A Case Management Program at Home to Reduce Fall Risk in Older Adults (the MAGIC Study): Protocol for a Single-Blind Randomized Controlled Trial.

BACKGROUND: Individual case management programs may be particularly effective in reducing fall risk as they can better identify barriers and facilitators to health recommendations. OBJECTIVE: This paper describes the protocol for a single-blind, parallel-group randomized controlled trial that aims to investigate the effectiveness and cost-effectiveness of a home-based multifactorial program targeting fall risk factors among people aged 60 years and over who have fallen at least twice in the past 12 months (the MAGIC trial). METHODS: Older people with a history of at least 2 falls in the last year will be divided into 2 groups. The intervention group will receive case management at home for reducing the risk of falls, including a multidimensional assessment, explanation of fall risk factors, and elaboration and monitoring of an individualized intervention plan based on the identified fall risk factors, personal preferences, and available resources. The control group will be monitored once a month. Assessments (clinical data, fall risk awareness, physical and mental factors, safety at home, feet and shoes, and risk and rate of falls) will be carried out at baseline, after 16 weeks of the intervention, and at the posttrial 6-week and 1-year follow-up. After 16 weeks of the intervention, satisfaction and adherence to the intervention will also be assessed. Economic health will be evaluated for the period up to the posttrial 1-year follow-up. RESULTS: Data collection started in April 2021, and we expected to end recruitment in December 2021. This case management program will address multifactorial assessments using validated tools and the implementation of individualized intervention plans focused on reducing fall risk factors. CONCLUSIONS: This trial may provide reliable and valuable information about the effectiveness of case management for increasing fall risk awareness and reducing fall risk in older people. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBec) RBR-3t85fd; https://ensaiosclinicos.gov.br/rg/RBR-3t85fd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34796.

Effects of postural threat on walking features of Parkinson's disease patients.

This study investigated whether or not gait kinematics among healthy older individuals and Parkinson's disease (PD) patients are influenced by postural threat. Eight healthy older individuals and eight PD patients were examined while walking at self-selected velocities, under three conditions of postural threat: unconstrained floor; constrained floor (19cm wide); constrained and elevated floor (19cm wide by 10cm high). Independent of the surface conditions, due to motor disturbances caused by the PD these patients walked slower, with shorter strides, and spent more time in the double support phase and less time in the swing phase than did their matched controls. Increases in postural threat resulted in altered gait kinematics for all subjects. Specifically, stride length, stride velocity, cadence, and heel contact velocity decreased, and stride duration and double support duration increased relative to increases in postural threat. All gait alterations were the result of participants' attempts to facilitate locomotion control and maintain stability. The results of this study reveal that width and height constraints effectively perturbed the balance of all of the walking older individuals. The PD patients were able to modulate gait parameters when faced by a postural threat task.

Cognitive Correlates of Timed Up and Go Subtasks in Older People With Preserved Cognition, Mild Cognitive Impairment, and Alzheimer's Disease.

OBJECTIVE: To determine whether impaired Timed Up and Go Test (TUG) subtask performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). DESIGN: TUG subtasks performances were assessed by the Qualisys motion system. Cognition was assessed by Addenbrooke's Cognitive Examination and the Frontal Assessment Battery (FAB). RESULTS: The highest correlations with transition subtasks were with aspects of executive function, i.e. the fluency domain in the PC group (n = 40), FAB scores in the MCI group (n = 40), and the visuospatial domain in the AD group (n = 38). No significant associations were found between the walking subtasks and cognition in any group. Multivariate linear regression models identified the fluency domain as an independent predictor of turn-to-walk and turn-to-sit measures in the PC group, and the visuospatial domain as an independent predictor of turn-to-walk and turn-to-sit measures in the AD group, adjusted for age and sex. CONCLUSIONS: Poorer executive functioning was associated with impaired transition mobility in all groups. The significant associations between visuospatial impairment and poor transition mobility in the AD participants may provide insight into why this group has an elevated fall risk.

Effects of 6-month, Multimodal Exercise Program on Clinical and Gait Parameters of Patients with Idiopathic Parkinson's Disease: A Pilot Study.

This pilot study aimed to identify the effects of a 6-month, multimodal exercise program on clinical and gait parameters in patients with Parkinson's disease. Two groups of participants were enrolled in the study: Trained Group (TG) and Control Group (CG). Individuals in the TG exercised three times a week for 24 weeks (in a multimodal exercise program), while the CG participants maintained their regular activity level. Participants in both the TG and the CG were assessed at pre- and posttest by clinical rates and the spatiotemporal parameters of self-paced walking. The two groups were not significantly different in demographic, clinical, and gait data at baseline. There were no significant differences between groups for clinical data at posttest. The purposed multimodal exercise program has found improvement in some kinematic gait parameters for the TG. Further study in the form of randomized controlled trial would be required to establish effectiveness of the intervention.

Validade de construção em testes de equilíbrio: ordenação cronológica na apresentação das tarefas / Construction validity in equilibrium tests: chronological order in tasks presentation

Os testes de equilíbrio da Escala de Desenvolvimento Motor de Rosa Neto1 são constituídos por dez tarefas correspondentes às idades cronológicas de 2 a 11 anos e determinam a Idade Motora dos participantes. A ordem de apresentação dos testes é crescente, partindo da idade cronológica da criança e a idade motora baseia-se no sucesso ou fracasso em cada tarefa. O objetivo deste estudo foi analisar a validade de construção dos testes motores em equilíbrio, observando a ordenação e os graus de dificuldade da tarefa. Participaram 76 crianças, com idade cronológica de 6 a 9 anos, que foram distribuídas em dois grupos: grupo controle, aplicação dos testes em ordem crescente; grupo invertido, aplicação dos testes em ordem decrescente. Os resultados não apresentaram diferenças estatisticamente significativas no desempenho entre os grupos, indicando que a ordem de apresentação dos testes não interferiu no desempenho das crianças, independente da idade cronológica. Baixas taxas de sucesso ocorreram em algumas tarefas específicas, seguidas por sucesso em tarefas posteriores. Como os resultados demonstraram que os participantes conseguem executar tarefas seguintes à tarefa em que houve o fracasso, a idade motora apontada pela Escala de Desenvolvimento Motor pode estar subestimando o desenvolvimento motor dessas crianças. A variação do desempenho das crianças nos testes sugere que o processo de desenvolvimento motor é não linear. As tarefas motoras em equilíbrio propostas na Escala de Desenvolvimento Motor apresentam validade de construção.

The equilibrium tests of the Rosa Neto1 Motor Development Scale are constituted by ten tasks related to the chronological ages from 2 to 11 years and they determine the participants Motor Age. The tests presentation order is crescent from the child chronological age and the motor age is based on the success or failure in each task. The aim of this study was to analyze the construction validity of the equilibrium motor tests observing the ordering the levels of task difficulty. 76 children with 6 to 9 years of chronological age participated and were assigned in two groups: control group, tests presentation in increased order; and inverted group, tests presentation in decreased order. The results did not revealed statistical significant differences between groups, which indicate that the presentation order of the tests did not interfere in the children performance, independently of the chronological age. Low success rates occurred in some specific tasks followed by success in advanced tasks. As the results revealed that the participants could perform the tasks after that in which the failure happened the motor age ascribed by the Motor Development Scale can underestimate the children motor development. The variation of the children performance in the tasks suggests that the motor development process is nonlinear. The equilibrium motor tasks purposed in the Motor Development Scale show construction validity.

Desenvolvimento motor de pré-escolares no intervalo de 13 meses / Motor development of kindergarten children in 13 months interval

O desenvolvimento motor é um processo de mudanças no nível de funcionamento de um indivíduo, onde uma maior capacidade de controlar movimentos é adquirida ao longo do tempo. Assim, o objetivo principal deste estudo foi analisar as mudanças no comportamento motor de crianças no intervalo de 13 meses. Participaram deste estudo 35 crianças entre 3 e 7 anos de idade distribuídas por faixa etária em 4 grupos. O desempenho motor de cada participante foi avaliado e re-avaliado após 13 meses por meio da Escala de Desenvolvimento Motor, que compreende uma bateria de testes envolvendo tarefas específicas por idade nos itens motricidade fina,motricidade global, equilíbrio, esquema corporal/rapidez e organização espacial. Foram realizadas comparaçõesdo desempenho motor intra e entre os grupos, para cada item da bateria. Os resultados mostraram que odesempenho motor nas tarefas de equilíbrio melhorou após 13 meses para todos os grupos etários; para motricidadefina, motricidade global e esquema corporal as crianças de 3, 4 e 5 anos melhoraram seu desempenho entre asavaliações; para organização espacial somente as crianças de 3 e 5 anos melhoraram seu desempenho quandore-avaliadas. Estes resultados sugerem que o desenvolvimento nesta faixa etária ocorre de forma não homogênea, ou seja, apresenta ritmos diferentes para os itens da motricidade. Fatores do ambiente, do indivíduo e da tarefa podem explicar as mudanças desenvolvimentistas ocorridas em um período de 13 meses. Conclui-se que o processo de desenvolvimento de cada componente da motricidade é dinâmico e apresenta aspectos e não linearidade

Atividade física extra-escolar e desenvolvimento motor de crianças / After-school physical activity and children motor development

The child needs to experience diverse motor situations in order to achieve its total motor development. Appropriated use of the free time is an important tool to learn and to practice competences and abilities. In association with the school activities, after-school activities in which the child is involved should influence the motor skills and reflect on the child motor development level. We aimed at verifying the relationship between the enrolment in after-school physical activities and the motor development. 117 children (7-to-10-years-old) were grouped by chronological age and by enrolment in after-school activities in three groups: SPA – sistematic physical activity enrolment at least for one year; PAFT – informal physical activity enrolment at free time; NPA – no enrolment in after-school physical activity. Motor development was evaluated in the Motor Development Scale components: fine skills, global skills, balance, body schema/fastness, spatial organization and temporal organization. Motor age by component was treated by means of descritive statistic and the effects of chronological age and physical activity enrolment were observed by means of multivariate analysis of variance. Chronological age affected fine skills (F3,105 = 14,618; p < 0,001), global skills (F3,105 = 4,333; p < 0,007), balance (F3,105 = 7,432; p < 0,001), body schema/fastness (F3,105 = 11,232; p < 0,001), spatial organization (F3,105 = 17,762; p < 0,001), and temporal organization (F3,105 = 4,685;p<0,005). The enrolment in after-school physical activities significantly affected the spatial (F2,105 = 4,471; p < 0,015) and the temporal (F2,105 = 7,555; p < 0,002) organizations, and marginally the global skills (F2,105 = 2,448; p < 0,092). Motor development is a non-linear process. Different motor components are affected by specific characteristics of the enrolment in physical activities in both the school and the formal and informal environments.

Para atingir seu pleno desenvolvimento motor, a criança necessita vivenciar situações motoras diversificadas. O uso adequado do tempo livre é uma importante ferramenta para a aprendizagem e prática de habilidades. Além das atividades escolares, as atividades extra-escolares em que a criança está envolvida deveria influenciar o repertório motor e refletir no nível de desenvolvimento motor da criança. Com este estudo, objetivamos investigar as relações entre o envolvimento em atividades físicas extra-escolares e o desenvolvimento motor. Cento e dezessete (117) crianças (7-10 anos) foram agrupadas por idade cronológica e por atividade extra-escolar, formando três grupos: AFS - atividade física sistemática há mais de um ano; AFTL - atividade física informal no tempo livre; SAF - não envolvimento em atividade física extra-escolar. O desenvolvimento motor foi avaliado por meio da Escala de Desenvolvimento Motor nos componentes: motricidade fina, motricidade global, equilíbrio, esquema corporal/rapidez, organização espacial e organização temporal. A idade motora por componente foi tratada por meio de estatística descritiva e os efeitos da idade cronológica e do envolvimento em atividade física foram observados por meio de análises de variância multivariadas. A idade cronológica influenciou a motricidade fina (F3,105 = 14,618; p < 0,001), motricidade global (F3,105 = 4,333; p < 0,007), equilíbrio (F3,105 = 7,432; p < 0,001), esquema corporal/rapidez (F3,105 = 11,232; p < 0,001), organização espacial (F3,105 = 17,762; p < 0,001) e organização temporal (F3,105 = 4,685; p < 0,005). O envolvimento em atividade física extra-escolar influenciou significativamente a organização espacial (F2,105 = 4,471; p < 0,015) e a organização temporal (F2,105 = 7,555; p < 0,002); e marginalmente a motricidade global (F2,105 = 2,448 ; p < 0,092). O desenvolvimento motor é um processo não-linear. Diferentes elementos da motricidade são influenciados por características específicas do envolvimento em atividades físicas tanto na escola como em outros ambientes formais e informais.