Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Objective To compare the curative effects of cognitive rehabilitation training and oral administration of Aricept on dementia associated with Parkinson's disease (PD).Methods Fifty patients with Parkinson's disease and mild to moderate dementia were divided into an experimental group (24 cases) and a control group (26 cases).The experimental group was given cognition training while the control group was given oral Aricept (5 mg daily for 4 weeks followed by 10mg daily for 8 weeks).The cognitive function of the two groups was evaluated using the Montreal cognitive assessment (MoCA) before treatment and at the end of the 4th,8th and 12th week of treatment.The severity of the patients' PD was assessed with the unified Parkinson's disease rating scale (UPDRS).Results After 4,8 and 12 weeks of treatment,the average MoCA score of the experimental group had significantly improved compared with before treatment.The average MoCA score of the control group was significantly improved after 8 and 12 weeks.After 4 weeks of treatment the average MoCA score of the experimental group was significantly higher than that of the control group.After 4 weeks of training,the average spirit,behavior and emotion scores of the experimental group in the UPDRS were significantly higher than before treatment and also significantly higher than the control group's average scores.The motor scores showed no significant difference until after 4 and 12 weeks of treatment.Conclusion Both cognition training and Aricept can alleviate dementia associated with PD,but the former works faster and has no adverse effect on movement. Key words: Parkinson's disease; Dementia; Cognition; Rehabilitation; Aricept

SIR—Fear of falling in community-dwelling older persons [1, 2] may lead to activity restriction [3]. It can predict future falls [4] and is an important fall-related psychological outcome [5–9]. The widely used 10-item Falls Efficacy Scale (FES) [5] does not evaluate the social dimension of fear of falling and refers almost exclusively to very basic activities of daily living, making it insensitive when used in active older persons. To remedy this, a new 16-item Falls Efficacy Scale-International (FES-I) [10] has been developed by the Prevention of Falls Network Europe (ProFaNE, www.profane.eu.org), showing excellent psychometric properties in a cross-cultural context [11]. Furthermore, a seven-item FES-I has been developed and recommended for use as part of a test battery and for screening purposes [12]. The evaluation of the FES-I has so far been performed in community-dwelling non-clinical samples. To examine the relevance of the two FES-I versions for health care settings, further evaluation of the instrument should include fall-prone older persons. The aim of this study was to test the psychometric properties of the Norwegian version of the 16-item FES-I in samples of fall-prone older home-dwelling persons recruited from the health care system and to assess if the seven-item FES-I has the same properties as the 16-item FES-I in these samples.

Objective To observe the changes of cognition and auditory event-related potential P300 on vascular cognitive impairment-no dementia (VCIND) patients before and after cognitive rehabilitation training,then further to explore the application value of P300 in early diagnosis of vascular cognitive impairment (VCI). Methods A total of 57 patients with VCIND were randomly assigned to the treatment group ( n =30) and the control group ( n =27),and 30 healthy volunteers without cognitive deficits were recruited as normal group.Each patient was examined with auditory-P300 and scored with mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scale.The measurement indicators were analyzed and evaluated with the factors of education,age and so on. Results The P300 latency in VCIND group was longer,and the amplitude lower than those in normal group before treatment (P＜0.05 ),the latency lengthening was more significant than the lowering of the amplitude ( P＜0.01 ).The cognitive assessment scale scores of MMSE,MoCA and ADL (Barther index,BI) in VCIND group were lower than those in normal group (P＜0.05),while no significant difference was revealed between the VCIND and normal groups with regard to naming and speech( P ＞ 0.05 ).A highly positive correlation between age and P300 latency as well as a significantly negative correlation between years of education and P300 latency were demonstrated( P＜0.05 ).After cognitive rehabilitation therapy the P300 latency in VCIND group was shortened,the amplitude increased (P＜0.05 ),scores of the items of cognitive scale raised(P＜0.05 ) and the change of each indicator was more statistically significant in treatment group(P＜0.05). Conclusion P300 could objectively reflect early cognitive dysfunction in VCIND patients.Early cognitive training could effectively promote cognitive function of VCI patients. Key words: Event-related potential, P300; Cognitive impairment, vascular; Assessment; Rehabilitation training

ObjectiveThe primary aim of this study is to compare the effectiveness of early active limb movement facilitated by virtual reality technologies with conventional exercise therapy in enhancing patient recovery in the Respiratory Intensive Care Unit. The follow-up period covers 1 week.MethodsIn this prospective randomized controlled trial, patients were allocated to either a control group, which received standard exercise therapy, or a virtual reality group, which utilized virtual reality software and equipment for active exercises. Patients were followed for 1 week. The study compared compliance, safety, and rehabilitative outcomes between these groups. Data were analysed using a linear mixed-effects model.ResultsPatients in the virtual reality-based exercise group exhibited significantly higher levels of average daily exercise time, out-of-bed exercise time, and overall exercise compliance compared with the control group (p < 0.05). There were no reports of adverse events related to exercise in either group. Notably, within the first week of intervention, the virtual reality-based exercise group showed significant improvements in various parameters, including muscle strength, grip strength, body mass index, and the Barthel Index, outperforming the control group in these areas (all p < 0.05).ConclusionBased on 1 week of follow-up data, the study confirms that virtual reality-based exercise modalities are more efficacious than traditional exercise approaches in enhancing exercise duration, compliance, and various health outcomes in Respiratory Intensive Care Unit patients. This approach also contributes to reducing Respiratory Intensive Care Unit stay duration. The system’s effectiveness could be further increased by integrating more varied and engaging rehabilitation games and features tailored to the needs of ICU patients.Trial registration: Chictr.org: ChiCTR1900021452LAY ABSTRACTThis study explored whether using virtual reality technology to help patients in the Respiratory Intensive Care Unit perform early limb exercises could improve their recovery compared to traditional exercise methods. Patients were divided into two groups: one used virtual reality to assist with exercises, while the other followed standard exercise routines. Over one week, the virtual reality group showed better results in terms of exercise time, muscle strength, grip strength, and overall recovery. The study found that virtual reality-based exercises were more engaging and effective, leading to higher patient compliance and faster improvements in physical health. This suggests that virtual reality could be a valuable tool in helping Respiratory Intensive Care Unit patients recover more quickly and efficiently.

Purpose To evaluate the effect of using lavender oil as an olfactory stimulus with vestibular rehabilitation (VR) on balance, fear of falling down, and activities of daily living of people with multiple sclerosis. Methods Forty participants were randomly assigned into experimental and control groups. The experimental group did the VR exercises while smelling the lavender oil scents. The control group did the VR exercises without it. Both groups did the exercises in ten 45-min sessions. We assessed the participants with the timed up and go (TUG) test, Berg balance scale (BBS), fall efficacy scale – international (FES-I), and the 29-item multiple sclerosis impact scale (MSIS-29). We did the tests at the baseline and after the last exercise session. Results The experimental group performed significantly better in the BBS (p = 0.007), TUG (p = 0.045), and FES-I (p = 0.016) tests as well as in the MSIS-29’s psychological subscale (p = 0.034) than did the control group. Conclusions Using lavender oil as olfactory stimulus while doing the VR exercises can improve balance and reduce fear of falling down compared to doing the VR exercises without it in people with multiple sclerosis. Implications for rehabilitation It seems that using lavender oil, as an olfactory stimulus, while doing vestibular rehabilitation exercises can improve balance and reduce fear of falling down in people with multiple sclerosis compared to doing the vestibular rehabilitation exercises without it. This treatment significantly alleviates the psychological effects of multiple sclerosis on daily life such as sleeping problems, feeling unwell, anxious, tense, depressed, etc.

Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons

Background and Purpose Balance impairment and fear of falling are two common risk factors for falls in people with multiple sclerosis (PwMS). Clinicians should use valid, reliable, and responsive tools to assess these risk factors and identify individuals at increased risk for falls. So, this study aimed to examine psychometric properties of the Persian-version of the Activities-specific Balance Confidence (ABC) scale and Fall Efficacy Scale-International (FES-I) in Iranian PwMS. Methods One hundred and fifty-three PwMS completed the Persian versions of ABC, FES-I, Multiple Sclerosis Walking Scale-12 (MSWS-12), and Berg Balance Scale (BBS) in the first session. To assess the test–retest reliability, 50 PwMS filled out ABC, and FES-I in retest session with an interval of 2–7 days. Also, for evaluating responsiveness, 50 PwMS completed ABC and FES-I before and after a 4-week treatment. Results Intra-class Correlation Coefficients were 0.96 and 0.93 and Cronbach’s alpha coefficients were 0.96 and 0.99 for the ABC and FES-I, respectively. There were significant correlations (p < .001) between ABC and BBS (r = 0.55), FES-I and BBS (r = −0.56), ABC and MSWS-12 (r = −0.72), and FES-I and MSWS-12 (r = 0.76). No floor or ceiling effect was found. ABC and FES-I had acceptable responsiveness (AUC > 0.70), and their minimally important difference (MID) were 10.5 and 9.5 points, respectively. Conclusion The Persian-versions of ABC and FES-I are reliable, valid, and responsive measures to quantify balance confidence and fear of falling in PwMS at both clinical and research settings. The MID can help clinicians to make a decision based on the clinical significance of changes in patients’ status.

O objetivo deste estudo foi investigar se défices na percepção visuoespacial e nas funções executivas apresentariam relação com o equilíbrio em idosos de baixa escolaridade. Participaram deste estudo 38 idosos (com média de idade 69,1±6,8 anos), com um a seis anos de escolaridade formal. Os testes aplicados foram: o teste de seqüência alfa-numérica - partes A, que avalia escaneamento visual e seqüenciamento (TSA-A), B, que avalia flexibilidade mental e memória operacional (TSA-B), considerando-se ainda o delta, que avalia função executiva (TSA-D); teste de cancelamento de estrelas (TCE), que avalia percepção espacial; a escala de equilíbrio de Berg (EEB) e a escala de eficácia de quedas (falls efficacy scale - international, FES-I), que avaliam equilíbrio e risco de quedas. As correlações foram verificadas pelo teste de Spearman, com p&lt;0,05. Foram encontradas fortes correlações significativas entre as escalas de equilíbrio (EEB e FES-I) e o TSA-B (r=-0,61 e r=0,60, respectivamente); e correlações moderadas entre a EEB e o TSA-A (r=-0,51) e entre a FES-I e o TSA-D (r=0,55). Também houve correlações significativas entre as escalas de equilíbrio (EEB e FES-I) e o TCE (r=0,45 e r=-0,45, respectivamente). A função executiva e a percepção espacial apresentaram relação com o equilíbrio e com o medo de cair em idosos de baixa escolaridade. Quanto melhores forem a função executiva e a percepção espacial, melhor tenderá a ser o equilíbrio e menor tenderá a ser o medo de cair.

A Single Question as a Screening Tool to Assess Fear of Falling in Young-Old Community-Dwelling Persons

the 16-item Falls Efficacy Scale-International (FES-I) has been shown to have excellent reliability and construct validity. However, for practical and clinical purposes, a shortened version of the FES-I would be useful. to develop and validate a shortened version of FES-I while preserving good psychometric properties. initial development of a shortened version using data from a UK survey (Short FES-I; n = 704), test of reliability and validity of the Short FES-I using data from a Dutch survey (n = 300). community samples. comparison of reliability and validity of the Short FES-I and the FES-I in a random sample of 193 people aged between 70 and 92. the internal and 4-week test-retest reliability of the Short FES-I is excellent (Cronbach's alpha 0.92, intra-class coefficient 0.83) and comparable to the FES-I. The correlation between the Short FES-I and the FES-I is 0.97. Patterns in differences with respect to mean scores according to age, sex, falls history, and overall fear of falling are similar for the Short FES-I and the FES-I. The FES-I had slightly better power to discriminate between groups differentiated by age, sex, falls history, and fear falling, but differences are small. the Short FES-I is a good and feasible measure to assess fear of falling in older persons. However, if researchers or clinicians are particularly interested in the distributions of specific fear of falling-related activities not included in the Short FES-I, the use of the full FES-I is recommended.

Introduction. Balance decreases with age, and factors influencing balance can increase postural sway and displace the center of pressure. Reduced physical activity is a significant problem that contributes to impaired balance and an increased risk of falling in the elderly population. Routine exercise programs are often challenging in improving balance, whereas game-based activity can be more engaging and motivating for older adults. Game-based training using the Balance Postural Sway System (BPSS) was applied in this study to reduce postural sway and therapeutically improve balance. Methods. This interventional study was conducted on 51 elderly adults who met the inclusion criteria. The intervention group (n = 26) underwent game-based activity with BPSS, while the control group (n = 25) received conventional balance training. The BPSS parameters used included the center of foot pressure X index (COFPXI) and Y index (COFPYI), which indicate the center of foot pressure with lateral sway and anterior-posterior sway, respectively. The left and right toe-heel values denote weight distribution between the toe and heel. The outcome measures used were the Fall Efficacy Scale International (FES-I) and the Berg Balance Scale (BBS). Results. The paired t-test showed a significant difference in all BPSS parameters—COFPXI, COFPYI, right toe, BBS, and FES-I—except for the left toe-heel in the intervention group. In contrast, the conventional group showed a significant difference only in BPSS COFPYI, FES-I, and BBS (p &lt; 0.05). The unpaired t-test demonstrated that the intervention group showed significantly greater improvements in all balance parameters of BPSS and FES-I (p &lt; 0.05) than the conventional group, except for BBS. Conclusion. Game-based activity with BPSS has been shown to reduce postural sway, improve pressure distribution on the foot, enhance balance, and decrease the risk of falls in the elderly population. The results suggest that incorporating such game-based activities into routine exercise programs for older adults can effectively improve balance and reduce fall risk.

Objective To explore the curative effect of cognitive function training combined with hyperbaric oxygen treatment in delayed encephalopathy after carbon monoxide poisoning. Methods Eighty patients with delayed encephalopathy after carbon monoxide poisoning in the emergency department of our hospital between November 2009 and December 2014 were included in the study. The patients were randomly into the combination treatment group (n=20) , cognitive function training group (n=20) , hyperbaric oxygen group (n=20) and control group (n=20). Conventional therapy was given to the patients in the control group and other treatment groups; in addition, the cognitive function training group received cognitive function training, hyperbaric oxygen group was given hyperbaric oxygen, and the combination treatment group received cognitive function training plus hyperbaric oxygen therapy. The outcomes of different therapies were evaluated after 30-day treatment. The general characteristics of the patients, including age, gender, disease duration, underlying diseases and level of education were recorded. At baseline and after the treatment, the patients were evaluated for cognitive function with Mini-Mental State Examimation (MMSE) and Montreal Cognitive Assessment (MoCA) , and active ability of daily life (ADL) with modified Barthel index (MBI). Results The age, gender, diseases duration, underlying diseases and level of education did not differ across the 4 groups (all P>0.05). The rates of effectiveness were 100.0% (20/20) in the combination treatment group, 90.0% (18/20) in the cognitive function training group and 85.0% (17/20) in the hyperbaric oxygen group, which were higher than that in the control group (75.0%, 15/20) (all P 0.05) , but these values were remarkably increased from baseline in all groups after treatments (all P<0.05). After treatment, the combination treatment group and cognitive function training group showed significantly higher MMSE scores, and the combination treatment group, cognitive function training group and hyperbaric oxygen group showed significantly higher MoCA and MBI scores compared with the control group (all P<0.05). The post-treatment MMSE scores were significantly lower in the hyperbaric oxygen group and control group than those in the combination treatment group; the post -treatment MoCA and MBI scores were lower in the cognitive function training group, hyperbaric oxygen group and control group than those in the combination treatment group (all P<0.05). Conclusion Cognitive function training combined with hyperbaric oxygen therapy can significantly improve the therapeutic efficacy of delayed encephalopathy after carbon monoxide poisoning by offering better cognitive function and ADL. Key words: Hyperbaric oxygenation; Carbon monoxide poisoning; Treatment outcome; Cognitive function training

From the December Issue of JAMDA

IntroductionWith increasing life expectancy of older adult population, maintaining independence and well-being in later years is of paramount importance. This study aims to investigate the impact of three distinct interventions:...