Cervical mobility and cervical proprioception in relation to fall risk among older adults: a prospective cohort study.

PURPOSE: Age-related decreases in cervical mobility and proprioception have previously been demonstrated. Potential associations of these deteriorations with fall risk have not been investigated so far. This study aims to compare cervical mobility and proprioception between fallers and non-fallers and prospectively assess the contribution of these parameters in fall risk identification among healthy older adults. METHODS: 95 community-dwelling older adults underwent a cervical screening. Active cervical range of motion (aCROM) was measured using a digital inclinometer and cervical proprioception was assessed by determining joint position error (JPE). Fear of falling was identified through the Iconographical Falls Efficacy Scale (iconFES). Falls were prospectively recorded during a 1-year follow-up period using monthly calendars. Univariate and multivariate logistic regression analyses were conducted to examine the association between these parameters and falls occurrence. RESULTS: Baseline measurements revealed reduced cervical performance (i.e., smaller aCROM and larger JPE) among individuals who reported at least one fall during the following year ("fallers"). The multivariate logistic regression model contained eight independent variables (age, sex, walking aid, fall history, iconFES, aCROM F, aCROM E and JPE) and correctly classified 77.8% of cases. CONCLUSION: Although the contribution of cervical parameters to fall risk identification seems to be rather small compared to well-known (though often unmodifiable) major risk factors, further research is needed to elucidate underlying mechanisms of cervical functions in relation to falls. Second, it would be interesting to develop a targeted fall preventive cervical exercise program and assess its effectiveness in terms of falls occurrence.

The Effects of Aerobic Exercise in Patients with Early-Onset Dementia: A Scoping Review.

BACKGROUND: Early-onset dementia (EOD) defines all dementia related conditions with an onset before the age of 65 years. EOD places a large and distressing psychological, emotional and financial burden on the individuals themselves and their caregivers. For various reasons, diagnostic and treatment strategies for EOD are very challenging. There is a general agreement that not only the human body but also the mind benefits from physical activity and/or exercise. Especially aerobic exercise has shown to have favorable effects on cognitive functions in healthy older adults, as well as in patients with MCI and dementia. However, there are major differences in age, physical fitness level and clinical presentation between EOD and late-onset dementia. Therefore, one cannot just assume that the same type and intensity of exercise will lead to similar effects in the former population. By conducting this scoping review, the authors aimed to identify the evidence on the effectiveness of aerobic exercise on physical and mental health outcomes in individuals with EOD, display gaps in this context, and formulate related directions for future research. SUMMARY: There are a number of reasons to assume that aerobic exercise might be extremely valuable within individuals with EOD. However, this scoping review led to the surprising and striking finding that not a single study so far has investigated the effects of physical exercise on cognition, physical performance and feelings of well-being and quality of life in EOD. Although nowadays the disease is increasingly recognized, coping and (non-pharmacological) treatment strategies for EOD are virtually non-existent. Key Messages: Exercise intervention studies in EOD are lacking. With this scoping review the authors hope to inspire researchers in the field for related directions for future research. The potential beneficial effects of aerobic exercise in individuals with EOD should be explored and assessed extensively. Secondarily, decent guidelines for non-pharmacological treatment and coping strategies should be developed, with the aim of supporting people with EOD and their caregivers.

Motivation in pediatric motor rehabilitation: A systematic search of the literature using the self-determination theory as a conceptual framework.

OBJECTIVE: Motivation is suggested as an important factor in pediatric motor rehabilitation. Therefore, we reviewed the existing evidence of (motivational) motor rehabilitation paradigms, and how motivation influences rehabilitation outcome using self-determination theory as conceptual framework. METHODS: PubMed and Web-of-Science databases were systematically searched until June 2015. Data were independently extracted and critiqued for quality by three authors. Studies reporting motivational aspects were included. Most studies examined new technology (e.g., virtual reality [VR]). RESULTS: Out of 479 records, three RCT, six case-control, and six non-comparative studies were included with mixed quality. Motivation was rarely reported. Training individualization to the child's capabilities with more variety seemed promising to increase motivation. Motivation increased when the exercises seemed helpful for daily activities. CONCLUSIONS: Motivation in pediatric rehabilitation should be comprehensively assessed within a theoretical framework as there are indications that motivated children have better rehabilitation outcomes, depending on the aspect of motivation.

Influence of Morphine and Naloxone on Pain Modulation in Rheumatoid Arthritis, Chronic Fatigue Syndrome/Fibromyalgia, and Controls: A Double-Blind, Randomized, Placebo-Controlled, Cross-Over Study.

BACKGROUND: Impaired pain inhibitory and enhanced pain facilitatory mechanisms are repeatedly reported in patients with central sensitization pain. However, the exact effects of frequently prescribed opioids on central pain modulation are still unknown. METHODS: A randomized, double-blind, placebo-controlled cross-over trial was carried out. Ten chronic fatigue syndrome (CFS)/fibromyalgia (FM) patients, 11 rheumatoid arthritis (RA) patients and 20 controls were randomly allocated to the experimental (10 mg morphine or 0.2 mg/mL Naloxone) and placebo (2 mL Aqua) group. Pressure pain thresholds (PPTs) and temporal summation at the Trapezius and Quadriceps were assessed by algometry. Conditioned pain modulation (CPM) efficacy and deep tissue pain pressure were assessed by adding ischemic occlusion at the opposite upper arm. RESULTS: Deep tissue pain pressure was lower and temporal summation higher in CFS/FM (P = 0.002 respectively P = 0.010) and RA patients (P = 0.011 respectively P = 0.047) compared to controls at baseline. Morphine had only a positive effect on PPTs in both patient groups (P time = 0.034). Accordingly, PPTs increased after placebo (P time = 0.015), and no effects on the other pain parameters were objectified. There were no significant effects of naloxone nor nocebo on PPT, deep tissue pain, temporal summation or CPM in the control group. CONCLUSIONS: This study revealed anti-hyperalgesia effects of morphine in CFS/FM and RA patients. Nevertheless, these effects were comparable to placebo. Besides, neither morphine nor naloxone influenced deep tissue pain, temporal summation or CPM. Therefore, these results suggest that the opioid system is not dominant in (enhanced) bottom-up sensitization (temporal summation) or (impaired) endogenous pain inhibition (CPM) in patients with CFS/FM or RA.

Does Footwear Matter When Performing Spatiotemporal Gait Analysis Among Older Women?

BACKGROUND AND PURPOSE: Although shoe type may influence gait performance and is considered to be an extrinsic fall risk factor, little or no attention is paid to it when conducting research in this field. Therefore, this study aimed to assess the effect of various types of footwear under single- and dual-task conditions on spatiotemporal gait characteristics in older women. METHODS: Fifty-seven community-dwelling women (68.0 ± 4.6 years) were enrolled in this study. Spatiotemporal gait analysis using the GAITRite walkway was performed under 4 footwear conditions (barefoot, slippers, high heels, and standard shoes) and 3 task conditions (single-task, motor dual-task, and cognitive dual-task). Two-factor repeated-measures analysis of variance was conducted. Primary outcomes were velocity, cadence, stride time, stride length, and stride length variability. RESULTS: Irrespective of task condition, walking barefoot resulted in a significantly slower gait pattern with decreased cadence and stride length and increased stride time and stride length variability compared with walking with the standard shoe. These significant gait alterations were also observed when adding a cognitive task to normal walking. The effects of footwear were most obvious during the cognitive dual-task condition and for the spatiotemporal parameters velocity and stride length. CONCLUSIONS: Footwear matters when analyzing gait in older women. It should be described in greater detail by gait researchers. Footwear should also be considered by clinicians in light of the study findings and its effects on gait. Older women are strongly discouraged to walk barefoot because barefoot walking adversely affects gait patterns. A well-fitting standard shoe with laces, a low and wide heel, firm heel collar and a grooved, moderately hard sole is recommended in research, rehabilitation, and daily use.

Understanding the relationship between walking aids and falls in older adults: a prospective cohort study.

BACKGROUND: A substantial proportion of older adults living in residential aged care facilities are use wheelchairs or walk with aids. The relationship between using walking aids and falling is somewhat inconsistent and poorly understood. PURPOSE: To investigate the use of walking aids as a risk factor for future falls among older adults living in residential aged care facilities and to identify spatiotemporal gait parameters that mediate the potential relationship between walking aids and falling. METHODS: Forty-three older adults (22 using walking aids and 21 not using walking aids) living in residential aged care facilities were enrolled in this study. Fall history, fear of falling, and the use of psychotropic agents were registered. Spatiotemporal gait (GAITRite®), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. RESULTS: Individuals using walking aids were older (P = .012), had a greater fear of falling (P = .017), and demonstrated a more conservative gait pattern compared with those not using walking aids. They walked slower (P < .001) and had a lower cadence (P < .001) and shorter step length (P = .018) and step time (P = .003). Twenty-two participants (15 using walking aids vs 7 not using walking aids) reported at least one fall ("fallers"). Univariate logistic regression identified using walking aids as a risk factor for future falls (odds ratio, 3.98; 95% confidence interval, 1.10-14.37; P = .035). A lower cadence, increased stance percentage, decreased swing percentage, increased age, and greater psychotropic drug intake were mediators that reduced the odds ratio of the relationship between using walking aids and faller status the most. CONCLUSIONS: Using walking aids is a risk factor for future falls among the older population living in residential settings. A substantial proportion of the relationship between walking aids and future falls could be explained by an altered spatiotemporal gait pattern, increased age, and psychotropic drug intake. This finding supports the aim of extensive training periods and appropriate instructions on the proper use of walking aids in terms of adequate and safe gait patterns.

Understanding the relationship between type 2 diabetes mellitus and falls in older adults: a prospective cohort study.

BACKGROUND: Older adults with type 2 Diabetes Mellitus are at increased risk of falling. The current study aims to identify risk factors that mediate the relationship between diabetes and falls. METHODS: 199 older adults (104 with diabetes and 95 healthy controls) underwent a medical screening. Gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test) were assessed. Falls were prospectively recorded during a 12-month follow-up period using monthly calendars. RESULTS: Compared to controls, diabetes participants scored worse on all physical and cognitive measures. Sixty-four participants (42 diabetes vs. 22 controls) reported at least one injurious fall or two non-injurious falls ("fallers"). Univariate logistic regression identified diabetes as a risk factor for future falls (Odds Ratio 2.25, 95%CI 1.21-4.15, p = 0.010). Stepwise multiple regressions defined diabetes and poor balance as independent risk factors for falling. Taking more medications, slower walking speed, shorter stride length and poor cognitive performance were mediators that reduced the Odds Ratio of the relationship between diabetes and faller status relationship the most followed by reduced grip strength and increased stride length variability. CONCLUSIONS: Diabetes is a major risk factor for falling, even after controlling for poor balance. Taking more medications, poorer walking performance and reduced cognitive functioning were mediators of the relationship between diabetes and falls. Tailored preventive programs including systematic medication reviews, specific balance exercises and cognitive training might be beneficial in reducing fall risk in older adults suffering from diabetes.

Vibration perception threshold in relation to postural control and fall risk assessment in elderly.

PURPOSE: This study investigates (i) the potential discriminative role of a clinical measure of peripheral neuropathy (PN) in assessing postural performance and fall risk and (ii) whether the integration of a simple screening vibration perception threshold (VPT) for PN in any physical (fall risk) assessment among elderly should be recommended, even if they do not suffer from DM. METHOD: One hundred and ninety-five elderly were entered in a four-group model: DM with PN (D+; n = 75), DM without PN (D-; n = 28), non-diabetic elderly with idiopathic PN (C+; n = 31) and non-diabetic elderly without PN (C-; n = 61). Posturographic sway parameters were captured during different static balance conditions (AMTI AccuGait, Watertown, MA). VPT, fall data, Mini-Mental State Examination and Clock Drawing Test were registered. Two-factor repeated-measures ANOVA was used to compare between groups and across balance conditions. RESULTS: The groups with PN demonstrated a strikingly comparable, though bigger sway, and a higher prospective fall incidence than their peers without PN. CONCLUSIONS: The indication of PN, irrespective of its cause, interferes with postural control and fall incidence. The integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. Implications for Rehabilitation The indication of peripheral neuropathy (PN), irrespective of its cause, interferes with postural control and fall incidence. Therefore, the integration of a simple screening for PN (like bio-thesiometry) in any fall risk assessment among elderly is highly recommended. It might be useful to integrate somatosensory stimulation in rehabilitation programs designed for fall prevention.

The impact of peripheral neuropathy and cognitive decrements on gait in older adults with type 2 diabetes mellitus.

OBJECTIVE: To investigate the effect of peripheral neuropathy and cognition on gait performance in older adults with type 2 diabetes mellitus. DESIGN: Cross-sectional study. SETTING: Community and residential aged care setting. PARTICIPANTS: Older adults (N=101; 56 patients with diabetes, 28 with peripheral neuropathy and 28 without peripheral neuropathy; and 45 matched controls). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spatiotemporal gait parameters were recorded under 3 conditions: simple, counting backward by 3 from 40, and reciting animal names. The Mini-Mental State Examination and the clock drawing test were used to estimate cognitive impairment levels. RESULTS: Compared with controls, older adults with diabetes walked slower, took shorter strides during all walking conditions, and showed more gait variability especially during dual-task conditions. Gait patterns did not differ between participants suffering from diabetes mellitus with and without neuropathy. Compared with normal walking, dual-task conditions affected all gait parameters similarly in all groups. Backward counting affected gait more than animal naming in participants with diabetes but not in healthy controls. Additional analyses in older adults with diabetes showed that participants with impaired cognitive function walked slower, took shorter strides, had shorter double support time, and increased gait variability compared with participants with intact cognitive function. CONCLUSIONS: This study showed that gait parameters are affected in older adults with type 2 diabetes. Gait was further affected by reduced cognitive function, irrespective of the presence of neuropathy.

Effect of combined exercise training on physical and metabolic fitness in adults with intellectual disability: a controlled trial.

OBJECTIVE: Investigating the effect of combined aerobic and strength training on metabolic and physical fitness in adults with intellectual disabilities compared to endurance training and no training. DESIGN: A controlled trial with patients receiving either combined (COM), endurance (END) or no training (C). SETTING: Two centres for intellectual disabilities (Sterrenhuis, Brasschaat and Emiliani, Lokeren, Belgium). SUBJECTS: Forty-five adults with intellectual disabilities (mean age: 42 (9,2), mean body mass index (BMI): 24 (3,9), mean IQ: 56 (5,6)). INTERVENTION: Combined exercise training (n = 15) and endurance training (n = 15) twice a week for 70 minutes per session for 20 weeks and no training (n = 15). Groups were matched for age, sex and intellectual disability. MAIN MEASURES: Lipid profile, physical fitness (primary); blood pressure and body composition. RESULTS: Compared to no training, combined exercise training has significant positive effects on total cholesterol levels, aerobic capacity, muscle strength and resting systolic blood pressure, while endurance exercise training has significant effects on aerobic capacity and resting systolic blood pressure. Compared to endurance training, combined exercise training resulted in a significant better evolution of total cholesterol (mean differences: -18 versus -3 mg/dl), 1RM upper (+6 versus +1 kg) and lower limb (+25 versus +8 kg) and abdominal muscles (+15 versus +1 kg), hand grip strength (+9 versus +2 kg), muscle fatigue resistance (+11 versus +5 sec), sit-to-stand (+5 versus +2/30 sec) and systolic blood pressure (-15 versus -10 mmHg). CONCLUSION: This study revealed a tendency towards more beneficial effects of combined exercise training in adults with intellectual disability.