Functional Mobility Tests Research Articles

Intrarater reliability and validity of outcome measures in myotonic dystrophy type 1.

To investigate intrarater reliability and concurrent and construct validity of muscle strength, balance, and functional mobility measures in individuals with noncongenital myotonic dystrophy type 1 (DM1). Seventy-eight adults with noncongenital DM1 participated in visit 1, and 73 of the them participated in visit 2 separated by 1 to 2 weeks. The assessments consisted of muscle strength tests with handheld dynamometry (HHD) and stationary dynamometry in the lower limb. The balance tests consisted of the step test, Timed Up and Go test, feet-together stance, tandem stance, 1-leg stance, and modified Clinical Test of Sensory Integration and Balance on a balance platform. The functional mobility tests consisted of the 10-m walk test (10mWT) and 10-times Sit-to-Stand test. The HHD and stationary dynamometry had sufficient intrarater reliability for most muscle groups on a group (SEM% ≤15%) and individual (minimal detectable difference [MDD95%] ≤30%) level, but the HHD was most reliable. Stationary dynamometry measured a higher torque than HHD for all extensor muscles, but for single individuals, none of the devices were favored. Overall, intrarater reliability and validity were sufficient only for the dynamic balance tests, not the static balance tests. Both functional mobility tests were sufficiently reliable and valid, but the 10mWT was most reliable. Overall, HHD is recommended as a reliable and valid tool for single individuals and for flexor muscles on a group level. For balance assessments, the dynamic balance tests are recommended as the most valid and reliable balance tests. Both functional mobility tests are recommended for valid and reliable outcomes, but the 10mWT was superior for reliability.

Reliability and validity of Five Times Sit to Stand Test in pregnancy-related pelvic girdle pain

BackgroundPelvic girdle pain (PGP) is a common musculoskeletal disorder during pregnancy, and functional mobility evaluation is very important in reflecting the treatment effects. ObjectivesTo investigate reliability and validity of Five Times Sit-to-Stand (5TSS) test in pregnant women with and without PGP. DesignA cross-sectional observational study. MethodsOne hundred sixty-seven women in the second or third trimester of pregnancy participated in two assessments one week apart. The 5TSS and Timed Up & Go (TUG) tests were used to assess functional mobility, in a randomized sequence, by two independent raters. Time to complete the tests were recorded. Perceived pain and difficulty during functional mobility tests were marked on two Visual Analogue Scales. Following tests of functional mobility, seven clinical tests were used to classify the subjects as with or without PGP. ResultsThe 25% of subjects had PGP. Inter-rater reliability of 5TSS was excellent for subjects with and without PGP (ICC = 0.999, 95% CI = 0.999–1.000; ICC = 0.999, 95% CI = 0.999–0.999, respectively). Test-retest reliability of 5TSS was also very high for subjects with and without PGP (ICC = 0.986, 95% CI = 0.959–0.995; ICC = 0.828, 95% CI = 0.632–0.920, respectively). The 5TSS scores were positively correlated with TUG scores (r = 0.420, p = 0.006 and r = 0.404, p = 0.000, respectively). The subjects reported higher pain (95% CI = 0.322–0.824) and difficulty (95%Cl = 0.500–1.042) during 5TSS than the TUG test. ConclusionsThe 5TSS test is a reliable and valid functional mobility outcome measure in pregnant women with and without PGP. Further psychometric properties of the measure such as responsiveness, should be investigated in the future.

Effectiveness of a Mini-Trampoline Training Program on Balance and Functional Mobility, Gait Performance, Strength, Fear of Falling and Bone Mineral Density in Older Women with Osteopenia.

PurposeTo evaluate the effectiveness of a combined balance-, strength-, and jumping-exercise intervention on a mini-trampoline performed by older women with osteopenia on static balance and functional mobility, gait speed, strength of the upper and lower limbs, fear of falling, as well as to investigate its influence on bone mineral density (BMD).Patient and methodsUsing a randomized controlled study design, participants (range: 56–83 years) were assigned either to the intervention group (IG; n=20, mean age 69.6 ± 5.3 years) performing a specifically tailored intervention on a mini-trampoline or to the control group (CG; n=20, 67.4 ± 6.8 years), that did not undertake any intervention beyond regular osteopenia treatment. The intervention was performed twice a week for 12 weeks, each session lasting 45–60 mins and consisted of balance, strength and jumping exercises. Static balance and functional mobility was measured by one-leg stance (OLS) and timed up and go test (TUG). Upper and lower limb strength was evaluated by the arm curl test (ACT) and the 30-s chair stand test (CST) whereas gait speed was measured by the 6 m walking test (WT). Fear of falling was measured using the Falls Efficacy Scale – International (FES-I). BMD was measured at the lumbar spine and femoral neck using Dual-energy X-ray absorptiometry (DXA).ResultsSignificant interactions (group x time) were found for all parameters (p<0.001) except for BMD, measured at the lumbar spine (p=0.064) and femoral neck (p=0.073). All test parameters of balance and functional mobility tests (OLS, TUG), strength tests (ACT, CST), WT, FES-I and BMD (femoral neck) showed significant improvement in the IG (p<0.05).ConclusionThe combined 12-week intervention was highly effective in improving balance and functional mobility, strength, gait performance and fear of falling in patients with osteopenia.

Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals

BackgroundHypertension (HT) contributes substantially to poor physical function, cognitive dysfunction, cardiovascular problems and to all-cause mortality. Performance in activities requiring attention, speed and coordination might also be affected in individuals with HT. ObjectiveThis study compared the processing speed, static and dynamic balance, functional mobility and fear of falling between individuals with hypertension (HT group) and normotensive individuals (NT group). MethodsOne-hundred and twenty-eight individuals were included: NT group (n = 64) and HT group (n = 64). The Choice Stepping Reaction Time Test was used for the evaluation of processing speed, Single Leg Stance test for static balance evaluation, “Y” Balance Test for dynamic balance evaluation, Timed Up and Go test with single and dual tasking for the evaluation of functional mobility and Falls Efficacy Scale for assessing fear of falling. ResultsThe processing speed of the HT group was slower than that of the NT group; the total response time (RsT) in Stepping Reaction Test (SRT) (mean difference [MD] = −0.2, 95% CI = −0.3, 0), and Stroop Test (ST) [ST-A (MD = −0.4, 95% CI = −0.5, −0.2), ST-B (MD = −0.5, 95% CI = −0.7, −0.2) and ST-C (MD = −0.6, 95% CI = −0.8, −0.3). Additionally, the static [single leg stance, eyes open, right side (MD = 12.7, 95% CI = 6.3, 19.0) and left side (MD = 13.6, 95% CI = 7.2, 19.9)] and dynamic balance [Y balance test, composite score, right lower extremity (MD = 8.5, 95% CI = 4.4, 12.5) and left lower extremity (MD = 5.2, 95% CI = 1.5, 8.8) scores of the HT group were lower than those of the NT group. The HT group required a longer time to complete the functional mobility test measured with Timed Up And Go Test during both single task (MD = −0.8, 95% CI = −1.1, −0.4), cognitive dual task (MD = −1.5, 95% CI = −2.4, −0.5) and manual dual task (MD = −0.9, 95% CI = −1.3, −0.4) in comparison to the NT group. Also, the HT group had higher levels of fear of falling (MD = −7.6, 95% CI = −10.9, −4.2). ConclusionHypertensive individuals present slower processing speed, reduced static and dynamic balance, decreased functional mobility and higher fear of falling in comparison to normotensive individuals.

Movement smoothness during a functional mobility task in subjects with Parkinson\u2019s disease and freezing of gait \u2013 an analysis using inertial measurement units

BackgroundImpairments of functional mobility may affect locomotion and quality of life in subjects with Parkinson’s disease (PD). Movement smoothness measurements, such as the spectral arc length (SPARC), are novel approaches to quantify movement quality. Previous studies analyzed SPARC in simple walking conditions. However, SPARC outcomes during functional mobility tasks in subjects with PD and freezing of gait (FOG) were never investigated. This study aimed to analyze SPARC during the Timed Up and Go (TUG) test in individuals with PD and FOG.MethodsThirty-one participants with PD and FOG and six healthy controls were included. SPARC during TUG test was calculated for linear and angular accelerations using an inertial measurement unit system. SPARC data were correlated with clinical parameters: motor section of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr scale, Freezing of Gait Questionnaire, and TUG test.ResultsWe reported lower SPARC values (reduced smoothness) during the entire TUG test, turn and stand to sit in subjects with PD and FOG, compared to healthy controls. Unlike healthy controls, individuals with PD and FOG displayed a broad spectral range that encompassed several dominant frequencies. SPARC metrics also correlated with all the above-mentioned clinical parameters.ConclusionSPARC values provide valid and relevant clinical data about movement quality (e.g., smoothness) of subjects with PD and FOG during a functional mobility test.

Disentangling stability and flexibility degrees in Parkinson\u2019s disease using a computational postural control model

BackgroundImpaired postural control in Parkinson’s disease (PD) seriously compromises life quality. Although balance training improves mobility and postural stability, lack of quantitative studies on the neurophysiological mechanisms of balance training in PD impedes the development of patient-specific therapies. We evaluated the effects of a balance-training program using functional balance and mobility tests, posturography, and a postural control model.MethodsCenter-of-pressure (COP) data of 40 PD patients before and after a 12-session balance-training program, and 20 healthy control subjects were recorded in four conditions with two tasks on a rigid surface (R-tasks) and two on foam. A postural control model was fitted to describe the posturography data. The model comprises a neuromuscular controller, a time delay, and a gain scaling the internal disturbance torque.ResultsPatients’ axial rigidity before training resulted in slower COP velocity in R-tasks; which was reflected as lower internal torque gain. Furthermore, patients exhibited poor stability on foam, remarked by abnormal higher sway amplitude. Lower control parameters as well as higher time delay were responsible for patients’ abnormal high sway amplitude. Balance training improved all clinical scores on functional balance and mobility. Consistently, improved ‘flexibility’ appeared as enhanced sway velocity (increased internal torque gain). Balance training also helped patients to develop the ‘stability degree’ (increase control parameters), and to respond more quickly in unstable condition of stance on foam.ConclusionsProjection of the common posturography measures on a postural control model provided a quantitative framework for unraveling the neurophysiological factors and different recovery mechanisms in impaired postural control in PD.

Effect of 24-week strength training on unstable surfaces on mobility, balance, and concern about falling in older adults.

To evaluate the effects of 24weeks of strength training on stable (ST) and unstable surfaces (UST) on the functional mobility, balance, and concern about falling in healthy older adults, younger than 70. A single-center randomized clinical trial. Sixty-four older adults (58 females and 6 males; 68years) were randomized into control, ST, or UST groups. Both ST and UST intervention groups received a core muscle, upper, and lower limb moderate-intensity strength exercises using stable and unstable surfaces. The classes were performed three times per week over a 24-week period. The control group did not receive any type of active intervention. The primary outcome measures were the dynamic balance (Berg Balance Scale (BBS)) and functional mobility (timed up and go (TUG) test). The secondary outcomes included the sitting and rising test (SRT) and Falls Efficacy Scale-International (FESI) scores. There was a significant improvement in balance performance (BBS=+4 points) after 24weeks of both ST (+1.22; 95% CI, -0.19 to 2.63) and UST (+2.26; 95% CI, 0.83-3.70) compared with the control group. Additionally, compared with the control, only UST experienced functional mobility gains (TUG=-2.44; 95% CI, -4.41 to -0.48; SRT=+1.12; 95% CI, 0.08-2.17) and decreased concern about falling (FESI=-4.41; 95% CI, -9.30 to -0.27). Long-term ST with and without unstable devices was effective to improve dynamic balance in older adults. Furthermore, the effects of UST were extended to functional mobility gains and reduced concern about falling.

ASSOCIATION OF SIT-TO-STAND PATTERN WITH FUNCTIONAL MOBILITY IN STROKE PATIENTS AND ELDERLY POPULATION

OBJECTIVE: To compare sit-to-stand (STS) pattern and different functional mobility tests in stroke and elderly population. METHODS: This cross-sectional study was carried at Physical therapy departments of Pakistan Railway Hospital Rawalpindi, Rafsan Neuro Rehabilitation Centre Peshawar and DOW Medical Hospital Karachi, Pakistan. Study duration was 6 months from June 2016 to November 2016 with a sample size of 100. Non-Probability purposive sampling technique was adopted for sample collection. After informed consent, data including demographics details and results of applied tests were recorded and analyzed through SPSS version-21. Independent sample T-test was used to measure difference among means, while Odds Ratio was calculated to measure the association. RESULTS: The mean age of stroke patients was 54.5±9.83 years and mean age of elder population was 65.3±9.44 years. The association of STS pattern and different functional mobility between stroke patients and elderly population showed higher odd for each step of elderly population with an OR of 42.667, 2.667, 1.826, 1.556 and 1.690 for feet behind knees, pre-extension, extension, knee extension and hip extension respectively. The mean scores of Five times sit-to-stand test in stroke population group was 33.8±8.59 sec and 18.4±8.59 sec in elder population (p&lt;0.05). Mean scores of timed up and go test, Tinneti performance oriented mobility scale, Berg Balance scale &amp; Mini-Best test showed a significant difference among these tests (p&lt;0.05). CONCLUSION: Elderly population can perform STS pattern with much ease as compared to stroke patients while the different functional mobility tests have a significant difference among its values.

Cognition Predicts Mobility Change in Lower Extremity Amputees Between Discharge From Rehabilitation and 4-Month Follow-up: A Prospective Cohort Study

ObjectivesTo assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months’ follow-up. DesignProspective cohort study. SettingRehabilitation hospital. ParticipantsPeople with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program. InterventionsNot applicable. Main Outcome MeasuresGait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment and Trail Making Test quantified cognition as secondary outcomes. Repeated measures analysis of variance evaluated the effects of task (single task and dual task) and time (at discharge and 4 months’ follow-up) and their interaction on each outcome. A performance-resource operating characteristic graph evaluated gait and cognitive task prioritization. Multivariable linear regression evaluated the association between cognition and change in mobility over time. ResultsNo significant interactions between task and time were found (all P>.121) for L Test and gait velocity. The L Test single task (P=.001) and dual task (P=.004) improved over time. Gait velocity improved over time for both single task and dual task (P<.001). Dual-task performance was slower than single-task performances at each time point. The Trail Making Test B was independently associated with the change in dual-task L Test (P=.012), and single-task (P=.003) and dual-task (P=.006) gait velocity at follow-up. ConclusionsGait velocity and L Test single and dual task improved over time. No significant interactions indicated that cognitive task did not differentially affect performance over time. Lower executive function scores at discharge were independently associated with lower gains in all gait velocity and dual-task L Test outcomes at follow-up.

Impact of geriatric vulnerability on outcomes of older patients in allogeneic hematopoietic cell transplantation.

7017 Background: Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pre-transplant assessments by interdisciplinary clinical providers may help uncover additional geriatric deficits. Methods: Using an institutional database of 457 adults age 60 years and older (range 60-78.7) who underwent first allo-HCT for hematological malignancies from 2010 to 2017, we retrospectively examined the prevalence and the prognostic impact of pre-transplant geriatric deficits identified by interdisciplinary clinical providers including geriatric domains of functional activity, cognition, medication, nutrition, mobility, and routine laboratory tests. Results: With a median follow-up of 37 months for survivors, the 3-year probability of overall survival (OS) was 50% (95% CI 45-55). The 2-year cumulative incidence of non-relapse mortality (NRM) was 25% (95% CI 22-28). Among pre-transplant geriatric variables, we found that impairment in instrumental activities of daily living (IADL) was associated with increased NRM and inferior PFS and OS. In multivariate analyses, mismatched donor, age-adjusted HCT-CI &gt; 4 (aaHCTCI), and IADL impairment were associated with NRM, while high/very high disease risk index (DRI), IADL impairment, and positive CMV status were associated with OS. The combination of IADL impairment with either aaHCTCI or DRI readily stratifies NRM and OS, respectively. Conclusions: Our findings establish a simple assessment tool to risk stratify older patients prior to allo-HCT using IADL and aaHCTCI and DRI. These results may provide an entry point for prospective, interventional trials to reduce NRM and toxicities for older allo-HCT patients.

The Validity of a Mixed Reality-Based Automated Functional Mobility Assessment.

Functional mobility assessments (i.e., Timed Up and Go) are commonly used clinical tools for mobility and fall risk screening in older adults. In this work, we proposed a new Mixed Reality (MR)-based assessment that utilized a Microsoft HoloLensTM headset to automatically lead and track the performance of functional mobility tests, and subsequently evaluated its validity in comparison with reference inertial sensors. Twenty-two healthy adults (10 older and 12 young adults) participated in this study. An automated functional mobility assessment app was developed, based on the HoloLens platform. The mobility performance was recorded with the headset built-in sensor and reference inertial sensor (Opal, APDM) taped on the headset and lower back. The results indicate that the vertical kinematic measurements by HoloLens were in good agreement with the reference sensor (Normalized RMSE ~ 10%, except for cases where the inertial sensor drift correction was not viable). Additionally, the HoloLens-based test completion time was in perfect agreement with the clinical standard stopwatch measure. Overall, our preliminary investigation indicates that it is possible to use an MR headset to automatically guide users (without severe mobility deficit) to complete common mobility tests, and this approach has the potential to provide an objective and efficient sensor-based mobility assessment that does not require any direct research/clinical oversight.

The Timed Up & Go test in pregnant women with pelvic girdle pain compared to asymptomatic pregnant and non-pregnant women

BackgroundThe Timed Up and Go (TUG) test, a standardized functional mobility test, has been proposed as a physical performance-based measure in pregnant women with pelvic girdle pain (PGP). ObjectivesThis cross-sectional study aimed to investigate physical function by the use of TUG in pregnant women with PGP compared to asymptomatic pregnant and non-pregnant women, and to identify factors associated with increased TUG. MethodsIn total, 25 pregnant women with PGP, 24 asymptomatic pregnant and 25 asymptomatic non-pregnant women participated. One-way analysis of variance was used to explore difference in TUG between the groups and multiple linear regression analyses to explore associations between TUG and potential explanatory variables. ResultsThe time on TUG varied among pregnant women with PGP, and was significantly higher (mean (95% CI) 6.9 (6.5, 7.3) seconds) than for asymptomatic pregnant (5.8 (5.5, 6.0), p < 0.001) and non-pregnant (5.5 (5.4, 5.6), p < 0.001) women. In the total study sample, group, increased BMI and sick leave were significantly associated with increased TUG (p-values≤0.02). In pregnant women with PGP, pain intensity was the only significant clinical factor associated with increased TUG (p = 0.002). ConclusionPregnant women with PGP used longer time and showed larger variation in TUG than asymptomatic pregnant and non-pregnant women, this underpins that TUG targets activities relevant to PGP. Our results provide new knowledge about factors influencing TUG time. Importantly, multivariable analyses suggest that pain intensity should be considered when interpreting TUG time in pregnant women with PGP.

The effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss

Background: The aim of the study was to examine the effect of Tai Chi on balance and functional mobility in children with congenital sensorineural hearing loss.Methods: The study included 39 children, aged 10–14 years, with congenital sensorineural hearing loss. The participants were divided into three groups as the Tai Chi group, conventional exercise group, and control group. The Tai Chi group and the conventional exercise group received a 1-h exercise program twice a week for 10 weeks. The balance function of the children was assessed using the Pediatric Balance Scale, the balance subtest of Bruininks-Oseretsky Test 2-Short Form, and the Functional Reach Test. The Timed Up and Go Test and the Timed Up and Down Stairs Test were used to assess functional mobility. The Wilcoxon rank, Kruskal–Wallis. and Mann–Whitney U-tests were used for statistical analyses.Results: When the pre-training values of the groups were compared, with the exception of the Timed Up and Go test, there was no statistically significant difference with respect to demographic data, balance, and functional mobility parameters (p > 0.05). After training, the overall balance and functional mobility tests improved compared to pre-training values in both the Tai Chi and conventional exercise groups (p < 0.05). When the post-training values were compared between the groups, with the exception of the Functional Reach Test and the Timed Up and Down Stairs Test, the results of both exercise groups were superior to those of the control group (p < 0.05).Conclusions: The results of this study indicate that Tai Chi and conventional exercise programs have positive effects on balance and functional mobility in children with congenital sensorineural hearing loss. However, no superiority of Tai Chi or the conventional exercise programs was determined over the other. Both Tai Chi and conventional exercise programs could be used to improve balance and functional mobility in children with congenital sensorineural hearing loss.Implications for rehabilitationTai Chi and conventional exercises are effective on balance in children with congenital sensorineural hearing loss.Tai Chi and conventional exercises are effective on functional mobility in children with congenital sensorineural hearing loss.Tai Chi may be added to the rehabilitation program for children with congenital sensorineural hearing loss.

A new two square agility test for workplace health-reliability, validity and minimal detectable change.

[Purpose] One promising strategy for workplace wellness programs is to emphasize functional mobility screening and coaching to promote suitable physical activity and reduce musculoskeletal risks. This study examined intra-rater reliability, test-retest reliability, concurrent validity, known-groups validity and minimal detectable change for a new Two Square Agility Test (TSAT) designed as a functional mobility measure to promote workplace health. [Participants and Methods] Two hundred forty eight non-disabled participants (ages 18–69) were measured for body size, physical activity and 3 trials of the Two Square Agility Test. 78 participants were tested a week later on the Two Square Agility Test and other functional mobility tests. [Results] Intra-rater reliability was excellent (ICC=0.94) and test-retest reliability was good (ICC=0.87). Two Square Agility Test correlated moderately with Timed Up and Go (r=0.63), Five Times Sit to Stand (r=0.62), and Maximum Step Length (r= −0.54), supporting its concurrent validity. Performances for Two Square Agility Test were better in males, younger age, higher physical activity, and non-obese groups. The minimal detectable change at a 95% confidence level (MDC95) was 1.37 s. [Conclusion] Preliminary results supported reliability and validity of Two Square Agility Test as a functional mobility measure to promote workplace health.

Inhospital Exercise Training in Children With Cancer: Does It Work for All?

Purpose: Physical exercise training might counteract the weakening effects of both pediatric cancer and anti-cancer treatment. We aimed to analyze the prevalence of “responders” and “non-responders” to inhospital exercise training in children with cancer and to identify the factors that could influence responsiveness, which might help personalize exercise interventions for this patient population.Methods: We performed an ancillary analysis of the randomized controlled trial “Physical activity in Pediatric Cancer” (NCT01645436), in which 49 children with solid tumors were allocated to an inhospital exercise intervention or control group. The present study focused on the children in the former group (n = 24, 10 ± 4 years), who performed 3 weekly training sessions (aerobic + strength exercises). The intervention lasted 19 ± 8 weeks (i.e., from the start to the end of neoadjuvant chemotherapy treatment). A responder-vs-non-responder analysis was performed for physical capacity-related endpoints (five-repetition maximum strength, functional mobility tests, and cardiorespiratory fitness [CRF]). Only those participants showing improvements in a given test of a magnitude greater than both the random error and the threshold for clinically meaningful changes were considered responders.Results: Most participants improved their performance in the strength tests, with 80, 88, and 93% of total showing a positive response for seated bench press, lateral row, and leg press, respectively (p < 0.001). No significant improvements were observed for the functional mobility tests or CRF (p > 0.05, rate of responsiveness ≤ 50%). No differences between responders and non-responders were observed for sex, age, type of cancer, or treatment (i.e., including or not anthracyclines/radiotherapy). However, significant differences (p < 0.05) were observed between responders and non-responders for baseline performance in all the tests, and a significant (p < 0.05) inverse relationship was found between baseline performance and relative improvement for most endpoints.Conclusions: Although most children improved their muscle strength after the exercise intervention, a considerable individual variability was observed for the training responsiveness of functional mobility and CRF. A lower baseline performance was associated with a higher responsiveness for all the study endpoints, with the fittest children at the start of treatment showing the lowest responses. Efforts to individualize exercise prescription are needed to maximize responsiveness in pediatric cancer patients.

Efficacy of Stochastic Vestibular Stimulation to Improve Locomotor Performance During Adaptation to Visuomotor and Somatosensory Distortion.

Astronauts exposed to microgravity face sensorimotor challenges affecting balance control when readapting to Earth's gravity upon return from spaceflight. Small amounts of electrical noise applied to the vestibular system have been shown to improve balance control during standing and walking under discordant sensory conditions in healthy subjects, likely by enhancing information transfer through the phenomenon of stochastic resonance. The purpose of this study was to test the hypothesis that imperceptible levels of stochastic vestibular stimulation (SVS) could improve short-term adaptation to a locomotor task in a novel sensory discordant environment. Healthy subjects (14 males, 10 females, age = 28.7 ± 5.3 years, height = 167.2 ± 9.6 cm, weight = 71.0 ± 12.8 kg) were tested for perceptual thresholds to sinusoidal currents applied across the mastoids. Subjects were then randomly and blindly assigned to an SVS group receiving a 0–30 Hz Gaussian white noise electrical stimulus at 50% of their perceptual threshold (stim) or a control group receiving zero stimulation during Functional Mobility Tests (FMTs), nine trials of which were done under conditions of visual discordance (wearing up/down vision reversing goggles). Time to complete the course (TCC) was used to test the effect of SVS between the two groups across the trials. Adaptation rates from the normalized TCCs were also compared utilizing exponent values of power fit trendline equations. A one-tailed independent-samples t-test indicated these adaptation rates were significantly faster in the stim group (n = 12) than the control (n = 12) group [t(16.18) = 2.00, p = 0.031]. When a secondary analysis was performed comparing “responders” (subjects who showed faster adaptation rates) of the stim (n = 7) group to the control group (n = 12), independent-samples t-tests revealed significantly faster trial times for the last five trials with goggles in the stim group “responders” than the controls. The data suggests that SVS may be capable of improving short-term adaptation to a locomotion task done under sensory discordance in a group of responsive subjects.

Five times sit-to-stand test in subjects with total knee replacement: Reliability and relationship with functional mobility tests

The objective was to determine the inter-observer and test/retest reliability of the “Five-repetition sit-to-stand” (5STS) test in patients with total knee replacement (TKR). To explore correlation between 5STS and two mobility tests. A reliability study was conducted among 24 (mean age 72.13, S.D. 10.67; 50% were women) outpatients with TKR. They were recruited from a traumatology unit of a public hospital via convenience sampling. A physiotherapist and trauma physician assessed each patient at the same time. The same physiotherapist realized a 5STS second measurement 45–60min after the first one. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots. Pearson coefficient was calculated to assess the correlation between 5STS, time up to go test (TUG) and four meters gait speed (4MGS). ICC for inter-observer and test-retest reliability of the 5STS were 0.998 (95% confidence interval [CI], 0.995–0.999) and 0.982 (95% CI, 0.959–0.992). Bland-Altman plot inter-observer showed limits between −0.82 and 1.06 with a mean of 0.11 and no heteroscedasticity within the data. Bland-Altman plot for test-retest showed the limits between 1.76 and 4.16, a mean of 1.20 and heteroscedasticity within the data. Pearson correlation coefficient revealed significant correlation between 5STS and TUG (r=0.7, p<0.001) and 4MGS (r=−0.583, p=0.003). This study demonstrates excellent inter-observer and test-retest reliability when it is used in people with TKR, and also significant correlation with other functional mobility tests. These findings support the use of 5STS as outcome measure in TKR population.

MoCA Domain Score Analysis and Relation to Mobility Outcomes in Dysvascular Lower Extremity Amputees

ObjectiveTo investigate the association between cognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), and functional outcomes upon discharge from prosthetic rehabilitation. DesignRetrospective chart audit. SettingRehabilitation hospital. ParticipantsConsecutive admissions (N=130; mean age, 66.21±11.19y) with lower extremity amputation of dysvascular etiology. InterventionsNot applicable. Main Outcome MeasuresCognitive status was assessed using the MoCA. The L Test of Functional Mobility (L Test) and the 2-minute walk test were used to estimate functional mobility and walking endurance. ResultsIn multivariable linear regression analysis, those who scored 2 on the visuospatial/executive functioning (out of 5) and language (out of 3) domains had statistically shorter distances walked on the 2-minute walk test than did those who scored the highest on these MoCA domains. These values were not clinically relevant. Time to complete the L Test for those who scored the lowest on the MoCA domains of visuospatial/executive functioning and delayed recall and 3 on the attention domain (out of 6) was significantly longer than that for those who scored the highest. ConclusionsIndividuals with lower extremity amputation have an increased risk of cognitive impairment related to amputation etiology. Lower levels of functioning on MoCA domains of visuospatial/executive functioning, delayed recall, and attention were shown to negatively relate to the rehabilitation outcome of functional mobility, as measured by the L Test.

'Timed up and go' and brain atrophy: a preliminary MRI study to assess functional mobility performance in multiple sclerosis.

Motor and cognitive disabilities are related to brain atrophy in multiple sclerosis (MS). 'Timed up and go' (TUG) has been recently tested in MS as functional mobility test, as it is able to evaluate ambulation/coordination-related tasks, as well as cognitive function related to mobility. The objective of this study is to evaluate the relationship between brain volumes and TUG performances. Inclusion criteria were a diagnosis of MS and the ability to walk at least 20m. TUG was performed using a wearable inertial sensor. Times and velocities of TUG sub-phases were calculated by processing trunk acceleration data. Patients underwent to a brain MRI, and volumes of whole brain, white matter (WM), grey matter (GM), and cortical GM (C) were estimated with SIENAX. Sixty patients were enrolled. Mean age was 41.5±11.6years and mean EDSS 2.3±1.2. Total TUG duration was correlated to lower WM (ρ=0.358, p=0.005) and GM (ρ=0.309, p=0.017) volumes. A stronger association with lower GM volume was observed for intermediate (ρ=0.427, p=0.001) and final turning (ρ=0.390, p=0.002). TUG is a useful tool in a clinical setting as it can not only evaluate patients' disability in terms of impaired functional mobility, but also estimate pathological features, such as grey atrophy.

Relation between functional mobility and dynapenia in institutionalized frail elderly.

ABSTRACTObjective To investigate the relation between functional mobility and dynapenia in institutionalized frail elderly.Methods A descriptive, correlational study involving 26 institutionalized elderly men and women, mean age 82.3±6 years. The instruments employed were the Mini Mental State Examination, the Geriatric Depression Scale, the International Physical Activity Questionnaire, the Timed Up and Go test, a handgrip dynamometer and a portable dynamometer for large muscle groups (shoulder, elbow and hip flexors, knee extensors and ankle dorsiflexors).Results Significant negative correlation between functional mobility levels assessed by the Timed Up and Go test and dynapenia was observed in all muscle groups evaluated, particularly in knee extensors (r -0.65).Conclusion A significant negative correlation between muscle strength, particularly knee extensor strength, and functional mobility was found in institutionalized elderly. Data presented indicate that the higher the muscle strength, the shorter the execution time, and this could demonstrate better performance in this functional mobility test.