Changes In Functional Mobility Research Articles

Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson’s disease: a randomized, four-arm controlled trial

BackgroundRepetitive Transcranial Magnetic Stimulation (rTMS) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson’s disease (PD). However, the effects of their combination are unknown. Our objective was to determine the immediate and short-term effects on motor and non-motor symptoms, and neurophysiological measures, of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD.MethodsA randomized, single-blinded controlled trial with 4 arms was conducted. Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over the Primary Motor Cortices; Group B received eight 30-minute EEG-guided neurofeedback sessions focused on reducing average bilateral alpha and beta bands; Group C received a combination of A and B; Group D did not receive any therapy. The primary outcome measure was the UPDRS-III at post-intervention and two weeks later. Secondary outcomes were functional mobility, limits of stability, depression, health-related quality-of-life and cortical silent periods. Treatment effects were obtained by longitudinal analysis of covariance mixed-effects models.ResultsForty people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1–3). Group C showed the largest effect on motor symptoms, health-related quality-of-life and cortical silent periods, followed by Group A and Group B. Negligible differences between Groups A-C and Group D for functional mobility or limits of stability were found.ConclusionsThe combination of rTMS and EEG-guided neurofeedback diminished overall motor symptoms and increased quality-of-life, but this was not reflected by changes in functional mobility, postural stability or depression levels.Trial registrationNCT04017481.

Using depth sensors for a fall risk prediction system for socially vulnerable older adults with cognitive impairment

AbstractFalls and fall‐related injuries are significant public health issues for adults 65 years of age and older. Over a third of older adults (OA) fall each year and 10‐20% of falls result in serious injuries such as fractures and head trauma. Cognitive impairment is a leading risk factor for falls in OA. Over 60% of OA with MCI fall annually – two to three times the rate of those without cognitive impairment. OA living in low‐resource neighborhoods with poor housing conditions have twice the risk of falling. We have developed a technology‐based intervention called Sense4Safety that facilitates fall risk management and fall risk reduction for older adults (OA) with cognitive impairment living in low‐resource communities. Specifically, the intervention is designed to to 1) identify escalating risk for falls real‐time through in‐home passive sensor monitoring using depth sensors; 2) employ machine learning to inform individualized alerts for fall risk; and 3) link OA with a nurse tele‐coach who guides them in implementing evidence‐based individualized plans to reduce fall‐risk. The nurse coach is accessible via video‐conferencing or phone to discuss fall prevention and risk reduction strategies with the OA and their trusted other depending on the patterns identified in sensor‐detected changes in functional mobility and gait. The measurable primary outcomes include number of fall and near‐fall events, number of fall‐related hospitalizations, functional mobility, self‐reports of fear of falling and perceived independence. We have conducted an initial feasibility study of the intervention with 10 older adults in low income housing settings for a period of 3 months. The Sense4Safety intervention has the potential to become a feasible and cost‐effective approach to increase safety and quality of life for community dwelling low income OA with cognitive impairment and prevent or reduce falls. Currently, in most cases fall risk is addressed only after an adverse event has occurred or cognitive decline has progressed significantly. This intervention changes that paradigm to maximize safety and promote aging in place.

Student Competition (Knowledge Generation) ID 1985159

Background When we walk, we swing our arms in rhythm with our legs due to neural connections in the spinal cord. Currently, rehabilitation protocols primarily focus on leg training to improve walking function. However, past research has highlighted the importance of engaging the arms in rehabilitative interventions through arm and leg cycling following an incomplete spinal cord injury (iSCI). Objectives The objective of this study is to determine if the application of non-invasive transcutaneous spinal cord stimulation (tSCS) paired with arm and leg cycling can improve walking for individuals with an iSCI. It is hypothesized that the addition of tSCS will activate previously inaccessible neural circuits within the spinal cord to produce significant improvements in walking capacity. Methods Individuals with an iSCI underwent arm and leg cycling training that was assisted by functional electrical stimulation applied to the main extensor muscles of the leg. tSCS was applied over the cervical and lumbar regions of the spinal cord. Training consisted of 1 hour of cycling, 5 days/week for 12 weeks. A series of clinical and biomechanical assessments were performed to assess changes in functional mobility. Results Preliminary results in three participants showed increases in maximal walking speed on the 10-metre walk test, increases in walking endurance on the 6-minute walk test, and improved balance on the Berg Balance Scale. Preliminary biomechanical results suggested that the addition of tSCS may reduce left-right asymmetry. Conclusions Arm and leg cycling paired with tSCS offers tremendous potential for improvements in walking function following an iSCI.

Changes in functional mobility of patients with solid tumors after discharge from intensive care unit

RESUMO Este estudo teve como objetivo analisar as mudanças na mobilidade funcional (MF) de pacientes com tumores sólidos entre a alta da unidade de terapia intensiva (UTI) e a alta hospitalar e os possíveis fatores associados à recuperação da MF. Trata-se de um estudo de coorte retrospectivo baseado na análise de prontuários de pacientes com tumores sólidos que receberam alta da UTI de uma unidade oncológica entre 1º de janeiro de 2018 e 28 de fevereiro de 2020. O desfecho primário foi a mudança na MF após a alta da UTI considerando a diferença entre a pontuação final na alta da UTI e a pontuação final na alta hospitalar, calculada através da ICU mobility scale (IMS). A associação entre as variáveis contínuas e os desfechos foi realizada por meio da análise de regressão linear univariada. No total, foram incluídos 65 pacientes com idade mediana de 61,4 anos (variação interquartil - IQR 54-69). O tempo médio de internação após a alta da UTI foi de 19,0 dias (±24,04). A pontuação média da IMS no momento da alta da UTI foi de 2,62 (±2,56), e a pontuação média da IMS no momento da alta hospitalar foi de 6,08 (±3,26). Os pacientes que realizaram cirurgia para o tratamento do tumor primário tiveram uma pontuação 1,89 vez maior em comparação aos que não foram submetidos a tratamento cirúrgico (p=0,048). Concluindo, foi observada melhora da MF em pacientes com tumores sólidos entre a alta da UTI e a alta hospitalar, e os pacientes submetidos à cirurgia apresentaram uma melhor recuperação da MF.

History of falls alters movement smoothness and time taken to complete a functional mobility task in the oldest-old: A case-control study.

Mobility smoothness assessed by the spectral arc length (SPARC) may reflect the complex biomechanical alterations that occur with aging and may help detect functional mobility changes after experiencing falls. Here, we sought to explore whether smoothness of angular velocities of the trunk measured using SPARC metrics in the instrumented timed-up-and-go (iTUG) test are assoacited with a history of falls in the oldest-old. A case-control study. The sample consisted of 64 community-dwelling oldest-old individuals who underwent the following assessments: clinical and sociodemographic questionnaire, Mini Mental State Examination (MMSE), Falls Efficacy-questionnaire International (FESI), the Activities-specific Balance Confidence (ABC), Functional Reaching Test (FRT), and the iTUG test. We used an inertial measurement unit (IMU) to obtain trunk angular velocities from the IMU's gyroscope, which was used to calculate mobility smoothness (SPARC). Standard deviation of the mobility smoothness around the anteroposterior axis of rotation (SPARC roll SD) (OR: 6.15 / CI 95%=1.58-23.94) and duration (OR: 1.11 / CI 95%=1.09-1.22) in the full iTUG test were associated with a history of falls in oldest-old. Using solely the full iTUG duration (59.19±2.18) or SPARC (61.87±2.40) resulted in lower probability to detect a history of falls in comparison with the combined measurement (66.21±2.50). SPARC roll SD in the full iTUG may be a relevant biomarker to detect mobility smoothness changes in the oldest-old. This study provides evidence the oldest-old with a history of falls may change their functional mobility, in terms of movement duration and smoothness.

Development of the Screening Tool for Everyday Mobility and Symptoms (STEMS) for skeletal dysplasia

BackgroundSkeletal dysplasia are genetic disorders of cartilage and bone, characterized by impairments commonly resulting in short stature, altered movement biomechanics, pain, fatigue and reduced functional performance. While current tools quantify functional mobility performance, they have not been standardly used in this population group and do not capture patient-reported symptoms such as pain or fatigue. This study evaluated a new tool, the Screening Tool for Everyday Mobility and Symptoms (STEMS), designed to accurately and objectively assess functional mobility and associated symptomology for individuals with skeletal dysplasia.MethodsIndividuals aged 5–75 years with a skeletal dysplasia completed the STEMS, the Functional Mobility Scale (FMS) and Six Minute Walk Test (6MWT). The correlation among the STEMS, use of mobility aides, FMS and 6MWT normalised for leg length was calculated. One-way analysis of variance compared the STEMS symptomatology to normalised 6MWT distance.ResultsOne hundred and fifty individuals with skeletal dysplasia (76 achondroplasia, 42 osteogenesis imperfecta, 32 other; 74 < 18 years, 76 ≥ 18 years) participated. Almost two thirds of the group reported pain and/or fatigue when mobilising at home, at work or school and within the community, but only twenty percent recorded use of a mobility device. The STEMS setting category demonstrated highly significant correlations with the corresponding FMS category (r = − 0.983 to − 0.0994, all p < 0.001), and a low significant correlation with the normalised 6MWT distance (r = − 0.323 to − 0.394, all p < 0.001). A decreased normalised 6MWT distance was recorded for individuals who reported symptoms of pain and/or fatigue when mobilising at home or at work/school (all p ≤ 0.004). Those who reported pain only when mobilising in the community had a normal 6MWT distance (p = 0.43–0.46).ConclusionsThe Screening Tool for Everyday Mobility and Symptoms (STEMS) is a useful new tool to identify and record mobility aide use and associated self-reported symptoms across three environmental settings for adults and children with skeletal dysplasia. The STEMS may assist clinicians to monitor individuals for changes in functional mobility and symptoms over time, identify individuals who are functioning poorly compared to peers and need further assessment, and to measure effectiveness of treatment interventions in both clinical and research settings.

Beetroot supplementation in women enjoying exercise together (BEE SWEET): Rationale, design and methods

BackgroundPostmenopausal women exhibit higher rates of disability and cardiovascular disease (CVD) with aging compared to men. Whereas habitual exercise training is a known strategy to enhance physiologic function in men and premenopausal women, exercise-related adaptations are often modest in postmenopausal women. We propose dietary nitrate (beetroot juice) administered prior to exercise training may be a feasible approach to improve mobility and cardio-metabolic health outcomes in postmenopausal women. MethodsOur randomized, placebo-controlled study aims to determine preliminary effects sizes for changes in functional mobility and endothelium-dependent vasodilation across three study arms: exercise only (EX), exercise + placebo (EX + PL), and exercise + beetroot (EX + BR). Thirty-six postmenopausal women are recruited in small cohorts wherein group exercise is implemented to facilitate social support and adherence to an 8-week training progression. Participants are randomized to one of three study arms (n = 12 per group) following baseline assessments. Post-intervention assessments are used to determine pre-post changes in outcome measures including distance covered during a 6 min walk test, walking economy, muscle speed and power, and endothelial-dependent vasodilation as determined by flow-mediated dilation. Measures of feasibility include recruitment, retention, adherence to exercise prescription, perceived exercise session difficulty, and adverse event rates. DiscussionEvidence-based, translational strategies are needed to optimize exercise training-related adaptations in postmenopausal women. Findings will inform larger randomized clinical trials to determine if pre-exercise consumption of beetroot juice is an efficacious strategy to promote mobility and attenuate CVD disease risk.

Coexistent Osteoarthritis and Parkinson's Disease: Data from the Parkinson's Foundation Outcomes Project.

The impact of concurrent osteoarthritis on mobility and mortality in individuals with Parkinson's disease is unknown. We sought to understand to what extent osteoarthritis severity influenced mobility across time and how osteoarthritis severity could affect mortality in individuals with Parkinson's disease. In a retrospective observational longitudinal study, data from the Parkinson's Foundation Quality Improvement Initiative was analyzed. We included 2,274 persons with Parkinson's disease. The main outcomes were the effects of osteoarthritis severity on functional mobility and mortality. The Timed Up and Go test measured functional mobility performance. Mortality was measured as the osteoarthritis group effect on survival time in years. More individuals with symptomatic osteoarthritis reported at least monthly falls compared to the other groups (14.5% vs. 7.2% without reported osteoarthritis and 8.4% asymptomatic/minimal osteoarthritis, p = 0.0004). The symptomatic group contained significantly more individuals with low functional mobility (TUG≥12 seconds) at baseline (51.5% vs. 29.0% and 36.1%, p < 0.0001). The odds of having low functional mobility for individuals with symptomatic osteoarthritis was 1.63 times compared to those without reported osteoarthritis (p < 0.0004); and was 1.57 times compared to those with asymptomatic/minimal osteoarthritis (p = 0.0026) after controlling pre-specified covariates. Similar results hold at the time of follow-up while changes in functional mobility were not significant across groups, suggesting that osteoarthritis likely does not accelerate the changes in functional mobility across time. Coexisting symptomatic osteoarthritis and Parkinson's disease seem to additively increase the risk of mortality (p = 0.007). Our results highlight the impact and potential additive effects of symptomatic osteoarthritis in persons with Parkinson's disease.

Predicting Longitudinal Progression in Functional Mobility After Stroke: A Prospective Cohort Study.

A majority of people with stroke remain impaired in their functional mobility. The aim of the study was to determine longitudinal changes in functional mobility after stroke. The study was of a longitudinal and prospective design. The functional mobility was assessed using the Timed Up-and-Go test on 5 different occasions: 5 days after onset, within 24 hours after discharge, 1 month after discharge, 3 months, and 1 year poststroke. Stroke severity was stratified based on impairments and activity limitations using a baseline cluster analysis. A multilevel model was developed to predict longitudinal progression in functional mobility based on stroke severity. One-hundred-thirty-five patients were included at baseline. Two distinct subgroups (moderate stroke [52%] and mild stroke [48%]) were identified based on impairments and activity limitations using clustering. Ninety-one patients were included in the longitudinal analysis. After controlling for age and cognition, significant improvements in functional mobility were found in the moderate stroke group between baseline and 1 year poststroke (mean difference in Timed Up-and-Go test time, -6.4 s, adjusted P<0.001). Patients with moderate stroke had a maximum rate of improvement in functional mobility during the first 3 months poststroke and then declined significantly at 1 year (12% increase in Timed Up-and-Go test time, adjusted P=0.025). Younger patients had better functional mobility. Although there was also a slight improvement in the mild stroke group, it was not statistically significant. The recovery of functional mobility differs between mild and moderate stroke. Patients with moderate stroke improved their functional mobility during the first 3 months, after which it decreased significantly. These findings suggest that long-term rehabilitation is desirable to maintain and perhaps increase the gained functional mobility. Older patients and those with moderate impairments and activity limitations have particular needs. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01622205.

Robotic-Assisted Backward Gait Result in Functional Mobility Changes in Two Children Diagnosed With Cerebral Palsy

The purpose is to investigate the utilization of robotic-assisted backward walking to provide high-level repetitions in task specific practice for two children diagnosed with cerebral palsy (CP). Would this training program of intensive and repetitive backward walking result in positive functional mobility changes in children with CP?

Intracranial Fluid Redistribution But No White Matter Microstructural Changes During a Spaceflight Analog

The neural correlates of spaceflight-induced sensorimotor impairments are unknown. Head down-tilt bed rest (HDBR) serves as a microgravity analog because it mimics the headward fluid shift and axial body unloading of spaceflight. We investigated focal brain white matter (WM) changes and fluid shifts during 70 days of 6° HDBR in 16 subjects who were assessed pre (2x), during (3x), and post-HDBR (2x). Changes over time were compared to those in control subjects (n = 12) assessed four times over 90 days. Diffusion MRI was used to assess WM microstructure and fluid shifts. Free-Water Imaging was used to quantify distribution of intracranial extracellular free water (FW). Additionally, we tested whether WM and FW changes correlated with changes in functional mobility and balance measures. HDBR resulted in FW increases in fronto-temporal regions and decreases in posterior-parietal regions that largely recovered by two weeks post-HDBR. WM microstructure was unaffected by HDBR. FW decreases in the post-central gyrus and precuneus correlated negatively with balance changes. We previously reported that gray matter increases in these regions were associated with less HDBR-induced balance impairment, suggesting adaptive structural neuroplasticity. Future studies are warranted to determine causality and underlying mechanisms.

Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review.

Human aging results in a variety of changes to skeletal muscle. Sarcopenia is the age-associated loss of muscle mass and is one of the main contributors to musculoskeletal impairments in the elderly. Previous research has demonstrated that resistance training can attenuate skeletal muscle function deficits in older adults, however few articles have focused on the effects of resistance training on functional mobility. The purpose of this systematic review was to 1) present the current state of literature regarding the effects of resistance training on functional mobility outcomes for older adults with skeletal muscle function deficits and 2) provide clinicians with practical guidelines that can be used with seniors during resistance training, or to encourage exercise. We set forth evidence that resistance training can attenuate age-related changes in functional mobility, including improvements in gait speed, static and dynamic balance, and fall risk reduction. Older adults should be encouraged to participate in progressive resistance training activities, and should be admonished to move along a continuum of exercise from immobility, toward the recommended daily amounts of activity.

Metadichol, A Novel ROR Gamma Inverse Agonist and Its Applications in Psoriasis

Background: There is limited information regarding changes in functional outcome among trauma patients during acute inpatient rehabilitation and the factors associated with such changes. Examining the factors associated with functional outcome changes can provide a meaningful way to predict and prognosticate the needs of trauma patients during post-acute care rehabilitation. Objective: The objective of this study was to evaluate the association between changes in functional mobility and factors such as age and gender among trauma patients admitted to an acute Inpatient rehabilitation facility. Design: The retrospective study consisted of a 330 patients treated in a Level I academic trauma center who were discharged to an acute inpatient rehabilitation facility. Admission- and discharge-acute inpatient rehabilitation functionality was measured using Functional Independence Measure (FIM) scores. Methods: Information from the hospital’s trauma database on patients admitted to the level 1 trauma center and subsequently discharged to the hospital’s inpatient acute rehabilitation was retrospectively extracted and analyzed. Main outcome Measure: FIM scores. Mean/proportion comparison tests were used to investigate whether admission- and discharge-FIM scores statistically differed by age and gender. Multivariate regression analyses were estimated to examine whether age and gender were associated with differences between patients admission- and discharge-acute inpatient rehabilitation FIM scores while controlling for confounding factors. Results: Improvements in patients’ FIM scores during acute inpatient rehabilitation (FIM-gains) were statistically higher (p ≤ 0.05) among patients under 65 years old (FIM-gains: 21.3) relative to patients aged 65 years and older (FIM-gains: 18.13) despite the younger age group’s higher injury severity scores and longer hospital length of stays. Increased age and admission-acute inpatient rehabilitation FIM scores were both associated with lower FIM score improvements during acute inpatient rehabilitation admissions. FIM-gains score was estimated to be 6.34 points (p=0.00) lower in patients aged 65 years and older relative to patients under the age of 65; while a one-unit increase in patients’ admission-acute inpatient rehabilitation FIM score was associated with a 0.36 decrease (p=0.00) in their FIM-gains score. No gender based differences in patients’ FIM-gains scores were found. Conclusion: Patients under 65 years of age had a greater improvement in FIM-gains scores relative to patients aged 65 years and older. Besides age, we also found that patients with a higher admission-acute inpatient rehabilitation FIM score had a lower improvement in their FIM-gains score. No gender differences were noted.

Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) Study.

Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity. To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. The Teen-Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015. Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14). Participants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion). Of the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P < .01), resting HR (mean, 84 beats per minute [bpm]; 95% CI, 82-86 to 74 bpm; 95% CI, 72-76), posttest HR (mean, 128 bpm; 95% CI, 125-131 to 113 bpm; 95% CI, 110-116), and HR difference (mean, 40 bpm; 95% CI, 36-42 to 34 bpm; 95% CI, 31-37). These changes in time to completion, resting HR, and HR difference persisted at 12 months and 24 months. Posttest HR further improved from 6 months to 12 months (mean, 113 bpm; 95% CI, 110-116 to 108 bpm; 95% CI, 105-111). There were statistically significant reductions in musculoskeletal pain concerns at all points. These data provide evidence that bariatric surgery in adolescents with severe obesity is associated with significant improvement in functional mobility and in the reduction of walking-related musculoskeletal pain up to 2 years after surgery.

The effect of hippotherapy on trunk muscles emg, grasping force and functional mobility changes for person after coma

The present research has been based on the case study. The changes of balance in trunk muscles, body mobility were evaluated during the hippotherapy sessions. During hypotherapy activities such as touching various parts of the horse’s body (e.g. the neck, flank, back) or reaching for an object (e.g. ball or ring), which involves crossing the midline while maintaining appropriate balance and posture are performed. Positive results were set up in isometric grip strength accordingly in right and in left hands 47 and 2 % and functional mobility in 50%. We found out greater EMG of RA, EO, LT and MF muscles in right vs left side during walking, and RA, LT during riding. We presume that increased grasping muscle strength is related with the increased trunk muscle strength and increased ability to maintain upright position

Feldenkrais method and functionality in Parkinson’s disease: a randomized controlled clinical trial

Abstract Background: The second most common age-related chronic neurodegenerative disease after Alzheimer’s disease is Parkinson’s disease (PD). Objective: The focus of this study was to improve the functional capabilities of the participants with PD. Study groups: The PD participants were randomized into two groups: Feldenkrais and control. Methods: The Feldenkrais group underwent 50 sessions of an exercise program based on the Feldenkrais method. The control group received educational lectures during this period. Unified Parkinson’s Disease Rate Scale (UPDRS – session III), mini-mental state evaluation (MMSE), Hoehn and Yahr scale, and functional tests (figure-of-eight walk test, timed-up-and-go test, rollover task, 360 degrees turn-in-place, functional-reach test, sitting-and-standing test, Berg balance scale (BBS), and hip-flexion strength) were assessed in both groups. Procedures during the 50 sessions were conducted in an appropriate room, twice-a-week, on alternate days and lasted 60 min. Results: Thirty subjects were randomly divided into two groups: the Feldenkrais (n=15) and the control (n=15) group. The Feldenkrais group presented significantly better in functional tests (p&lt;0.05) when compared to the control group. The control group received lower scores after the 50-session period in the sitting/standing test (p=0.02), 360 degrees turn-in-place (p=0.01), and rollover test (p=0.01). Results of the BBS demonstrated significantly higher scores in the Feldenkrais group after treatment (p=0.004) when compared to the control group (p=0.01). Conclusion: The Feldenkrais lessons produced specific changes in functional mobility in PD participants.

Malay

Functional mobility among the older population is an important element for a meaningful quality of life. The implementation of functional mobility assessments among the older people is vital to ensure appropriate steps can be taken in order to detect changes in functional mobility. There are varieties of functional mobility assessments available however most of the reliability test are based on Western countries. Therefore this study was to determine the reliability of three types of functional mobility status assessment of physical activity, especially among the older person. Sixty older respondents with the average age of 76.32 years and standard deviation of 8.66 participated in this study performed three types of functional assessments; Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Sit-to-Stand Test (STS). Two measurements were carried out with a week gap from the first measurement. Intraclass Correlation (ICC), Limits of Agreement (LOA) and Standard Error of Measurement (SEM) statistical tests followed by the combination of the three statistical analysis measurements were used for data analysis. The results showed all functional measurement tools using ICC, LOA, SEM and combination of three types analysis were highy reliable. The ICC value was exceeded 0.90 (ICC=0.94-0.99). The LOA graph for all activity measurement tools showed some degree of reliability while the SEM percentage recorded a value of less than 10% (SEM%=0.95%-9.95%). In conclusion, all three functional measurement tools are highly reliable and can be used as one of the functional test among the older people in Malaysia. DOI : http://dx.doi.org/10.17576/JSKM-2016-1401-08

Longitudinal changes in mobility among nonagenarians: the Vitality 90+ Study.

BackgroundSeveral studies have focused on predictors of mobility limitations and disabilities. Yet little is known about the pace and patterns of mobility changes among very old people. This study examined changes in functional mobility among individuals aged 90 years and older during a 2-9-year follow-up. In addition, we were interested in the patterns of mobility changes.MethodsData were collected through a mailed questionnaire in the years 2001, 2003, 2007 and 2010. The study population (n = 948) consisted of individuals from three cohorts (2001, 2003, 2007) who participated in at least two survey rounds and answered the mobility questions. The length of the follow-up varied from 2–9 years between individuals as well as according to how many times an individual took part in the survey. Multilevel ordinal logistic regression analysis was used to evaluate the effects of time, age, gender, cohort and chronic conditions on changes in mobility.ResultsAt the baseline, “younger” old people, men and individuals in the cohorts for 2003 and 2007 had significantly better mobility compared with women, older individuals and individuals in the 2001 cohort. In addition, individuals with fewer chronic conditions had better mobility than those with more diseases. Mobility declined for most of the participants during the follow-up. The difference in the change in mobility over time for gender, age or chronic conditions was not statistically significant. The analyses were performed with a subgroup of participants aged 90–91 years at the baseline, and results did not differ substantially from the results for the entire study sample. However, the effect of chronic conditions on the change in mobility was statistically significant among participants aged 90-91years.ConclusionsNo differences were observed in the rate of mobility decline over time between age or gender. The effect of chronic conditions on the change in mobility was significant only among individuals aged 90–91 years. The prevention efforts are important and should focus even more, also among the oldest-old, on additional modifiable risk factors such as maintaining muscle strength.

Functional Outcomes After the Prosthetic Training Phase of Rehabilitation After Dysvascular Lower Extremity Amputation

ObjectiveTo describe physical function outcomes and modes of physical therapy intervention for a cohort of patients with dysvascular lower extremity amputation (LEA) during the prosthetic training phase of rehabilitation. DesignA retrospective cohort study. SettingPhysical rehabilitation clinics at a Veterans Affairs medical center and a university hospital. PatientsForty-two patients (38 men, 4 women, age 60.2 ± 8.4 years) who completed outpatient physical therapy rehabilitation with prosthetic training after dysvascular LEA. MethodsAll patients underwent a prosthetic training phase of rehabilitation, with standardized outcome measures performed at initiation and discharge. Main Outcome MeasuresPerformance-based physical function measures included Two-Minute Walk (2MW), Timed-Up and Go (TUG), and 5-meter gait speed. Self-report physical function measures included the Prosthesis Evaluation Questionnaire–Mobility Section (PEQ-MS) and the Patient-Specific Functional Scale. Rehabilitation dose was tracked as total number of clinic visits, rehabilitation duration, and specific intervention modes. ResultsThere were significant improvements between initial and discharge values (mean ± SD) for the Two-Minute Walk (67.5 ± 29.9 m and 103.3 ± 45.8 m, respectively, P < .001), gait speed (0.58 ± 0.27 m/s and 0.88 ± 0.39 m/s, respectively, P < .001), TUG (34.8 ± 21.3 seconds and 18.6 ± 13.9 seconds, respectively, P < .001), PEQ-MS (2.2 ± 0.9 and 2.8 ± 0.8, respectively, P < .001), and Patient-Specific Functional Scale (3.2 ± 2.0 and 5.9 ± 2.3, respectively, P < .001). Performance-based (TUG) and self-report (PEQ-MS) changes in functional mobility from initial exam to discharge had low or no correlations with rehabilitation dose measures. The number of clinic visits was 12.7 ± 13.1 and rehabilitation duration was 13.7 ± 16.8 weeks. ConclusionsSignificant improvements in performance-based and self-report measures of physical function occurred during the prosthetic training phase of physical rehabilitation after dysvascular major LEA. Despite improvements in function, gait speed, and TUG outcomes remained below clinically important thresholds, indicating patients were limited in community ambulation and at risk for falls. Lack of moderate or greater correlation between rehabilitation dose and outcome measures may indicate the need for more specific rehabilitation dose measures.

Changes in Functional Outcomes After an Inpatient Rehabilitation Program for Solid Organ Transplant Recipients.

Purpose: To describe the changes in functional outcomes after an inpatient rehabilitation program for solid organ transplant (SOT) recipients and determine whether any changes in functional mobility, lower body strength and lower limb muscle strength were associated with changes in functional exercise capacity. Methods: Twenty-one SOT recipients (7 liver; 2 liver + kidney; 1 kidney + pancreas; 2 heart; 2 single lung; 7 double lung; 58±8 yrs; 62% men (n = 13)) were enrolled in the study and participated in a multidisciplinary program (total duration: 23 ± 9 days) that was comprised of occupational therapy, physical therapy, psychological and nutritional support and nursing. Functional exercise capacity (2 Minute Walk test (2MWT)), balance (Berg Balance Scale (BBS)), functional mobility (Time Up and Go (TUG)), lower body strength (30 Second Sit-To-Stand Test), functional independence (Functional Independence Measure (FIM®)), self-reported performance during activities of daily living (ADL) (Canadian Occupational Performance Measure (COPM)) and health related quality of life (Rand-36) were measured before and after the rehabilitation program. Elbow flexion and knee extension force were measured using a hand-held dynamometer. Results: Sixteen subjects completed the study and showed significant improvements in 2MWT (32.7 ± 21 meters; p<.001), BBS (16 ± 9 points; p<.001), FIM (21 ±16 points; p<.001), COPM ( 3 ± 2.5 points; p<.001), elbow flexion (3 ± 4 newtons; p= 0.01) and knee extension (5.5 ± 4.4 newtons; p<.001) but not in TUG (-0.7 ± 13 seconds; p = 0.8), 30 second sit-to-stand (1 ± 2.4 repetitions; p = 0.1) or Rand-36 (-1 ± 26 points; p = 0.9). There was a weak non-significant correlation between 2MWT and TUG (r = 0.3; p = 0.2), 30 second sit-to-stand (r = 0.04; p = 0.8) and knee extension (r = - 0.2; p = 0.4) Conclusion: An inpatient rehabilitation program is effective in improving functional outcomes in SOT recipients.