutional care and to analyse the associations between HGS and mobility, leg strength, flexibility, and postural balance. MATERIALS AND METHODS: This is a cross-sectional study carried out at care homes in southeastern Poland. After considering the inclusion criteria, 209 older people aged 65 to 85 were included in the study. Sociodemographic data were collected, and tests of muscular strength, mobility, flexibility, and postural balance were carried out by the use of the stabilometric platform CQ Stab 2P. RESULTS: The average handgrip strength in the study group amounted to 19.8 kg, including 14.8 kg in women and 25.9 kg in men. Low grip strength was found in 67.83% women and 52.13% men in institutional care. A negative correlation between handgrip strength (HGS) and the Timed Up and Go (TUG) test was demonstrated, both with and without cognitive task and strength of lower limbs. Gait speed and dynamic balance were positively correlated with HGS. A negative correlation was found between the total length of the centre of pressure (COP) path, the length of the COP path in the lateral-medial direction, and the sway area delimited by the COP and HGS for the dominant hand. Speaking of women, gait speed was most strongly associated with HGS, while among men, it was upper limb flexibility. CONCLUSION: Regardless of gender, HGS is associated with mobility, strength of the lower limbs, and dynamic balance. By means of simple tools, early diagnosis will facilitate the planning of appropriate interventions in order to prevent disability and mortality in long-term care facilities.

Comparison of selected body composition parameters in women using DXA and anthropometric method.

BACKGROUND: An excessive accumulation of the adipose tissue in women's organism is a frequent and important medical problem which should be monitored. The aim of this study was to explore correlations between the selected parameters of body composition assessed using DXA and anthropometric methods. MATERIALS AND METHODS: The study group consisted of 50 women aged 51-85. Both adipose mass and fat-free mass were assessed with the DXA method, and the nutritional status of the participants was evaluated with the anthropometric methods. RESULTS: The mean body mass index (BMI) value assessed with the DXA method amounted to 28.4 (±5.12). The Spearman's Rho correlation indicated the presence of a moderate association (0.27-0.50) between: (1) right arm lean and the circumference of the arm (P = 0.020), forearm (P = 0.011), and transverse cross-section of the arm (P = 0.020), (2) right leg fat and circumference of the thigh (P = 0.003), shin (P = 0.009), and also the musculature index of the lower extremity (P = 0.034), (3) visceral adipose tissue (VAT) mass and BMI (P = 0.050), Waist to HeightRatio (WtHR) (P = 0.031), (4) Android fat and WHtR (P = 0.044), and (5) gynoid fat and Skerlj index (P = 0.025). CONCLUSION: The selected parameters assessed with DXA were significantly correlated with the selected parameters assessed with anthropometric methods. WHtR anthropometric parameter is significantly correlated with DXA parameters: VAT mass, gynoid region % fat and android region % fat.

Assessment of psychophysical capacities for professional work in late middle age and at the beginning of old age

BACKGROUND: In Poland average life expectancy extends, while the number of the elderly who are active in the labor market decreases MATERIAL AND METHODS: The study population consisted of 429 people aged 50­70 years old living in the community of south-eastern Poland. The respondents were divided into 2 study groups: group I ­ late middle age (50­60 years old) and group II ­ early old age (61­70 years old). With the use of questionnaires they were given, we obtained their socio-demographic data, assessed their cognitive and emotional state, as their physical activity levels. We used the Tinetti test to assess their gait and balance. RESULTS: We did not find statistically significant difference in cognitive functioning between the studied groups (p = 0.109). Moreover, there was no significant relationship between belonging to an age group and suffering from depression (p = 0.06) as well as no major differences were observed in the general level of physical activity in relation to age (p = 0.112). Our study found that most of our subjects, regardless of gender, declared their willingness to continue professional work after reaching retirement age. CONCLUSIONS: The results of own research did not show significant differences in psychophysical state between people in late middle age and at the beginning of old age. Most of the researched participants declared their willingness to continue professional work. Due to changing demographic conditions, it is becoming an important issue to maintain the highest possible level of professional activity of older people in the labor market in Poland. Med Pr 2018;69(4):375­381