Gait In Older Adults Research Articles

Self-reported physical activity and gait in older adults without dementia: A longitudinal study.

Physical activity (PA) is associated with higher gait speed. We aimed to examine the associations between PA and change in spatial and temporal gait measures as well as fall risk in community-dwelling individuals free of dementia. Longitudinal study among 4173 individuals aged ≥50 years (mean age 71 years; 2078 males; median follow-up 4 years) enrolled in the Mayo Clinic Study of Aging. Self-reported late-life PA was used to calculate overall PA and moderate-vigorous PA (MVPA) scores. Gait was assessed using GAITRite® and Zeno™ systems. Incident falls information was based on diagnostic codes retrieved from medical records. We ran linear mixed effects models to examine associations between z-scored PA variables and longitudinal gait parameters, adjusted for age, sex, education, body mass index (BMI), medical comorbidities, and including interactions between PA and time since baseline. In secondary analyses, we calculated Cox Proportional hazard models with age as time scale predicting incident falls by PA, adjusting for sex, education, BMI, medical comorbidities, and falls history. At baseline, higher PA was associated with higher velocity (overall PA: estimate 2.9935; MVPA: 2.2961; p < 0.001), higher cadence (overall PA: 1.0665; MVPA: 0.9073; p < 0.001), greater stride length (overall PA: 2.0805; MVPA: 1.4726; p < 0.001), shorter double support time (overall PA: -0.0257; MVPA: -0.0205; p < 0.001), and lower stance time variability (overall PA: -0.0204, p < 0.001; MVPA: -0.0152; p = 0.006). Overall PA was longitudinally associated with less decline in cadence, and MVPA with less increase in intraindividual stance time variability. Overall PA (Hazard ratio 0.892, 95% confidence interval 0.828-0.961, p = 0.003) and MVPA (HR 0.901; 95% CI 0.835-0.973, p = 0.008) were associated with a decreased risk of incident falls. Late-life PA was associated with favorable gait outcomes and decreased risk of incident falls. Thus, late-life PA may help to maintain gait performance and decrease fall risk in old age.

Gait Training of Healthy Older Adults in a Sitting Position using the Wearable Robot to Assist Arm-swing Rhythm, WALK-MATE ROBOT

Although various walking training robots have been developed and their effectiveness has been recognised, operating these robots requires the implementation of safety measures to avoid the risk of falling. This study aimed to confirm whether arm swing rhythm training in the sitting position using an arm swing rhythm-assisted robot, WMR, improved subsequent walking. Healthy older adults (N = 20) performed arm swing rhythm training in a sitting position for 1 min ×\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ imes$$\\end{document} three times while being presented with tactile stimulation synchronised with the arm swing rhythm from a robot. An increase in walking performance was observed with increases in stride length and speed. In addition, the stabilisation of the gait pattern was observed, with a decrease in the proportion of the double-foot support phase and an increase in the proportion of the swing phase in one gait cycle. These results suggest that arm swing rhythm training in a sitting position using WMR improves gait in older adults. This will lead to the realisation of safe and low-cost robot-based walking training in sitting position.

Self-supervised learning of wrist-worn daily living accelerometer data improves the automated detection of gait in older adults

Progressive gait impairment is common among aging adults. Remote phenotyping of gait during daily living has the potential to quantify gait alterations and evaluate the effects of interventions that may prevent disability in the aging population. Here, we developed ElderNet, a self-supervised learning model for gait detection from wrist-worn accelerometer data. Validation involved two diverse cohorts, including over 1000 participants without gait labels, as well as 83 participants with labeled data: older adults with Parkinson's disease, proximal femoral fracture, chronic obstructive pulmonary disease, congestive heart failure, and healthy adults. ElderNet presented high accuracy (96.43 ± 2.27), specificity (98.87 ± 2.15), recall (82.32 ± 11.37), precision (86.69 ± 17.61), and F1 score (82.92 ± 13.39). The suggested method yielded superior performance compared to two state-of-the-art gait detection algorithms, with improved accuracy and F1 score (p < 0.05). In an initial evaluation of construct validity, ElderNet identified differences in estimated daily walking durations across cohorts with different clinical characteristics, such as mobility disability (p < 0.001) and parkinsonism (p < 0.001). The proposed self-supervised method has the potential to serve as a valuable tool for remote phenotyping of gait function during daily living in aging adults, even among those with gait impairments.

Vestibular perceptual learning improves self-motion perception, posture, and gait in older adults

Vestibular motion perception declines with age, increasing the risk of falling substantially. We performed a two-week perceptual learning intervention using a self-motion direction discrimination task (2800 training trials per person) on a 6 degrees of freedom motion platform in healthy older adults (n = 40, aged 70–88 yr). Linear inter-aural and angular roll tilt vestibular thresholds improved with training (95% credible interval for pre/post difference), suggesting altered sensitivity post-training. Moreover, improved perceptual abilities transfer to actual posture (reduced sway) and gait parameters. Passive self-motion discrimination training provides a new and promising way to counteract age-related sensory decline. It can reduce the risk of falling, and thereby maintain individual autonomy and quality of life.

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol

BackgroundFalling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.MethodsFor this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant’s progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA’s are used to analyze the trial outcomes.DiscussionThe results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.Trial registrationThe trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).

Gait Assessment Using Smartphone Applications in Older Adults: A Scoping Review.

Spatiotemporal parameters such as gait velocity and stride length are simple indicators of functional status and can be used to predict major adverse outcomes in older adults. A smartphone can be used for gait analysis by providing spatiotemporal parameters useful for improving the diagnosis and rehabilitation processes in frail people. The aim of this study was to review articles published in the last 20 years (from 2004 to 2024) concerning the application of smartphones to assess the spatiotemporal parameters of gait in older adults. This systematic review was performed in line with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), and original articles were identified by searching seven electronic databases: SciVerse (ScienceDirect), Excerpta Medica Database (EMBASE), Medline, Scopus, PubMed, Web of Science and the Cochrane Library. Studies were rigorously screened using the inclusion criteria of smartphones and mobile apps, older adults and spatiotemporal gait parameters, and results were narratively synthesized. Seventy-three articles were initially identified while searching the scientific literature regarding this topic. Eleven articles were selected and included in this review. Analysis of these studies covered information about gait assessment using mobile apps recorded in 723 older adults and 164 control cases. Analysis of data related to the application of smartphones to assess spatiotemporal parameters of gait in older adults showed moderate-to-excellent test-retest reliability and validity (ICCs around 0.9) of gait speed, the most common parameter reported. Additionally, gait speeds recorded with mobile apps showed excellent agreement when compared to gold standard systems. Smartphones and mobile apps are useful, non-invasive, low-cost and objective tools that are being extensively used to perform gait analysis in older adults. Smartphones and mobile apps can reliably identify spatiotemporal parameters related to adverse outcomes, such as a slow gait speed, as predictors and outcomes in clinical practice and research involving older adults.

Rhythmic Movement Training Improves Spatial and Temporal Modulation of Gait in Older Adults with and Without Mild Cognitive Impairment

Rhythmic Movement Training Improves Spatial and Temporal Modulation of Gait in Older Adults with and Without Mild Cognitive Impairment

Gait abnormalities in older adults with transthyretin cardiac amyloidosis

Background Transthyretin cardiac amyloidosis (ATTR cardiac amyloidosis) is caused by variant (ATTRv) or wild type (ATTRwt) transthyretin. While gait abnormalities have been studied in younger patients with ATTRv amyloidosis, research on gait in older adults with ATTR cardiac amyloidosis is lacking. Given ATTR cardiac amyloidosis’ association with neuropathy and orthopedic manifestations, we explore the gait in this population. Methods Twenty-eight older male ATTR cardiac amyloidosis patients and 11 healthy older male controls walked overground with and without a dual cognitive task. Gait parameters: stride width, length, velocity and stance time percentage were measured using an instrumented mat. ATTR amyloidosis patients were further categorized based on clinical and functional assessments. Results We found significant gait differences between ATTR cardiac amyloidosis patients and healthy controls; patients had more variable, slower, narrower and shorter strides, with their feet spending more time in contact with the ground as opposed to in swing. However, the observed gait differences did not correlate with clinical and functional measures of ATTR cardiac amyloidosis severity. Conclusions Our results suggest that gait analysis could be a complementary tool for characterizing ATTR cardiac amyloidosis patients and may inform clinical care as it relates to falls, management of anticoagulation, and functional independence.

Associations of Neurological Biomarkers in Serum With Gait Measures: The Cardiovascular Health Study.

Gait impairment leads to increased mobility decline and may have neurological contributions. This study explores how neurological biomarkers are related to gait in older adults. We studied participants in the Cardiovascular Health Study, a population-based cohort of older Americans, who underwent a serum biomarker assessment from samples collected in 1996-1997 for neurofilament light chain (NfL), glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and total tau (n = 1959, mean age = 78.0 years, 60.8% female). In a subsample (n = 380), cross-sectional associations with quantitative gait measures were explored. This subsample was assessed on a mat for gait speed, step length, double support time, step time, step length variability, and step time variability. Gait speed was also measured over a 15-ft walkway annually from 1996-1997 to 1998-1999 for longitudinal analyses. Linear regression models assessed cross-sectional associations of biomarkers with gait measures, whereas mixed effects models assessed longitudinal gait speed change from baseline to 1998-1999. Neurofilament light chain was significantly associated with annual gait speed decline (standardized β = -0.64 m/s, 95% CI: [-1.23, -0.06]) after adjustment for demographic and health factors. Among gait mat-assessed phenotypes, NfL was also cross-sectionally associated with gait speed (β = 0.001 m/s [0.0003, 0.002]) but not with other gait measures. None of the remaining biomarkers were significantly related to gait in either longitudinal or cross-sectional analyses. Higher NfL levels were related to greater annual gait speed decline. Gait speed decline may be related to axonal degeneration. The clinical utility of NfL should be explored.

Changes in gait performances during walking with head movements in older adults with chronic neck pain.

Chronic neck pain (CNP) can lead to altered gait which is worse when combined with head movement. Gait parameters for indicating speed and symmetry have not been thoroughly investigated in older adults with CNP. This study aimed to compare gait performance in term of speed and symmetry in older adults with and without CNP during walking with head movement. Fifty young older adults, consisting of 36 healthy controls without neck pain (OLDs) and 14 older adults with CNP, participated in the study. Participants completed the Neck Disability Index and Activities-specific Balance Confidence Scale. The 10-Meter Walk Test (10MWT) was used to assess gait performance. Participants were instructed to walk at preferred speed under three different head movement patterns: no head movement (NM), horizontal head movement (HM), and vertical head movement (VM). The Inertial Measurement Unit was used to capture gait performance, and its software was used to analyze gait variables; gait speed, Locomotor Rehabilitation Index (LRI), gait asymmetry index, Phase Coordination Index (PCI). The CNP group reported moderate neck pain with mild disability in activities of daily living, and less balance confidence than the OLD group (p < 0.05). The CNP group showed significantly slower gait speed and lower LRI during walking with both the HM and VM (p < 0.05), which corresponded to lower stride length and cadence. The gait asymmetry index in the CNP group was significantly higher than the OLD group during walking with VM (p < 0.05), whereas the PCI was significantly higher than the OLD group during walking with both HM and VM (p < 0.05). Chronic neck pain affects both speed and symmetry when walking with head movement. Gait parameters in this study could be implemented to identify changes in speed and symmetry of gait in older adults with CNP who have mild disability and high physical functioning.

Comparative Analysis of the Impact of Virtual Reality Training and Conventional Physiotherapy on Balance and Gait in Older Adults with Parkinson's Disease

Background: Parkinson's disease (PD) is a neurodegenerative condition predominantly manifesting in motor impairments, notably in balance and gait. Recent advancements have highlighted Virtual Reality (VR) training as a potent alternative or adjunct to conventional physiotherapy (CPT) for the rehabilitation of these motor disturbances in PD patients. Objective: This study aimed to evaluate and compare the efficacy of VR training and CPT in ameliorating balance and gait issues in older adults diagnosed with PD. Methods: In this randomized controlled trial, 56 patients with PD were assigned either to VR training or to CPT. The VR training entailed immersive and interactive exercises specifically designed for balance and gait enhancement using VR technology. Conversely, CPT consisted of traditional exercises targeting similar motor skills. Standardized assessments for balance and gait were administered both prior to and following the intervention to all participants. Results: The intervention demonstrated that VR training led to more pronounced improvements in balance and gait parameters as compared to CPT. Notably, the Timed Up and Go test (TUG) exhibited an improvement of 4.2 seconds in the VR group versus 3.6 seconds in the CPT group, a difference statistically significant (p&lt;0.05). Similarly, the Berg Balance Scale (BBS) scores increased by 12.4 points in the VR group and 10.8 points in the CPT group, again showing a significant advantage for VR (p&lt;0.05). The Mini-BESTest scores improved by 2.6 points in the VR group compared to 2.1 points in the CPT group, reinforcing the superiority of VR (p&lt;0.05). Conclusion: The study conclusively finds that VR training surpasses CPT in enhancing balance and gait in older adults with PD. Offering an immersive, engaging, and tailored therapeutic environment, VR training emerges as a potent modality for augmenting rehabilitation outcomes in this demographic.

Effectiveness of virtual reality-based balance and gait in older adults with fear of movement: A systematic review and meta-analysis.

To summarize the current evidence from randomized controlled trials (RCTs) regarding the effectiveness of Virtual Reality (VR) training and functional mobility in older adults with fear of movement. TYPE: Systematic review and meta-analysis of randomized clinical trials. An electronic search was performed using PubMed, Embase, Medline, SPORTDiscus, Scopus, and CINAHL. A data search from January 2015 to December 2022 and a manual electronic literature search were conducted to identify published RCTs. The effectiveness of VR-based balance training for balance and gait was evaluated in older adults with a fear of movement, which was measured by the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES). Three reviewers independently performed the study selection, and the quality assessment of the included studies was performed using the Physiotherapy Evidence Database (PEDro) scale. The reporting was based on the new Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. The search product produced 345 results, from which 23 full text articles were studied. Seven RCTs of good methodological quality, including 265 participants, were included in the review. Overall, the studies reported that VR had a significant improvement on the TUG (Cohen's d=-0.91 [-1.38; -0.44], p=0.001), while the FES was not significantly different (Cohen's d=-0.54 [-1.80; 0.71] p=0.40). The average for PEDro scores (6.14) was good, and the risk of bias revealed that more than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. VR-based training is effective on balance or gait training based on the TUG; however, there were mixed results to improve FES scores following VR intervention. These inconsistent results might be limited due to variations in the studies, including heterogeneous training paradigms, sensitive outcome measures, small sample sizes, and short intervention durations, which limit the validity of our findings. Future investigations should compare different VR protocols to help establish better guidelines for clinicians.

Can elderly individuals perform partial weight bearing on their lower limbs? A prospective cohort study using ambulatory real-time biofeedback

BackgroundPartial weight bearing in an orthosis and with forearm crutches is a widespread and well-accepted therapeutic principle after an injury of the lower extremity during early rehabilitation. Complying may be challenging to do under these circumstances, especially for elderly people. This study compares the spatiotemporal parameters and peak loads performed by a group of older participants before and after activating real-time biofeedback (BF) to determine whether they benefit from a biofeedback.MethodsTwenty-four healthy subjects between 61 and 80 years learned how to walk using forearm crutches in a lower leg orthosis while performing a weight of 20 kg using a bathroom scale with the aim of loading in a zone between 15 and 30 kg. After that, they completed a course that was on level ground (50 m) and another course on stairs (11 steps). They did a walk without BF first, and then with BF. Each step was given a maximum load, which was determined and statistically checked. In addition, spatiotemporal parameters were collected.ResultsThe classical teaching method with a bathroom scale was ineffective. Only 32.3% of the loads could be adequately carried by a person on level ground in the 15–30 kg target zone. On the stairs, it was 48.2% and 34.3%, respectively. Thus, on level ground, 52.7% of loads exceeded 30 kg. Downstairs it was 46.4%, and upstairs it was 41.6%. Subjects clearly benefit from activated biofeedback. Biofeedback significantly reduced missteps > 30 kg in every course. The loads decreased significantly to 25.0% on level ground, to 23.0% upstairs, and to 24.4% downstairs. At the same time, speed and stride length decreased per course while total time increased.ConclusionPartial weight bearing is more complex and difficult for the elderly. These study results may help better understand 3-point gait in older adults in an outpatient setting. When partial weight bearing is recommended, special follow-up attention must be given for this group. Age-based therapy strategies can be developed and monitored with the assistance of ambulatory biofeedback devices.Trial registration Retrospectively registered, https://www.drks.de/DRKS00031136.

Plasma metabolomic signatures of dual decline in memory and gait in older adults

Older adults experiencing dual decline in memory and gait have greater dementia risk than those with memory or gait decline only, but mechanisms are unknown. Dual decline may indicate specific pathophysiological pathways to dementia which can be reflected by circulating metabolites. We compared longitudinal changes in plasma metabolite biomarkers of older adults with and without dual decline in the Baltimore Longitudinal Study of Aging (BLSA). Participants were grouped into 4 phenotypes based on annual rates of decline in verbal memory and gait speed: no decline in memory or gait, memory decline only, gait decline only, and dual decline. Repeated measures of plasma metabolomics were measured by biocrates p500 kit during the same time of memory and gait assessments. In BLSA, 18 metabolites differed across groups (q-value < 0.05). Metabolites differentially abundant were enriched for lysophosphatidylcholines (lysoPC C18:0,C16:0,C17:0,C18:1,C18:2), ceramides (d18:2/24:0,d16:1/24:0,d16:1/23:0), and amino acids (glycine) classes. Compared to no decline, the dual decline group showed greater declines in lysoPC C18:0, homoarginine synthesis, and the metabolite module containing mostly triglycerides, and showed a greater increase in indoleamine 2,3-dioxygenase (IDO) activity. Metabolites distinguishing dual decline and no decline groups were implicated in metabolic pathways of the aminoacyl-tRNA biosynthesis, valine, leucine and isoleucine biosynthesis, histidine metabolism, and sphingolipid metabolism. Older adults with dual decline exhibit the most extensive alterations in metabolic profiling of lysoPCs, ceramides, IDO activity, and homoarginine synthesis. Alterations in these metabolites may indicate mitochondrial dysfunction, compromised immunity, and elevated burden of cardiovascular and kidney pathology.

Fall history in older adults impacts acceleration profiles after a near collision with a moving pedestrian hazard.

Environmental hazards (e.g., pedestrian traffic) cause falls and testing environment impacts gait in older adults. However, most fall risk evaluations do not assess real-world moving hazard avoidance. This study examined the effect of fall history in older adults on acceleration profiles before, during, and after a near collision with a moving hazard, in laboratory and real-world settings. Older adults with (n = 14) and without a fall history (n = 15) performed a collision avoidance walking task with a sudden moving hazard in real-world and laboratory settings. Gait acceleration and video data of participants' first-person views were recorded. Four mixed effects multilevel models analyzed the magnitude and variability of mean and peak anteroposterior and mediolateral acceleration while walking before, during, and after the moving hazard in both environments. In the real-world environment, older adults without a fall history increased their mean anteroposterior acceleration after the moving hazard (p = 0.046), but those with a fall history did not (p > 0.05). Older adults without a fall history exhibited more intersubject variability than those with a fall history in mean (p < 0.001) and peak anteroposterior (p = 0.015) acceleration across environments and epochs. Older adults without a fall history exhibited a slower peak mediolateral reaction during the moving hazard (p = 0.014) than those with a fall history. These results suggest that compared to older adults with a fall history, older adults without a fall history are more adaptable and able to respond last-minute to unexpected hazards. Older adults with a fall history exhibited more homogenous responses.

Does GERAS DANCE improve gait in older adults?

BackgroundOlder adults at increased fall risk walk slower with less rhythm and coordination. This study explored the effect of dance on spatiotemporal gait parameters in older adults. MethodsParticipants (N = 23) in a single-arm trial were enrolled in the 12-week GERAS DANCE program (total dose of 36 h). Gait was assessed at baseline and 12-weeks under two experimental conditions: normal walking or walking while performing serial subtraction by 3. Outcome measures were gait speed, stride length time, double support time, stride length and stride width. Separate two-way repeated measures ANOVAs were used to determine estimates of the magnitude of effect of GERAS DANCE on spatiotemporal gait parameters and a paired t-test was used to examine differences in cognitive performance before and after dance. ResultsOlder adults (72.50 ± 7.13 years; 75% female) had excellent attendance (82.73% adherence). GERAS DANCE resulted in increased gait speed (p<0.001), reduced stride length time (p = 0.034), reduced double support time (p = 0.001), increased stride length (p = 0.003) and marginally reduced stride width (p = 0.064), regardless of the experimental condition. Improvements in walking performance were observed with sustained performance on the serial subtraction task before and after GERAS DANCE. ConclusionsGERAS DANCE may be a safe and feasible program to help improve spatiotemporal gait parameters in older adults with early memory or mobility impairments. Next steps include testing the efficacy for fall prevention to help inform clinical practice guidelines and virtual intervention implementation.

Depth-Imaging for Gait Analysis on a Treadmill in Older Adults at Risk of Falling.

Accidental falls are a major health issue in older people. One significant and potentially modifiable risk factor is reduced gait stability. Clinicians do not have sophisticated kinematic options to measure this risk factor with simple and affordable systems. Depth-imaging with AI-pose estimation can be used for gait analysis in young healthy adults. However, is it applicable for measuring gait in older adults at a risk of falling? In this methodological comparison 59 older adults with and without a history of falls walked on a treadmill while their gait pattern was recorded with multiple inertial measurement units and with an Azure Kinect depth-camera. Spatiotemporal gait parameters of both systems were compared for convergent validity and with a Bland-Altman plot. Correlation between systems for stride length (r=.992, [Formula: see text]) and stride time (r=0.914, [Formula: see text]) was high. Bland-Altman plots revealed a moderate agreement in stride length (-0.74 ± 3.68 cm; [-7.96 cm to 6.47 cm]) and stride time (-3.7±54 ms; [-109 ms to 102 ms]). Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect cameras. Affordable and small depth-cameras agree with IMUs for gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact. Clinical Translation Statement- Gait parameters in older adults with and without a history of falls can be measured with inertial measurement units and Azure Kinect. Affordable and small depth-cameras, developed for various purposes in research and industry, agree with IMUs in clinical gait analysis in older adults with and without an increased risk of falling. However, tolerable accuracy to assess function or monitor changes in gait is limited to the average over multiple steps of spatiotemporal parameters derived from the initial foot contact.

Inadvertent obstacle contacts when older adults step over obstacles: Effect of sex, self-reported fatigue, gait parameters, and prescription medications

Background: Tripping is a common cause of falls, but the factors that are associated with trip risk are understudied.&#x0D; Aim: To quantify inadvertent trips with a stationary, visible obstacle in older adults, and to determine how inadvertent trips are related to fatigue, sex, gait measures, and prescription medications.&#x0D; Methods: Forty-one subjects walked on a 6 m walkway and stepped over a visible, stationary obstacle (height: 25% of leg length) 100 times; inadvertent trips with the obstacle were documented. We also collected gait measures on a clear walkway, self-reported fatigue every 25 obstacle crossing trials, and number of prescription medications. Participants were categorized as: 0 contacts or ≥1 contact.&#x0D; Results: The obstacle was contacted by 15 participants (37%) in 29 trials (0.7% of all trials); 52% of contacts were with the lead limb. Self-reported fatigue increased during the obstacle crossing protocol (p&lt;0.001). Participants in the ≥1 contact group had slower gait speed, shorter stride length, and higher gait cycle time variability (p≤0.041). They also reported higher maximum fatigue (p=0.022) and a higher number of prescription medications (p=0.019). Males and females were not different in contact frequency (p=0.93).&#x0D; Interpretation: Inadvertent trips were not uncommon in older adults, even with a visible, stationary obstacle. Lead limb contacts indicate that older adults will have more difficulty recovering their balance after a trip. The strong association between fatigue (induced by walking) and impaired gait is highly relevant when quantifying gait in older adults, and also when developing fall prevention programs.

Six month lower-leg mechanical tactile sensory stimulation alters functional network connectivity associated with improved gait in older adults with peripheral neuropathy - A pilot study.

Foot sole somatosensory impairment associated with peripheral neuropathy (PN) is prevalent and a strong independent risk factor for gait disturbance and falls in older adults. Walkasins, a lower-limb sensory prosthesis, has been shown to improve gait and mobility in people with PN by providing afferent input related to foot sole pressure distributions via lower-leg mechanical tactile stimulation. Given that gait and mobility are regulated by sensorimotor and cognitive brain networks, it is plausible improvements in gait and mobility from wearing the Walkasins may be associated with elicited neuroplastic changes in the brain. As such, this study aimed to examine changes in brain network connectivity after 26 weeks of daily use of the prosthesis among individuals with diagnosed PN and balance problems. In this exploratory investigation, assessments of participant characteristics, Functional Gait Assessment (FGA), and resting-state functional magnetic resonance imaging were completed at study baseline and 26 weeks follow-up. We found that among those who have completed the study (N = 8; mean age 73.7 years) we observed a five-point improvement in FGA performance as well as significant changes in network connectivity over the 26 weeks that were correlated with improved FGA performance. Specifically, greater improvement in FGA score over 26 weeks was associated with increased connectivity within the Default Mode Network (DMN; p < 0.01), the Somatosensory Network (SMN; p < 0.01), and the Frontoparietal Network (FPN; p < 0.01). FGA improvement was also correlated with increased connectivity between the DMN and the FPN (p < 0.01), and decreased connectivity between the SMN and both the FPN (p < 0.01) and cerebellum (p < 0.01). These findings suggest that 26 weeks of daily use of the Walkasins device may provide beneficial neural modulatory changes in brain network connectivity via the sensory replacement stimulation that are relevant to gait improvements among older adults with PN.

The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study

BackgroundCognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in Motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive impairment.MethodsEmploying a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome.ResultsCogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups.ConclusionsThe findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements.Trial registrationACTRN12616001543471. Date: 08/11/2016.