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1.
Med Clin North Am ; 104(2): 327-343, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035572

RESUMO

Aging-associated anatomic and physiologic decline begins during the fourth decade of life and progresses over the ensuing decades sometimes to a state of frailty, with the decline amplified when there is deconditioning. Aging-related gait and balance disorders leading to an increased risk of falling can be compensated for with the use of exercise interventions, durable medical equipment, and environmental modifications. Caregiver training is an essential component of geriatric rehabilitation.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica/métodos , Doença de Parkinson , Velocidade de Caminhada , Idoso , Cuidadores/educação , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação
2.
J Sports Sci ; 38(4): 383-389, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31818198

RESUMO

The purpose of this study is to establish evidence of validity for wearable activity monitors providing real-time cadence against a criterion measure. Thirty-six healthy adults, aged 18-65 years, participated in the study. Four activity monitors including 2 watch-based monitors and 2 cadence sensors attaching to shoelaces were tested. Each participant completed the study protocol consisting of 2 distinct components: (1) treadmill protocol and (2) overground protocol. Lin's concordance correlation and mean absolute percentage error (MAPE) were calculated for the comparisons between the criterion and measures of the monitors. Bland-Altman analysis was performed to determine the mean bias and 95% limits of agreement. All activity monitors showed high correlations with the criterion measures (p < .01). Lower correlations were observed at slow walking speeds in the watch-based monitors. In contrast, consistent and strong correlations were found with both cadence sensors regardless of walking speeds (p < .01). Similar patterns were observed in the MAPE scores. Greater than 90% of the participants were able to maintain prescribed walking intensity using real-time cadence. The results suggest that the wearable activity monitors are an acceptable measure of real-time cadence and provide the potential to improve intensity-based prescription of physical activity using the monitors.


Assuntos
Monitores de Aptidão Física , Velocidade de Caminhada/fisiologia , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Corrida/fisiologia , Adulto Jovem
3.
Br J Sports Med ; 54(2): 94-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31331944

RESUMO

OBJECTIVES: To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment . DESIGN: Systematic review and meta-analysis using individual participant data (IPD). DATA SOURCES: The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case-control matching. DATA EXTRACTION AND SYNTHESIS: Our review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a 'one-stage', random-effects model. RESULTS: 26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference -0.0039 m; 95% CI: -0.0075 to -0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion. SUMMARY/CONCLUSIONS: Our IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7-10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion. PROTOCOL PRE-REGISTRATION: This systematic review was prospectively registered in PROSPERO CRD42017064861.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Exame Neurológico/métodos , Velocidade de Caminhada , Fenômenos Biomecânicos , Humanos , Equilíbrio Postural , Análise e Desempenho de Tarefas
4.
Gait Posture ; 75: 142-148, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31683184

RESUMO

BACKGROUND: A relationship exists between step width and energy expenditure, yet the contribution of dynamic stability to energy expenditure is not completely understood. Chronic obstructive pulmonary disease (COPD) patients' energy expenditure is increased due to airway obstruction. Further, they have a higher prevalence of falls and balance deficits compared to controls. RESEARCH QUESTION: Is dynamic stability different between COPD patients and controls; and is the association between dynamic stability and energy expenditure different between groups? METHODS: Seventeen COPD patients (64.3 ±â€¯7.6years) and 23 controls (59.9 ±â€¯6.6years) walked on a treadmill at three speeds: self-selected walking speed (SSWS), -20%SSWS, and +20%SSWS. Mean and variability (standard deviation) of the anterior-posterior (AP) and medio-lateral (ML) margins of stability (MOS) were compared between groups and speed conditions, while controlling for covariates. Additionally, their association to metabolic power was examined. RESULTS: The association between stability and power did not significantly differ between groups. However, increased metabolic power was associated with decreased MOS AP mean (p < 0.0001), independent of speed. Increased MOS AP variability (p = 0.01) and increased SSWS (p's < 0.05) were associated with increased metabolic power. The MOS ML mean for COPD patients was greater than that of healthy patients (p = 0.02). MOS AP mean decreased as speed increased and differed by group (p = 0.048). For COPD patients, a plateau was observed at SSWS and did not decrease further at +20%SSWS compared to controls. MOS AP variability (p < 0.0001), MOS ML mean (p < 0.0001), and MOS ML variability (p = 0.003) decreased as speed increased and did not differ by group. SIGNIFICANCE: Patients with COPD operate at the upper limit of their metabolic reserve due to an increased cost of breathing. To compensate for their lack of stability, they walked with larger margins of stability in the ML direction, instead of changing the stability margins in the AP direction, due to its association with energy expenditure.


Assuntos
Metabolismo Energético/fisiologia , Equilíbrio Postural/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Caminhada/fisiologia , Idoso , Estudos de Casos e Controles , Teste de Esforço , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Velocidade de Caminhada/fisiologia
5.
Gait Posture ; 75: 155-162, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31698186

RESUMO

Individuals with autism spectrum disorder (ASD) can exhibit a range of movement issues, which are often characterized by a general slowing of movement responses that can extend to walking speed. The current study was designed to examine the spatio-temporal features and pattern of acceleration for the trunk, neck and head during walking for a cohort of adults with ASD compared to neurotypical individuals. Twenty young adults with ASD and 20 age-matched neurotypical adults participated in this study. Participants performed five walking trials across a 20ft Protokinetics pressure sensitive surface at their preferred walking speed. Accelerations were collected using three triaxial accelerometers affixed to the head, neck, and lower trunk. Comparisons of acceleration amplitude (i.e., RMS), frequency, segmental gain and regularity (i.e., SampEn) during the walking tasks were performed. Results revealed that the adults with ASD walked slower than the neurotypical persons with a greater proportion of time spent in double stance. Despite walking at a slower pace overall, the adults with ASD exhibited a decreased ability to attenuate gait-related oscillations from the trunk to the head. Overall, these findings suggest that adults with ASD exhibited a decreased ability to accommodate and dampen those accelerations related to walking. As declines in gait speed are often linked with loss of head control, one suggestion is that the inability to appropriately compensate for gait-related oscillations may, in part, explain why persons with ASD walk slower.


Assuntos
Aceleração , Transtorno do Espectro Autista/fisiopatologia , Marcha/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Cabeça/fisiologia , Humanos , Masculino , Pescoço/fisiologia , Equilíbrio Postural/fisiologia , Análise Espaço-Temporal , Tronco/fisiologia , Velocidade de Caminhada/fisiologia , Adulto Jovem
6.
Medicine (Baltimore) ; 98(50): e18286, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852105

RESUMO

RATIONALE: Spinal cord injury (SCI) patients who experience difficulties with independent walking use gait-assistive devices such as a cane, walker, or wheelchair. Few studies have explored gait patterns or cardiopulmonary function in chronic SCI patients after powered exoskeleton training. We investigated whether the cardiopulmonary function of a patient with an incomplete chronic cervical SCI and a hemiplegic gait pattern could be improved by walking training using a powered exoskeleton (Angelegs). PATIENT CONCERNS: A 57-year-old male was diagnosed with an SCI at C3-C4. The right upper and lower limb motor functions differed when evaluated before entry into the program. Motor function was good in the right leg but poor in the left one. Before program entry, the patient could walk for about 10 m using a cane. He did not have a history of severe medical or psychological problems and was not cognitively impaired. DIAGNOSIS: The patient was tetraplegia with incomplete SCI at C3-C4. INTERVENTIONS: The patient was trained for 6 weeks using a powered exoskeleton. The training program consisted of sit-to-stand and stand-to-sit movements, maintenance of balanced standing for 5 minutes, and walking for 15 minutes. OUTCOMES: After 6 weeks of training, gait speed improved in the timed up-and-go test, and cardiac function was enhanced as measured by the metabolic equivalent and VO2 tests. LESSIONS: Walking training using a powered exoskeleton can facilitate the effective rehabilitation and improve the gait speed and cardiopulmonary function of patients with chronic SCIs or strokes.


Assuntos
Vértebras Cervicais/lesões , Terapia por Exercício/instrumentação , Exoesqueleto Energizado , Extremidade Inferior/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Velocidade de Caminhada/fisiologia , Caminhada/fisiologia , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/fisiopatologia
7.
Clin Interv Aging ; 14: 2145-2153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849458

RESUMO

Purpose: This study compared the effects of a combination of soy peptide supplementation and exercise with those of exercise only, on the cognitive function of elderly adults. Patients and methods: This randomized, non-blinded, controlled clinical trial included 67 participants aged 60 years or more with non-cognitive dysfunction who were divided into two groups according to the intervention method: an exercise group (Ex group, n = 36) and an exercise plus nutrition group (Ex+Nt group, n = 31). The Ex group completed a memory training activity for 15 mins and aerobic exercise for 45 mins once a week for 90 days. The Ex+Nt group completed the same training plus received soy peptide for 90 days. The Mini-Mental Status Examination score, trail-making test A/B score, skeletal muscle mass index, grip strength, gait speed, and geriatric depression scale were measured at baseline and post intervention. For comparison between the pretest and posttest measurements to determine the intervention effects, a two-way analysis of variance was performed. The significance level was set at < 5%. Results: A two-way analysis of variance revealed significant time effects on trail-making test-A score, skeletal muscle index, grip strength, and gait speed in both groups. There were significant time x group interactions for greater increase in calculation score. Conclusion: A combination of exercise and soy peptide supplementation was effective in improving a portion of cognitive function.


Assuntos
Cognição , Terapia por Exercício , Apoio Nutricional , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Velocidade de Caminhada
8.
Hum Mov Sci ; 68: 102540, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31683084

RESUMO

BACKGROUND: With increases in life expectancy, it is important to understand the influence of aging on gait, given that this activity is related to the independence of older adults and may help in the development of health strategies that encourage successful aging in all phases of this process. RESEARCH QUESTION: To compare gait parameters with usual and fast speeds for independent and autonomous older adults throughout the aging process (60 to 102 years old), and also to identify which of the gait variables are best for identifying differences across the different age groups. METHODS: Two hundred older adults aged between 60 and 102 years were evaluated. The sample was divided into 3 age groups: 60 to 79 years, 80 to 89 years and 90 years and over. The analyzed gait variables were: speed (meters/s), cadence (steps/min), stride time (seconds), step length (centimeters), double support (percentage of the gait cycle), swing (percentage of the gait cycle), step length variability (CoV%) and stride time variability (CoV%). RESULTS: Group comparison regarding usual gait and fast gait revealed a significant difference in all gait variables. In addition, it can be seen that variables such as gait speed and step length showed greater effect sizes in intergroup comparison (usual gait: 0.48 and 0.47; fast gait: 0.36 and 0.40; respectively), possibly showing that these variables can better detect the changes observed with increasing age. CONCLUSION: There are differences in the gait performance of older adults from different age groups for usual and fast gait speeds, which is more evident regarding gait speed and step length variables. We recommend the use of usual gait for the identification of the effects of aging because, besides showing a higher effect size values it is more comfortable and requires less effort from older subjects.


Assuntos
Envelhecimento/fisiologia , Marcha/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Velocidade de Caminhada/fisiologia
9.
Clin Interv Aging ; 14: 1567-1577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695345

RESUMO

Purpose: Exercise programs designed for falls prevention have been proven effective in reducing falls by approximately 21%. Virtual reality may provide a viable alternative intervention for falls prevention. This study compared the effects of virtual reality training using the Balance Rehabilitation Unit (BRU) versus exercise using a modified Otago Exercise Programme (EX) on improving balance and physical performance in the short-term restorative care setting of the Gait and Balance Gym (Gabagym). Patients and methods: This was a pre- and post-intervention study of 195 participants (median age 78 years, IQR 73-84; 67% female) who presented with a risk and/or history of falls. Participants were assigned to either EX (n=82) or BRU (n=63). Supervised sessions occurred twice a week for 6 weeks. Participants receiving interventions were compared to a separate group (n=50) with similar characteristics who did not receive any intervention. Balance and physical performance were assessed at initial and final attendance and included the 5 Times Sit to Stand (5STS) test, Timed Up and Go (TUG), gait speed and posturography assessment using the BRU. Fear of falling was assessed using the Falls Efficacy Scale. Handgrip strength and adherence were also monitored. Results: Post-intervention, EX and BRU groups achieved similar improvements and reported similar adherence rates (71% vs 72%, respectively). Both intervention groups improved in balance and physical performance measures. Both interventions showed significantly better improvement than the non-intervention group in TUG (p<0.001), gait speed (p=0.021), limits of stability in posturography assessment (p=0.008), FES-I score (p=0.013) and handgrip strength (p=0.021). Only the BRU group improved control of static posture in the eyes closed (p=0.002) and foam eyes closed (p=0.006) tasks. Conclusion: This study highlights the potential use of virtual reality as a practical alternative to improve outcomes of balance training for reduction of falls risk in older adults.


Assuntos
Acidentes por Quedas/prevenção & controle , Exercício , Condicionamento Físico Humano/métodos , Condicionamento Físico Humano/fisiologia , Equilíbrio Postural , Realidade Virtual , Idoso , Idoso de 80 Anos ou mais , Medo , Feminino , Força da Mão , Humanos , Masculino , Desempenho Físico Funcional , Velocidade de Caminhada
10.
Medicine (Baltimore) ; 98(45): e17882, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702661

RESUMO

The asymmetry in lower extremity strength is known to be related to the functional mobility in older adults living in the community. However, little is known about the association between lower extremity lean mass asymmetry and functional mobility in this patient group. Hence, this study aimed to determine whether asymmetry in lower extremity muscle mass has a significant relationship with functional mobility in older adults living in the community.This cross-sectional study analyzed the pre-existing data from the Korean Frailty and Aging Cohort Study. A total of 435 older people (aged 70-84 years) were divided into the following groups according to their Limb Asymmetry Index (LAsI): low, intermediate, and high asymmetric groups. LAsI is calculated using lower extremity lean mass, and comparisons between groups were conducted. The participants were also further divided into better and worse mobility groups based on their physical performance test results (Timed Up and Go and Short Physical Performance Battery), and comparisons between groups were conducted. Comparisons between fallers and non-fallers were also conducted. In addition, this study investigated the factors that had a significant effect on gait speed and fall experience within the past year among older adults living in the community.The LAsI was significantly associated with gait speed in older adults living in the community. Older adults in the highest tertile of the LAsI had a slower gait speed than those in the lowest tertile of the LAsI. However, no significant difference was observed in the LAsI between the better mobility group and worse mobility group. Moreover, the LAsI was not a significant predictor of falls.Asymmetry in lower extremity lean mass was significantly associated with gait speed in older adults living in the community.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Composição Corporal , Extremidade Inferior/patologia , Força Muscular , Desempenho Físico Funcional , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Fragilidade/complicações , Fragilidade/fisiopatologia , Avaliação Geriátrica/métodos , Humanos , Masculino , República da Coreia , Inquéritos e Questionários , Velocidade de Caminhada/fisiologia
11.
Bone Joint J ; 101-B(11): 1459-1463, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674236

RESUMO

AIMS: Rotational acetabular osteotomy (RAO) is an effective joint-preserving surgical treatment for acetabular dysplasia. The purpose of this study was to investigate changes in muscle strength, gait speed, and clinical outcome in the operated hip after RAO over a one-year period using a standard protocol for rehabilitation. PATIENTS AND METHODS: A total of 57 patients underwent RAO for acetabular dysplasia. Changes in muscle strength of the operated hip, 10 m gait speed, Japanese Orthopaedic Association (JOA) hip score, and factors correlated with hip muscle strength after RAO were retrospectively analyzed. RESULTS: Three months postoperatively, the strength of the operated hip in flexion and abduction and gait speed had decreased from their preoperative levels. After six months, the strength of flexion and abduction had recovered to their preoperative level, as had gait speed. At one-year follow-up, significant improvements were seen in the strength of hip abduction and gait speed, but muscle strength in hip flexion remained at the preoperative level. The mean JOA score for hip function was 91.4 (51 to 100)) at one-year follow-up. Body mass index (BMI) showed a negative correlation with both strength of hip flexion (r = -0.4203) and abduction (r = -0.4589) one year after RAO. Although weak negative correlations were detected between strength of hip flexion one year after surgery and age (r = -0.2755) and centre-edge (CE) angle (r = -0.2989), no correlation was found between the strength of abduction and age and radiological evaluations of CE angle and acetabular roof obliquity (ARO). CONCLUSION: Hip muscle strength and gait speed had recovered to their preoperative levels six months after RAO. The clinical outcome at one year was excellent, although the strength of hip flexion did not improve to the same degree as that of hip abduction and gait speed. A higher BMI may result in poorer recovery of hip muscle strength after RAO. Radiologically, acetabular coverage did not affect the recovery of hip muscle strength at one year's follow-up. A more intensive rehabilitation programme may improve this. Cite this article: Bone Joint J 2019;101-B:1459-1463.


Assuntos
Acetábulo/cirurgia , Luxação do Quadril/fisiopatologia , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Osteotomia/métodos , Adulto , Feminino , Marcha/fisiologia , Luxação do Quadril/cirurgia , Articulação do Quadril/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/reabilitação , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento , Velocidade de Caminhada/fisiologia , Suporte de Carga/fisiologia , Adulto Jovem
12.
Bone Joint J ; 101-B(11): 1423-1430, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674240

RESUMO

AIMS: The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA). PATIENTS AND METHODS: A total of 28 patients (23 male, five female; mean age, 56 years (25 to 73)) awaiting Birmingham HRA volunteered for this prospective gait study, with an age-matched control group of 26 healthy adults (16 male, ten female; mean age, 56 years (33 to 84)). The Oxford Hip Score (OHS) and gait analysis using an instrumented treadmill were used preoperatively and more than two years postoperatively to measure the functional change attributable to the intervention. RESULTS: The mean OHS improved significantly from 27 to 46 points (p < 0.001) at a mean of 29 months (12 to 60) after HRA. The mean metal ion levels at a mean 32 months (13 to 60) postoperatively were 1.71 (0.77 to 4.83) µg/l (ppb) and 1.77 (0.68 to 4.16) µg/l (ppb) for cobalt and chromium, respectively. When compared with healthy controls, preoperative patients overloaded the contralateral good hip, limping significantly. After HRA, patients walked at high speeds, with symmetrical gait, statistically indistinguishable from healthy controls over almost all characteristics. The control group could only be distinguished by an increased push-off force at higher speeds, which may reflect the operative approach. CONCLUSION: Patients undergoing HRA improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. HRA with an approved device offers substantial functional gains, almost indistinguishable from healthy controls. Cite this article: Bone Joint J 2019;101-B:1423-1430.


Assuntos
Artroplastia de Quadril/métodos , Marcha/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Análise da Marcha/instrumentação , Análise da Marcha/métodos , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/fisiopatologia , Osteoartrite do Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Velocidade de Caminhada/fisiologia
13.
Hum Mov Sci ; 68: 102527, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689575

RESUMO

Arm swing asymmetry is commonly observed in early Parkinson's disease (PD) and has been found to be useful for early diagnosis. However, there are uncertainties about the nature of its relationships with gait parameters, especially shoulder and elbow motions. Therefore, this study explored how these relationships are different between PD and controls. Forty one early PD and 23 controls were included. Participants walked at self-selected speed for 3D motion analysis. Arm swing at the wrist (AS), temporospatial parameters and kinematics in elbow, shoulder and trunk were obtained. Amplitudes and asymmetries of these variables were compared between PD and control groups. PD group showed increased AS asymmetry, compared to controls. Multiple hierarchical regression analysis on AS asymmetry was conducted in order to investigate how PD influences on the relationship between AS asymmetry and other variables. In pooled data (PD and control group), asymmetries in elbow and shoulder range of motion (RoM) were significant predictors for AS asymmetry but walking speed and asymmetries in temporospatial parameters were not significant. Group effect (PD effect) was significantly mediated by only elbow RoM asymmetry. Interaction between group and elbow RoM asymmetry was statistically significant, indicating that group was an effect modifier for elbow RoM asymmetry effect on AS asymmetry. Conclusively, arm swing asymmetry measured at the wrist represents the involvement of PD effect on the unilateral and distal upper limb in early stage. These findings are helpful for future researches related to clinical applications and mechanisms of arm swing asymmetry in PD.


Assuntos
Braço/fisiopatologia , Doença de Parkinson/fisiopatologia , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Articulação do Cotovelo/fisiopatologia , Feminino , Marcha/fisiologia , Humanos , Masculino , Movimento/fisiologia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/fisiopatologia , Tronco/fisiopatologia , Velocidade de Caminhada/fisiologia
14.
Hum Mov Sci ; 68: 102524, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31733429

RESUMO

In computational models of human walking, both magnitude and timing of locomotor propulsion are important for mechanical and metabolic efficiency, suggesting that these are likely tightly controlled by the neuromuscular system. Studies of actual human walking have focused primarily on magnitude-related measures of propulsion, often ignoring its timing. The purpose of this study was to quantify the timing of onset and peak propulsion relative to contralateral heel strike (HS) in healthy, young adults walking at multiple speeds. Propulsion was quantified at the ground-level using the anterior component of the anteroposterior ground reaction force, the limb-level using individual limb power, and the joint-level using ankle power. Contrary to common computational models, most of our timing-related measures indicated that propulsion occurred after contralateral HS. Timing-related measures of propulsion also changed with walking speed - as speed increased, individuals initiated propulsion earlier in the support phase. Timing of locomotor propulsion is theoretically important for walking performance, especially metabolic efficiency, and could therefore provide important clinical information. This study provides a set of relatively simple metrics that can be used to quantify propulsion and benchmark data that can be used for future comparisons with individuals or populations with gait impairments.


Assuntos
Caminhada/fisiologia , Adulto , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos/fisiologia , Teste de Esforço/métodos , Feminino , Calcanhar/fisiologia , Humanos , Masculino , Velocidade de Caminhada/fisiologia , Adulto Jovem
16.
J Frailty Aging ; 8(4): 205-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637407

RESUMO

BACKGROUND: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. OBJECTIVES: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. DESIGN: This was a clinical demonstration project/quality improvement project. SETTING: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). PARTICIPANTS: Older Veterans, aged ≥60 years. INTERVENTION: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. MEASUREMENTS: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. RESULTS: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). CONCLUSIONS: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.


Assuntos
Terapia por Exercício/métodos , Fragilidade/prevenção & controle , Veteranos/estatística & dados numéricos , Caminhada/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Velocidade de Caminhada/fisiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-31614595

RESUMO

BACKGROUND: Deteriorated physical function makes older adults prone to fall, and it is therefore known to prompt elders to require long-term care. In this regard, oral function can be related to the loss of motor function. This cross-sectional study assessed the oral factors that increase the risk of falling among older adults. METHODS: We surveyed 672 self-reliant elderly individuals aged ≥65 years who were dwelling in a rural area. We assessed each subject's risk of falling and any related anxiety. Oral-related conditions (number of teeth, occlusal support, masticatory performance, occlusal force, and tongue pressure) and physical motor functions (gait speed, knee extension force, and one-legged standing) were also assessed. Statistical analyses were performed using Mann-Whitney's U-test, the χ2 test, and a logistic regression model. RESULTS: In all subjects, 23% had a history of falling, while 40% had anxiety over falling. Both factors were significantly higher among female subjects, who also had slower gait speeds, and greater lateral differences in occlusion. The subjects with histories of falling were older, had impaired physical motor function, and exhibited a decrease in occlusal force and left/right occlusal imbalances. We recognized similar trends for anxiety about falling. CONCLUSIONS: These results revealed that the risk of falling might be lessened by maintaining healthy teeth occlusion and promoting healthy oral function.


Assuntos
Acidentes por Quedas , Saúde Bucal , Idoso , Ansiedade , Força de Mordida , Estudos Transversais , Feminino , Humanos , Japão , Modelos Logísticos , Masculino , Pressão , Inquéritos e Questionários , Língua , Dente , Velocidade de Caminhada
19.
Nat Med ; 25(9): 1356-1363, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501600

RESUMO

Conventional leg prostheses do not convey sensory information about motion or interaction with the ground to above-knee amputees, thereby reducing confidence and walking speed in the users that is associated with high mental and physical fatigue1-4. The lack of physiological feedback from the remaining extremity to the brain also contributes to the generation of phantom limb pain from the missing leg5,6. To determine whether neural sensory feedback restoration addresses these issues, we conducted a study with two transfemoral amputees, implanted with four intraneural stimulation electrodes7 in the remaining tibial nerve (ClinicalTrials.gov identifier NCT03350061). Participants were evaluated while using a neuroprosthetic device consisting of a prosthetic leg equipped with foot and knee sensors. These sensors drive neural stimulation, which elicits sensations of knee motion and the sole of the foot touching the ground. We found that walking speed and self-reported confidence increased while mental and physical fatigue decreased for both participants during neural sensory feedback compared to the no stimulation trials. Furthermore, participants exhibited reduced phantom limb pain with neural sensory feedback. The results from these proof-of-concept cases provide the rationale for larger population studies investigating the clinical utility of neuroprostheses that restore sensory feedback.


Assuntos
Amputados/reabilitação , Membros Artificiais , Joelho/fisiopatologia , Membro Fantasma/prevenção & controle , Adulto , Fenômenos Biomecânicos , Retroalimentação Sensorial , Humanos , Joelho/inervação , Masculino , Pessoa de Meia-Idade , Membro Fantasma/fisiopatologia , Velocidade de Caminhada/fisiologia
20.
J Sports Sci ; 37(23): 2751-2758, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31506039

RESUMO

This study used the intensity gradient (IG) and average acceleration metrics to describe children's activity profiles and explore associations with body mass index (BMI) z-score. Two hundred and forty-six children (n = 138 girls) aged 9.6 ± 1.4 years wore a wrist-mounted ActiGraph wGT3X-BT accelerometer for 7 days on their non-dominant wrist. Physical activity (PA) metrics captured included: the IG which describes the intensity distribution of accelerations across the 24 h monitoring period; average acceleration which provides a measure of the volume of activity; total moderate-to-vigorous PA (MVPA) and inactive time. Acceleration was averaged over 5s epochs. Finally, BMI z-score was calculated for each participant. Average acceleration was negatively associated with BMI z-score (p < 0.05) independent of age and gender but not IG. The IG was negatively associated with BMI z-score independent of potential correlates and average acceleration. Total MVPA was not associated with BMI-z score. The IG and average acceleration metrics may be used to explore the independent or cumulative effects of the volume and intensity distribution of activity upon measures of health and well-being in children to inform specific activity recommendations.


Assuntos
Índice de Massa Corporal , Exercício/fisiologia , Aceleração , Actigrafia/instrumentação , Criança , Estudos Transversais , Feminino , Monitores de Aptidão Física , Humanos , Masculino , Análise de Regressão , Corrida/fisiologia , Comportamento Sedentário , Velocidade de Caminhada/fisiologia
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