Decrease In Functional Performance Research Articles

Ab. No. 167 Association between Balance, Cognition and Quality of Life in Middle Aged Postmenopausal Women: A Cross Sectional Study

Introduction: The hormonal changes occurring in women during and after menopause transition have a relevant impact on physical performance and health-related quality of life. The use of challenging balance conditions to detect sub clinical risk of balance impairment has been reported in aging population. Postmenopausal women may experience a decline in cognitive skills in their daily lives. A decrease in functional performance and cognitive function may lead to poor quality of life in postmenopausal women. There are studies reporting that low physical function can predict low cognitive function during menopause. The aim of the study is to find out association between balance, cognition and quality of life of middle-aged postmenopausal women. Methods: Middle aged 102 postmenopausal females aged 40-60years were included for study. A cross sectional study was conducted among 102 postmenopausal women who had natural history of menopause were included. Any women who had hysterectomy, hormonal replacement therapy, any severe musculoskeletal impairment, abnormal hearing and vision were excluded. Data was collected using the menopause specific quality of life questionnaire, timed up and go test for dynamic balance and Montreal cognitive assessment used for level of cognition. Result: Total 102 postmenopausal females aged 49.66±3.46 years. Mean scores for TUG (9.27 + 1.25), MOCA (21.46 + 2.90) and MENQOL (40.37 + 8.34) were seen. Correlation was found between TUG and MOCA were (p=.009) (r=.928), between TUG and MENQOL were (p=.056) (r=.574) and MENQOL with MOCA were(p=-.031) (r=.756) statistically significant. Conclusion: There is positive relationship between balance, cognition and quality of life is seen in middle aged postmenopausal females. Implications: Assessing and intervening early in the functional performance is essential to maintain and preserve cognitive function in aging by tailored cognitive motor training with holistic approach to maintain quality of life.

Immunosenescence is a therapeutic target for frailty in older adults: a narrative review.

Aging refers to a progressive decrease in functional performance, leading to increased mortality risk. At present, life expectancy is increasing worldwide and is expected to exceed 80 years by 2040. However, this increase in life expectancy also indicates a rise in the incidence and prevalence of diseases, such as cardiovascular, neurological, musculoskeletal, and oncological diseases, which are associated with aging. The exact underlying mechanisms of aging remain unknown, and whether it is a programmed process or the consequence of an accumulation of stress events remains unclear. Thus, more scientific research is needed to improve the management of complex and frail patients. Several databases were searched with the following key words: immunosenescence, inflamm-aging, frailty, sarcopenia and skeletal muscle, etc. Skeletal muscle is the core phenotype of frailty and sarcopenia. Immune aging and skeletal muscle decline interplay with each other and form a vicious circle. Maintaining muscle health is beneficial for immune function and delays the onset of frailty. Particularly, in the context of the ongoing corona virus disease (COVID)-19 pandemic, studies have shown that the elderly are more prone to the consequences of the SARS-CoV-2 virus. It has been reported that the rates of hospitalization in the 65-74, 75-84, and ≥85 years old group were 5×, 8×, and 10× greater than the 18-29 years old group, with corresponding COVID-19-related deaths being 60×, 140×, and 330× that of the younger reference group, respectively. Considering the above, this review aims to discuss the relationship between immunosenescence, skeletal muscle, and frailty, and to explore immunosenescence as a potential therapeutic target to prevent frailty and extend healthspan, with some emphasis on the effects of the COVID-19 pandemic on the elderly. Immunosenescence is a promising potential therapeutic target for frailty and is worthy of further investigation.

Feasibility and Safety of Applying the Functional Electrical Stimulation to Child with Facioscapulohumeral Dystrophy: A Case Report

Aims This study aims to investigate the feasibility and safety of short-term functional electrical stimulation (FES) training of the quadriceps femoris muscles in a child with facioscapulohumeral muscular dystrophy (FSHD). Methods A 7-year-old child with FSHD received treatment due to a decrease in functional performance and difficulty climbing stairs. The child was followed up with a home-based exercise program. FES was applied twice a week during stair climbing for six weeks. Muscle activation of the quadriceps femoris was measured using superficial electromyography, muscle strength was measured with a hand-held dynamometer, and functional performance was assessed with the 6-Minute Walk and the Stair Climb Tests before and after the treatment period. Results At the end of the treatment, there was an improvement in muscle activation. While muscle strength increased in the quadriceps femoris muscle of the non-dominant side, it remained constant on the dominant side. Functional performance test results also improved. Conclusions FES was a feasible and safe tool to use in our case, a child with FSHD.

Should we rely on the limb symmetry index to evaluate functional performance after anterior cruciate ligament injury and reconstruction?

Introduction: A limb symmetry index (LSI) >90% on hop tests is a widely advocated benchmark for functional recovery and return-to-sport clearance after ACL injury. Yet, the LSI assumes the contralateral limb is the “gold standard” and immune to decline. Due to the bilateral functional deficits evident after ACL injury and ACLR, other assessment methods such as comparing performance of both limbs to age, sex and activity-level matched uninjured peers may be required. Our primary aim was to describe the functional performance changes in the ACL-injured and contralateral limbs 1- to 5-years post-ACL reconstruction (ACLR) to determine the influence on LSI. Our secondary aim was to compare the ACLR group results to uninjured healthy controls. Methods: 59 participants (38 men) aged 29±16 years completed three hop-tests and a one-leg rise 1- and 5-years post-ACLR. Mean(±SD) scores for the ACLR and contralateral limbs, and LSI at 1- and 5-years were reported. Linear mixed-effects models evaluated the difference in change between the ACLR and contralateral limbs. Participants were classified with stable, improving or worsening function relative to previously published minimal detectable change thresholds. Healthy controls completed the hop-tests (n=41) and one-leg rise (n=31) at a single time-point to provide reference data. Linear regression models (adjusted for age and body mass index), assessed the differences in functional performance at 1- and 5-years between the ACLR group and the healthy control group. Results: The contralateral limb had a significantly (p<0.05) greater decrease in functional performance between 1- and 5-years for the three hop-tests, compared to the ACLR limb. Worsening was more common in the contralateral limb than the ACLR limb; resulting in significant improvements in the LSI for the single-hop (mean 87% at 1-year to 95% at 5-years), side hop (77% to 86%) and one-leg rise (76% to 85%). The LSI on all four tests at 1-year post-ACLR was significantly lower than healthy controls, but did not generally differ between groups at 5-years. Discussion: Although the LSI significantly improved between 1- and 5-years post-ACLR, this was mostly due to worsening function in the contralateral limb. The LSI should not be used in isolation to evaluate functional performance changes after ACLR, as it may overestimate functional improvement. Exercise-based interventions may need to continue beyond the typical rehabilitation period of 6-12 months to improve or maintain function in both limbs, considering the deficits at 1-year post-ACLR compared to healthy controls, and minimal improvement over the proceeding 4-years. Conflict of Interest: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract

The Relationship Between Osteoarthritis and Sarcopenia in Geriatric Diabetic Patients

Objectives:Osteoarthritis is a common disease affecting the quality of life in the elderly population. Osteoarthritis is a painful condition commonly encountered in patients aged 65 years and older and it may cause muscle weakness. Sarcopenia is a condition that has an increasing prevalence in the elderly population. The present study evaluated the relationship between sarcopenia and osteoarthritis.Methods:The study included 100 patients aged 65 years and older who were diagnosed with diabetes mellitus. The patients were divided into two groups as Group 1 and Group 2. Group 1 was composed of 50 patients with diabetes and osteoarthritis and Group 2 was composed of 50 patients with diabetes but without osteoarthritis. A detailed medical history was obtained from all patients and all patients underwent physical examination. The get-up and go test was performed, handgrip strength was measured with a hand dynamometer, bioimpedance analysis was performed, and mid-upper arm circumference, calf circumference and waist circumference were measured, and laboratory tests including complete blood count, biochemical nutritional parameters, liver and kidney function tests, and erythrocyte sedimentation rate were ordered. The Kellgren and Lawrence grading system was used to evaluate the severity of osteoarthritis and the skeletal muscle mass index was used to evaluate the muscle mass. These parameters were compared between the two groups.Results:Of the study participants, 1% had severe sarcopenia, 22% had moderate sarcopenia, and 77% did not have sarcopenia. Albumin (p=0.013), magnesium (p=0.038), total protein (0.004), erythrocyte sedimentation rate (p=0.047), hemoglobin level (p=0.018), muscle strength (p=0.046), height (p=0.033), and muscle mass (p<0.05) were significantly different in patients with osteoarthritis compared to patients without osteoarthritis. Patients with osteoarthritis achieved poorer results on the get-up and go test (p=0.014), and mid-upper arm circumference (p=0.028), and calf circumference (p=0.016) were lower in this group. There was a negative moderate correlation between the muscle mass and the Kellgren and Lawrence grade (p<0.05, r: −0.405), whereas there was a positive moderate correlation between sarcopenia index and the Kellgren and Lawrence grade (p<0.05, r: 0.320) in patients with osteoarthritis.Conclusion:The present study is the first to evaluate the relationship between sarcopenia and osteoarthritis in geriatric diabetic patients. The present study found a significant relationship between osteoarthritis and sarcopenia in geriatric patients with type II diabetes mellitus. The authors suggest that pain associated with osteoarthritis results in immobility, decrease in functional performance, and thus development of sarcopenia.

Limb symmetry index on a functional test battery improves between one and five years after anterior cruciate ligament reconstruction, primarily due to worsening contralateral limb function

ObjectiveEvaluate change in functional performance from 1- to 5-years after anterior cruciate ligament reconstruction (ACLR). Methods59 participants (38 men) aged 29 ± 16 years completed three hops and one-leg rise 1- and 5-years following ACLR. Linear mixed-effects models evaluated differences in change between the ACLR and contralateral limbs. Participants were classified with stable, improving or worsening function relative to previously published minimal detectable change thresholds. Healthy controls completed the three hops (n = 41) and one-leg rise (n = 31) as reference data. ResultsThe contralateral limb had a significantly greater decrease in functional performance between 1- and 5-years for the three hops, compared to the ACLR limb. Worsening was more common in the contralateral limb than the ACLR limb; resulting in significant improvements in the LSI for the single hop (mean 87% at 1-year to 95% at 5-years), side hop (77%to 86%) and one-leg rise (76% to85%). Performance of both ACLR and contralateral limbs and the LSI remained below the healthy controls. ConclusionFunctional performance changes differ between limbs between 1- and 5-years post-ACLR. The LSI should not be used in isolation to evaluate functional performance changes after ACLR, as it may overestimate functional improvement, due to worsening contralateral limb function.

Senior citizens losing vision as a challenge to contemporary special education

Kornelia Czerwińska, Izabella Kucharczyk, Senior citizens losing vision as a challenge to contemporary special education. Interdisciplinary Contexts of Special Pedagogy, no. 25, Poznań 2019. Pp. 333-351. Adam Mickiewicz University Press. ISSN 2300-391X. DOI: https://doi.org/10.14746/ikps.2019.25.14&#x0D; Acquiring blindness or low vision at the senior age usually results in decreased quality of life due to a decrease in functional performance in the areas of activities of everyday activities, spatial orientation and mobility, physical activity, spending free time and obtaining information. Loss of vision also implies serious emotional consequences, which in the absence of professional therapeutic help and social support can lead to mental health disorders. Research analyses indicate that the level of satisfying rehabilitation needs of seniors who are losing vision is relatively low, and the specificity of their functioning resulting from the coexistence of various health problems is rarely included in support programs. The aim of the article is to indicate areas that have been so far neglected in the rehabilitation of elderly people who have acquired visual impairment and to formulate proposals aimed at increasing the availability and quality of therapeutic services for this social group.

FUNCTIONALITY OF UPPER GASTROINTESTINAL CANCER PATIENTS WHICH HAVE UNDERTAKEN SURGERY IN HOSPITAL PHASE.

ABSTRACTBackground: Cancer patients present various physiological, metabolic, social and emotional changes as a consequence of the disease’s own catabolism, and may be potentiated in the gastrointestinal tract cancer by their interference with food intake, digestion and absorption. Aim: To evaluate the functionality of upper gastrointestinal cancer patients which have undertaken surgery and analyze the factors associated with changes in strength and functionality during hospitalization time. Methods: Prospective analytical study in patients with cancer of the upper gastrointestinal tract which have undertaken surgery. Was evaluated the handgrip strength using a hand dynamometer and functionality through the functional independence measure and Functional Status Scale for Intensive Care Unit in the preoperative period, 2nd and 7th postoperative day. Results:Were included 12 patients, 75% men, and mean age was 58.17 years old. The most prevalent tumor site was stomach (66.7%). There was a progressive reduction from the pre-operative palmar grip strength to the 2nd and 7th postoperative day, respectively. There was a decrease in functional performance from the preoperative period to the 2nd and a gain from the 2nd to the 7th postoperative day (p<0.001). Conclusion: An important reduction in the handgrip strength and functionality was evidenced during the postoperative period in relation to the basal value in the pre-operative period.

Effect Of Cryotherapy To A Muscle Versus A Joint On Functional Performance

Cryotherapy is a common intervention used to treat acute and chronic injuries, and it can be used to facilitate rehabilitation exercises. A common practice in athletic training is allowing a patient to return to activity after the application of some type of cryotherapy. However, the effect of applying cryotherapy to a muscle or a joint on functional performance is unclear. PURPOSE: To investigate if cooling a muscle compared to cooling a joint affects functional performance in healthy, active individuals. METHODS: Forty-five healthy, college student volunteers (21 males; 24 females) with ages ranging from 18 to 23 years (M = 20.67; SD = 1.09) were randomly assigned to muscle (low leg) cryotherapy, joint (ankle) cryotherapy, or control (no cryotherapy) intervention for 20 minutes. After a 10 minute warm-up, subjects performed practice trials of a shuttle run and single leg vertical jump (SLVJ). Subjects performed three trials of a shuttle run (4 – 6.1 m sprints) for time, and performed three trials of a SLVJ for height measured prior to and immediately following the intervention. A mixed model ANOVA with a Bonferroni Correction was used to determine significant interactions between intervention groups and times with an alpha level of .05 for statistical significance. RESULTS: For the SLVJ, there was a significant interaction between the intervention groups and time; F(2,42)=3.349, p=0.045; however, group differences were unable to be determined. The muscle intervention group had a significant decrease in jump height between pre- (M=12.24, SD=3.61) and post-test (M=10.89, SD=3.21); p=0.01. For the shuttle run test, there were no significant interactions between group and time; F(2,42)=0.747, p=0.480. The joint (pre-M=7.43, SD=0.77; post-M=7.56, SD=0.70); p=0.036, and muscle (pre-M=7.63, SD=0.71; post-M=7.79, SD=0.78); p=0.013 intervention groups had a significant increase in run times between pre- and post-test. CONCLUSIONS: Cryotherapy application for 20 minutes to a muscle significantly decreased SLVJ height and increased shuttle run time, while, cryotherapy application for 20 minutes to a joint significantly increased shuttle run time pre-to post-test. If cryotherapy application is utilized prior to performance, a warm-up should be initiated to prevent a decrease in functional performance.

Relationship Between Functional Knee Joint Position Sense and Functional Performance Scores Following Anterior Cruciate Ligament Reconstruction (Pilot Study)

Objectives:The aim of this study was to assess the relationship between functional knee joint position sense (JPS) and functional performance following ACL reconstructionMethods:Seven male patients (mean age=32,66 ±6,47) who had undergone ACL reconstruction and 10 male healthy control subjects participated in the study. Knee joint position sense was evaluated by reproduction of 20° knee flexion angle in weight-bearing position with single and bilateral limb movement into flexion and extension. The deviations in the angle were recorded and compared to both noninjured side and healthy controls’. Functional performance was evaluated with Single Leg Hop Test in both injured and non-injured sides. The scores were also compared with healthy controls and non-injured sides. Relationship between measured values was tested with Spearman Correlation Analysis.Results:There was no significant difference in knee joint position sense in functional position between the operated and uninjured knees of patients or between patients and healthy controls (p>0,05). However, there is significant difference in Single Leg Hop test scores between operated and non-operated or between patients and healthy controls (p=0,037; p<0,05). There was no significant correlation between Single Leg Hop test scores and knee joint position sense (p>0,05).Conclusion:There was no evidence of impaired joint position sense in weight-bearing positions in subjects with ACL reconstruction but there was a decrease in functional performance. This decrease in functional performance may depend on the other parameters except proprioceptive deficits.

Muscular power as a function of load in elderly women

Ageing has been associated with a decrease in the ability to perform daily tasks (Reid and Fielding 2012). This decrease in functional performance is due to a lower capacity of developing muscle force and power, which results in impaired performance, particularly in activities where intense and rapid movements are essential (e.g. counter-acting a fall). It has been shown that increasing muscle power in older adults results in a functional improvement and reduces the incidence of disability (Pereira et al. 2012). To improve muscular power, trainings that maximise power output are indicated (Kawamori and Haff 2004). Muscular power can be assessed using iso-kinetic or iso-inertial dynamometry. Even if iso-kinetic testing remains one of the more popular methods for power assessment, it may not be appropriate to assess the ability to perform daily tasks (Jane 1995). Indeed, the fixed velocity of movement utilised during iso-kinetic testing is not characteristic of most daily activities. Instead, iso-inertial testing approximates more closely functional movements, which are characterised by accelerations of a constant mass. In this study, we have measured the average power during upper and lower body exercises using an iso-inertial method in older women. The aim was (1) to evaluate the strength and power in ageing women and (2) to determine the load (or range of loads) that maximises the mechanical power output.

Autologous chondrocyte implantation versus microfracture for knee cartilage injury: a prospective randomized trial, with 2-year follow-up

The objective was to evaluate the functional performance over a 2-year period following autologous chondrocyte implantation (ACI) in an open knee procedure compared to microfracture. Objective functional outcome was studied as secondary analysis in a subgroup of patients, in a randomized clinical trial, with concealed allocation and independent evaluators. Sixty-seven patients with local cartilage defect, with a mean size of 2.4 cm(2) (SD 1.5) of the femoral condyle of the knee were included. Thirty-three patients underwent the microfracture and 34 the ACI procedure. An identical rehabilitation protocol was implemented for both groups. Active knee flexion and extension range, anterior laxity, knee extension strength (concentric at 60 degrees/s) and single leg hop performance (single hop, crossover triple hop and 6 m timed hop test) were evaluated pre-surgery and at 6, 9,12 and 24 months post-surgery. We calculated the symmetry index for individual and four performance tests pooled. Mixed linear model analyses were used with confidence interval set at 95%. The change over 2 years for the pooled performance-based tests was comparable between the two treatment arms. At 2 years, 70% (38/54) of all patients returned to >85% symmetry in overall functional performance. A decrease in functional performance at 6 months following ACI resulted in slower recovery at 9 and 12 months compared to microfracture. Rehabilitation following both cartilage repair procedures is a lengthy process. At 2 years after surgery, ACI patients have similar overall functional outcome compared to microfracture patients.

Mitigating functional performance decrement in cancer patients undergoing treatment

9105 Background: It is well-documented that treatment side-effects cause physical and psychosocial de-conditioning in cancer patient. Decrease in functional performance (FP), as measured by activities of daily living (ADL), is a major contributor to a decline in patient quality of life (QOL). Relatively little information is available on the effects of a specific exercise regimen targeting muscle groups/energy systems involved in FP. Methods: 30 male and female cancer patients receiving treatment were randomly assigned to either the experimental (EX) or control (C) groups. EX participated in two exercise sessions per week for 17 weeks. Sessions included a combination of aerobic, resistance, flexibility, and balance training. C did not participate in any structured exercise. Data were collected post-diagnosis (1), post- surgery (2), at 9 weeks post-diagnosis (3), and at 17 weeks post-diagnosis (4). Measurements included resting heart rate (RHR), fatigue, physical activity level (PA), QOL, and the FP tasks of: treadmill walking (TRED), stair climb/descent (STAIR), lifting/carrying (CARRY), sit to stand (STAND), and balance (REACH). Results: Factor analysis yielded four variables: FP1 = [(0.5 × TRED) - (0.5 × RHR)]; FP2 = [(STAIR) + (CARRY) + (STAND)]/3]; FP3 = [(0.333 × QOL) + (0.333 × PA) - (0.333 × FT)]; FP4 = REACH. Repeated-measures ANOVA with within-subjects contrasts detected significant differences between groups. No significant differences existed at 1 or from 1 to 2. Significant differences were found on all variables from 1 to 4, 1 to 3 and 3 to 4 (p &lt; 0.001) (significant improvement for experimental group vs. significant decline for control group). Mean changes for the experimental vs. control groups from 1 to 4 are as follows: FP1 (+65.5 vs. -29.5); FP2 (-5.3 vs. +3.6); FP3 (+1.8 vs. -3.4); FP4 (+1.7 vs. -0.81). Conclusions: Specifically-designed exercise interventions promote positive adaptations that elicit significant improvement in ADL, QOL, and decrease fatigue. Prescriptive exercise is a viable therapy during treatment for mitigating side effects and avoiding de-conditioning. No significant financial relationships to disclose.

Part II: Radionuclide evaluation of aortic regurgitation

The timing for valve replacement in patients with aortic regurgitation remains a complex clinical problem. Rest radionuclide angiography measurement of ejection fraction is a simple informative study to help evaluate the appropriate timing for valve replacement in the asymptomatic patients or those with mild symptoms. In patients with normal ejection fractions the disease probably has not yet evolved to the phase in which valve replacement is essential. If the ejection fraction is mildly depressed (0.40 to 0.49) the time is right for intervention. By the time the ejection fraction falls to < 0.40 the left ventricle is likely damaged and unlikely to regain normal function. If the patient has severe symptoms with maximal medical therapy, surgery is indicated no matter what the ejection fraction. The latter situation can arise especially when aortic regurgitation evolves over a short period, as might be the case in patients with bacterial endocarditis. A single ejection fraction measurement is not as reliable as serial studies. If, for example, the ejection fraction (under similar circumstances) falls from the ≥0.50 range to the 0.40 to 0.49 range, the physician should be alerted to the possibility that the left ventricle is deteriorating, and surgery should be considered. It should be understood that multiple hemodynamic factors in aortic regurgitation can alter the ejection fraction and could limit its use as the sole measure of left ventricular performance. Other systolic or diastolic parameters cannot be relied on in isolation as an indication or contraindication for aortic valve replacement. The exercise ejection fraction response reflects the total stroke volume and does not distinguish between regurgitant flow and forward flow. It is therefore possible to observe a decrease in ejection fraction in association with an increase in forward stroke volume during exercise as a result of an increase in heart rate and a decrease in peripheral resistance. Accordingly, it is not appropriate to compare the ejection fraction during exercise in aortic insufficiency with the expected response of the normal ventricle. Exercise position (sitting vs. supine) affects loading conditions and ejection fraction response. 44Because of the complexity of the exercise ejection fraction response, it is not clear that there is a role for exercise ejection fraction measurements in determining the appropriate time for aortic valve replacement. Criteria based on supine exercise may not be applicable to studies in the upright position. Other markers of left ventricular performance, including end-systolic volumes and pressure-volume relationships, also have been examined. These parameters are preload independent and incorporate the effects of afterload. End-ejection pressure-volume ratios appear to be reasonable predictors of left ventricular contractile performance in chronic aortic regurgitation. 45 The continued problem of the timing of aortic valve replacement inspires the hope that serial measurement left ventricular function with exercise may have some predictive power. Parameters other than ejection fraction, such as regurgitant fraction and end-systolic and end-diastolic volume response, also may be useful. Careful consideration of aortic valve replacement should be given to patients with deterioration of these other radionuclide angiographic parameters, particularly when associated with a decrease in functional performance and worsening of symptoms. Nevertheless, only the resting LVEF has been shown to correlate with survival after valve replacement. Radionuclide studies provide a means to assess the change in left ventricular function after valve replacement. It has been observed that soon after valve replacement LVEF decreases, likely due to acute reduction in preload and increase in heart rate. This reduction should not be misconstrued as reduction in left ventricular performance, and under these circumstances end-systolic volume-endsystolic pressure may be a more useful test of left ventricular function. However, over the ensuing weeks to months ejection fraction tends to normalize in those patients in whom surgery was appropriately timed. The frequent occurrence of late postoperative deaths due to chronic congestive heart failure (78% in the National Institutes of Health study 46) underscores the importance of continued serial radionuclide evaluation of left ventricular performance in the improved methods to better time when aortic valve replacement should be performed. Operated and unoperated patients receiving chronic vasodilator therapy also benefit from serial evaluation of ventricular function to assess the response to therapy and define prognosis.