A modified seated side tapping test in which the arms are crossed also reflects gait function in community-dwelling elderly.

[Purpose] Seated side tapping test (SST) performance is associated with mobility impairment in the elderly. Although this test was developed to assess trunk function, interpretation of its results may be confounded by the upper-limb movements in its protocol. Here, this study aimed to validate the association between trunk function and gait function by means of the Arms Crossed SST (AC-SST), a modified version of the SST in which the arms are crossed over the chest, to exclude the effects of the upper limbs. [Subjects and Methods] A total of 116 community-dwelling elderly people were enrolled in the study (mean age: 75.1 ± 5.5 yrs). Measurement categories were gait function (gait speed and TUG), lower extremity strength (knee extension and flexion strength), trunk muscle endurance (trunk extension and flexion endurance), and trunk function (SST and AC-SST). [Results] AC-SST performance significantly correlated with gait function items, as did SST performance. Moreover, AC-SST was one of the significant predictor variables of gait function selected in stepwise multiple regressions. [Conclusion] Gait function associated with performance on the AC-SST, a test of trunk function in which the effects of upper limb function were excluded, reinforcing the importance of trunk function to elderly mobility.

Toe-Out Gait Decreases the Second Peak of the Medial Knee Contact Force.

Toe-out angle alternation is a potential tactic for decreasing the knee adduction moment during walking. Published reports have not examined the medial knee contact force during the toe-out gait, although it is a factor affecting knee articular cartilage damage. This study investigated the effects of increased toe-out angle on the medial knee contact force, using musculoskeletal simulation analysis. For normal and toe-out gaits in 18 healthy subjects, the muscle tension forces were simulated based on the joint moments and ground reaction forces with optimization process. The medial knee contact force during stance phase was determined using the sum of the muscle force and joint reaction force components. The first and second peaks of the medial knee contact force were compared between the gaits. The toe-out gait showed a significant decrease in the medial knee contact force at the second peak, compared with the normal gait. In contrast, the medial knee contact forces at the first peak were not significantly different between the gaits. These results suggest that the toe-out gait is beneficial for decreasing the second peak of the medial knee contact force.

Effect of aging on seated stepping variability.

[Purpose] Accuracy in coordinating limb movements decreases with aging. The effect of aging on the variability of cyclic movements is not well known. The aim of this study was to examine the effect of aging on seated stepping variability. [Subjects and Methods] Twenty-six healthy young adults and 15 healthy elderly adults were instructed to walk at their preferred speed. Foot contact was monitored using reflective markers. Seated stepping was performed on force plates. The participants synchronized their stepping with 6 different metronome beats: 90-140 beats per minute (bpm). The time-series coefficient of variation (CV) was calculated. [Results] The cadence of young adults was 121 steps/min and that of the elderly adults was 125 steps/min in the elderly adults. The seated stepping CV decreased gradually from 90 to 120 bpm, but sharply increased at 130 and 140 bpm. Compared to young adults, the elderly adults had significantly higher CVs of seated stepping; however, the intergroup difference in the CV of seated stepping at 120 bpm was negligible. [Conclusions] Our results suggest that the stepping accuracy of the elderly is decreased; however, the rhythmic seated stepping accuracy does not decrease at the same rate as gait.

[Lateral trunk control in a sitting test is associated with mobility and Instrumental Activities of Daily Living among community-dwelling elderly people].

AIM: We hypothesized that during walking, mediolateral instability with gait disorders could be reflected in the characteristics of lateral trunk control while sitting. We investigated the association between lateral trunk control while sitting, mobility and Instrumental Activities of Daily Living (IADL) among community-dwelling elderly people. METHODS: A cross-sectional analysis was carried out of the data of 33 men and 102 women in a community-dwelling elderly population (average age, 73.2±6.0 years). A Seated Side-Tapping test was developed to assess lateral trunk control while sitting. We used the Lawton IADL scale, the 5-m normal walking test and the Timed "Up & Go" test (TUG) to measure mobility. RESULTS: The mean duration of the Seated Side-Tapping test was 5.0±0.9 seconds, ranging from 3.1 to 8.2 seconds. The test was normally distributed (p=0.200). The Seated Side-Tapping test was significantly associated with TUG, after controlling for age (r=0.46). The group with disability in at least 1 IADL item was significantly slower in the Seated Side-Tapping test, especially in men (5.7 sec for men, 5.5 sec for women vs. the independent group, 4.8 sec for both). Only the Seated Side-Tapping test remained significantly associated with IADL disability after logistic regression analysis. CONCLUSIONS: These results indicate that lateral trunk control in sitting is associated with mobility and disability in at least 1 item of the IADL. These results support the potential use of the Seated Side-Tapping test to safely carry out risk assessments for frail elderly patients.

Characteristics of locomotion, muscle strength, and muscle tissue in regenerating rat skeletal muscles.

Although numerous studies have aimed to elucidate the mechanisms used to repair the structure and function of injured skeletal muscles, it remains unclear how and when movement recovers following damage. We performed a temporal analysis to characterize the changes in movement, muscle function, and muscle structure after muscle injury induced by the drop-mass technique. At each time-point, movement recovery was determined by ankle kinematic analysis of locomotion, and functional recovery was represented by isometric force. As a histological analysis, the cross-sectional area of myotubes was measured to examine structural regeneration. The dorsiflexion angle of the ankle, as assessed by kinematic analysis of locomotion, increased after injury and then returned to control levels by day 14 post-injury. The isometric force returned to normal levels by day 21 post-injury. However, the size of the myotubes did not reach normal levels, even at day 21 post-injury. These results indicate that recovery of locomotion occurs prior to recovery of isometric force and that functional recovery occurs earlier than structural regeneration. Thus, it is suggested that recovery of the movement and function of injured skeletal muscles might be insufficient as markers for estimating the degree of neuromuscular system reconstitution.

Muscle contributions to center of mass excursion in ankle and hip strategies during forward body tilting.

Humans employ two distinct strategies to maintain balance during standing: the ankle and hip strategies. People with a high fall risk tend to alter their motion patterns during forward body tilting from a hip to an ankle strategy. Improved knowledge regarding how muscles control the center of mass (COM) during balancing would facilitate clinical assessment. The present study aimed to investigate individual muscle contributions to COM motion during forward body tilting with both ankle and hip strategies in 16 healthy adults. While standing, participants were instructed to oscillate their bodies and touch anterior and posterior targets at 0.5Hz. The anterior target was positioned at the sternum height level in a HIGH and 5% lower in a LOW condition to induce ankle and hip strategies, respectively. The muscle tension force was calculated from measured angle data using a two-dimensional, muscle-driven forward simulation model. Muscle contributions to COM acceleration during forward body tilting were calculated via induced acceleration analysis. Long hamstrings were found to increase upward-contributing action and forward COM acceleration in the LOW condition during forward tilting. In contrast, the contribution of the soleus to backward COM acceleration was reduced. These results imply that the contribution of hamstrings to forward COM acceleration is disadvantageous to fore-aft COM control and balance recovery during forward body tilting.

The association between intersegmental coordination in the lower limb and gait speed in elderly females.

Human multi-segmental motion is a complex task requiring motor coordination. Uncoordinated motor control may contribute to the decline in mobility; however, it is unknown whether the age-related decline in intersegmental coordination relates to the decline in gait performance. The aim of this study was to clarify the association between intersegmental coordination and gait speed in elderly females. Gait measurements were performed in 91 community-dwelling elderly females over 60 years old. Foot, shank, and thigh sagittal motions were assessed. Intersegmental coordination was analyzed using the mean value of the continuous relative phase (mCRP) during four phases of the gait cycle to investigate phase differences in foot-shank and shank-thigh motions during a normal gait. The results showed that foot-shank mCRP at late stance had negative correlations with gait speed (r=-0.53) and cadence (r=-0.54) and a positive correlation with age (r=0.25). In contrast, shank-thigh mCRP at late stance had positive correlations with gait speed (r=0.37) and cadence (r=0.56). Moreover, partial correlation, controlling age, height, and weight, revealed that foot-shank mCRP at late stance had negative correlations with gait speed (r=-0.52) and cadence (r=-0.54). Shank-thigh mCRP at late stance had a positive correlation with gait speed (r=0.28) and cadence (r=0.51). These findings imply that the foot-shank and shank-thigh coordination patterns at late stance relate to gait speed, and uncoordinated lower limb motion is believed to be associated with the age-related decline in cadence.

Knee adduction moment and medial knee contact force during gait in older people.

External knee adduction moment has been studied as a surrogate for medial knee contact force. However, it is not known whether adduction moment is a rational measure for predicting medial knee contact force. The aim of this study was to investigate the correlation between knee adduction moment and medial knee contact force in older people, using musculo-skeletal simulation analysis. One hundred and twenty-two healthy older subjects participated in this study. Knee moment and medial knee contact force were calculated based on inverse dynamics analysis of normal walking. Muscle force and joint reaction force were used to determine the medial knee contact force during stance phase. The results showed that the maximum medial knee contact force was moderately correlated to the maximum knee adduction (r = 0.59) as well as the maximum extension moment (r = 0.60). The first peak of medial knee contact force had a significant strong correlation with the first peak of adduction moment and a moderate correlation with the maximum flexion moment. The second peak of medial knee contact force had a significant moderate correlation with both the second peak of adduction and the maximum extension moment. These results implied that the maximum adduction moment value could be used, to some extent, as a measure of the maximum medial knee contact force.

Quickness of trunk movements in a seated position, regardless of the direction, is more important to determine the mobility in the elderly than the range of the trunk movement.

Although trunk function is known to be critical for maintaining balance during gait, a detailed evaluation regarding the relationship between trunk function and mobility has not been performed. We previously reported that the ability of quick lateral trunk movements in a seated position reflects mobility in elderly people. In this study, we further examined whether trunk movement in the anterior-posterior direction is also a determinant of mobility. In addition, the correlation between range of lateral trunk movement and mobility was also examined. One hundred and forty community-dwelling elderly participants (73.3±6.2 years) were enrolled in this study. We performed various trunk movement tests in a seated position, such as the seated side tapping test (SST), the seated anterior-posterior tapping test (APT), and the lateral sitting functional reach test (sitting reach test). Maximum gait speed and the timed up and go test (TUG) were performed to determine mobility. Parameters of trunk movement were compared. SST and APT showed moderate significant correlations with both maximum gate speed and TUG, while the sitting reach test weakly correlated (SST r=-0.58, p<0.01, APT r=-0.63, p<0.01, sitting reach test r=0.30, p<0.01). Moreover, multiple regression analysis revealed that SST and APT were independent indicators of both maximum gate speed and TUG, while the sitting reach test was not. These findings indicate that quickness, regardless of the direction of the movement, is more important than range in determining mobility in the elderly.

Maximum movement velocity of the upper limbs reflects maximum gait speed in community-dwelling adults aged older than 60 years.

AIM: A number of studies have shown that the maximum movement velocity of the lower limbs is a critical determinant of gait speed in elderly adults. However, it is still unclear whether gait speed is associated with the movement velocity of the lower limbs or the movement velocity itself. Therefore, we measured the movement velocity of upper limbs that would not have a direct effect on gait, and examined the relationship between the movement velocity and gait speed. METHODS: A total of 76 community-dwelling adults aged older than 60 years (mean age 73.3 years) participated in the study. We measured the movement velocity of the upper limbs, maximum gait speed, quadriceps strength, trunk muscle endurance and skeletal muscle mass index. RESULTS: A significant correlation was found between the movement velocity of the upper limbs and maximum gait speed (r=0.47; P<0.01). In a stepwise multiple regression analysis using maximum gait speed as a dependent variable, age, movement velocity of the upper limbs, body mass index and quadriceps strength were selected as independent variables (R(2)=0.55, P<0.001). CONCLUSIONS: The movement velocity of the upper limbs is a significant determinant of maximum gait speed, suggesting that the ability to move any region rapidly might be a critical factor in maximum gait speed.

Quick lateral movements of the trunk in a seated position reflect mobility and activities of daily living (ADL) function in frail elderly individuals.

A novel and safe performance test for measuring mobility is described. The test, which we have named the Seated Side Tapping test (Side Tapping test), requires the subjects to move their bodies laterally to the left and right in turn as quickly as possible whilst remaining in a seated position. We examined the associations between the results of the new test and those of other mobility tests, ADL, and the use of walking aids. The participants were 75 frail elderly people who were receiving rehabilitation services. Gait speed and the timed up and go (TUG) test were employed as mobility tests, and the participants' use of walking aids was recorded. The ADL score was assessed using the Barthel Index. Significant correlations were found between the side tapping test and gait speed (r=-0.59, p<0.01), and TUG (r=0.63, p<0.01). This test also revealed significant relationships with the ADL scores and the use of walking aids. These results indicate that an ability to perform quick lateral trunk movements in a seated position reflects their mobility during standing. Thus, we concluded that since the side tapping test is simple and safe, it is useful for detecting mobility impairments, ADL levels, and the need for walking aids, especially in frail elderly individuals.

Does fear of falling relate to low physical function in frail elderly persons?: associations of fear of falling, balance, and gait.

Falls are a major public health problem for older people. Recent research suggests that fear of falling may be a more pervasive and serious problem than falls among the elderly. The present study was conducted to determine whether frail elderly persons with fear of falling have lower physical function. A total of 47 subjects (aged 73 to 95) were recruited from a geriatric health services facility in Osaka. Physical function including balance, mobility, and muscular strength were measured using the following tests: Timed up & go test (TUG), functional reach test, single limb stance with eyes open, ten-meter walk, and knee extensor strength. Twenty-nine subjects (62%) had fear of falling and 18 (38%) had no fear of falling. There was no significant difference in age, sex, or the proportion using assistive devices. Results from the statistical tests showed that there were no differences in physical function, except in the functional reach test. The ratio of TUG to 10 m walk was used to determine the association between balance and mobility. In frail elderly persons with fear of falling and in those without fear of falling, the means of the ratios were 1.20 (SD=0.27) and 1.03 (SD=0.16), respectively. The ratios for frail elderly persons with fear of falling were higher (p=0.024) than the frail elderly without fear of falling. Our study suggests that even if frail elderly individuals walk slowly, they are not afraid of falling if there is a feasible balance function. We conclude that, in low-functioning frail elderly, fear of falling is associated with a combination of balance function and gait speed.