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Anaick Perrochon, Gilles Kemoun Laboratoire Mobilité, Vieillissement, Exercice (MOVE), EA 6314, Faculté des Sciences du Sport, Université de Poitiers, 8 Allée Jean Monnet, 86000 Poitiers, France; ISIS, Research Institute on Handicap and Aging, Paris, France Background: Executive function impairment (in particular, mental flexibility) in the elderly, and in patients with mild cognitive impairment (MCI), is strongly correlated with difficulties in performing complex walking tasks. The aim of this study was to determine if the adaptation of a neuropsychological test (the Trail-Making Test), to evaluate executive functions during walking, can be an early detection tool for cognitive impairment. Methods: Fifty subjects (15 young, 20 older, presumably healthy, and 15 MCI) were first evaluated for cognitive functions (Mini-Mental State Examination, Frontal Assessment Battery, and Trail-Making Test) and motor functions (10-meter walking test). All subjects then performed a spatial navigation, or a complex walking test (the Walking Trail-Making Test: [WTMT]), and their spatiotemporal walking variables were analyzed using cluster analysis. Results: Following evaluation of WTMT locomotor performance, cluster analysis revealed three groups that were distinctly different in age and cognitive abilities: a group of young subjects, a group of healthy older subjects, MCI subjects with amnestic impairment, and a group of MCI subjects with executive function impairment. The WTMT enabled early detection, (ie, borderline MCI) of dysexecutive impairment, with 78% sensitivity and 90% specificity. Conclusion: The WTMT is of interest in that it can help provide early detection of dysexecutive cognitive impairment. Keywords: spatial navigation, walking, trail making test, detection, mild cognitive impairment

A Perrochon,1,2,5 G Kemoun,1,2 E Watelain,3,4 A Berthoz51ISIS, Research Institute on Handicap and Aging, Paris; 2Université de Poitiers, Laboratoire Mobilité, Vieillissement et Exercice (MOVE), EA 6314, 3Université de Valenciennes, LAMIH, UMR CNRS 8201, 4Université Sud Toulon Var, HandiBio, EA 4322, La Garde, 5LPPA, UMR CNRS 7152, Collège de France, Paris, FranceBackground: Several studies have reported the potential value of the dual-task concept during locomotion in clinical evaluation because cognitive decline is strongly associated with gait abnormalities. However, current dual-task tests appear to be insufficient for early diagnosis of cognitive impairment.Methods: Forty-nine subjects (young, old, with or without mild cognitive impairment) underwent cognitive evaluation (Mini-Mental State Examination, Frontal Assessment Battery, five-word test, Stroop, clock-drawing) and single-task locomotor evaluation on an electronic walkway. They were then dual-task-tested on the Walking Stroop carpet, which is an adaptation of the Stroop color–word task for locomotion. A cluster analysis, followed by an analysis of variance, was performed to assess gait parameters.Results: Cluster analysis of gait parameters on the Walking Stroop carpet revealed an interaction between cognitive and functional abilities because it made it possible to distinguish dysexecutive cognitive fragility or decline with a sensitivity of 89% and a specificity of 94%. Locomotor abilities differed according to the group and dual-task conditions. Healthy subjects performed less well on dual-tasking under reading conditions than when they were asked to distinguish colors, whereas dysexecutive subjects had worse motor performances when they were required to dual task.Conclusion: The Walking Stroop carpet is a dual-task test that enables early detection of cognitive fragility that has not been revealed by traditional neuropsychological tests or single-task walking analysis.Keywords: stroop, dual-task, walking, mild cognitive impairment

The aim of this study was to investigate the kinematic and kinetic characteristics of walking in healthy non-faller elderly in order to develop predictive parameters for falls. A 1-year prospective trial was completed on a walking circuit with two integrated force platforms and an optoelectronic system for three-dimensional movement analysis. Gait was investigated in 54 volunteers who were healthy people over 60 who had not fallen in the previous year. The subjects were contacted 2-monthly over a period of 1 year. The results showed that 16 of the 54 people tested had fallen. There was no significant age difference between the group of fallers and the group of non-fallers. Fallers walked more slowly and tended to use a double support for a longer period of time. Fallers were less powerful but mainly showed fewer power and moment variations. The range of motion at the ankle and the hip was reduced. We noticed a change in the walking pattern, showing a delay in the dorsiflexion of the ankle at the swing phase. In conclusion, subclinical gait parameters occur in older people. The advent of neuromotor pattern alterations when walking is related to the tendency to fall. Ankle dorsiflexion delays, in particular, appear to be predictive of falls. [ABSTRACT FROM AUTHOR]

Objectives Study relevance a priori of a mobile service robot dedicated to seniors living in institution. The robot have three functionality: moving support for the fragile person, orientation help of the cognitively vulnerable person and assistance to carry the personal objects. Method Beforehand, a slide show was presented suggesting the potential functionality of the robot. Then residents answered semi-structured interview and questionnaire about issues related to five areas: safety, operability, functionality, and mutual support, design. Results Sixty-two residents were interviewed. 82,3% of residents think that robot acts as an ordinary tele-alarm. The favourite robot's control mode was the voice (82.6%). The robot was rarely viewed as a companion, but it offered for anyone the image of a servant device to support the resident when moving, guidance as well as carrying objects. Fifty percent of the residents appreciated the three robot's functions especially in case of loss of autonomy. Residents preferred basin height for the robot, while standing. Whatever, the robot presented through a simulation was still subject of surprise and interrogation for 42% of the residents. Finally, the residents attached more importance to the functionalities compared to the design. Discussion and conclusion This study shows that the accession of the elderly to the robot in an institution is very nuanced. The assessment is potentially biased by the difficulty of the very old person to project into the possible use of such a device. The function of security or reinsurance dominates the expectations to compensate for the delay of intervention of caregivers particularly at night and/or the discomfort to produce the call. However, this type of investigation can offer designers all the negative and/or positive representations aroused by such a device and warns about the need to offer immediately a simple but very functional prototype to convince users and financers. [ABSTRACT FROM AUTHOR]

Abstract: The Dandy–Walker syndrome is a rare malformation usually diagnosed during pregnancy or early in the course of life. We report a case in an elderly hospitalised for gait disorders and recurrent falls. Cerebral MRI revealed hydrocephalus and posterior fossa cyst. The patient improved after ventriculocisternostomia. [Copyright &y& Elsevier]

Introduction Une chute peut avoir d’importantes conséquences psychologiques qui peuvent être vues sous l’angle d’un syndrome de stress post-traumatique (SSPT). La réalité virtuelle, qui a fait ses preuves dans le traitement du SSPT, pourrait être alors une solution efficace pour rééduquer les conséquences psychologiques post-chute. L’objectif était de développer un programme de rééducation en réalité virtuelle chez des sujets âgés associant un serious game et un fauteuil de stimulation de marche. Matériel et méthode Le serious game permettait au sujet de faire parcourir la plus grande distance d’un parcourt virtuel à un avatar, à l’aide d’un joystick en étant assis sur le fauteuil de stimulation de marche. Ce fauteuil, développé par « Backwell Active Balance Solution » reproduit un mouvement coordonné de bascule antéropostérieure, latérale et de rotation du bassin. Les mouvements du fauteuil étaient synchronisés au déplacement de l’avatar pour améliorer l’immersion dans l’environnement virtuel avec une approche de type « Living-Lab ». Résultats Nous avons testé chez 8 sujets âgés de plus de 80 ans trois environnements virtuels : un couloir sans fin, une ville moderne et un jardin public. Différents joysticks ont été utilisés mais aucun d’entre eux ne convenait parfaitement. Discussion–conclusion Il apparaît que l’esthétique de l’environnement virtuel était un important facteur de motivation pour les sujets âgés et que la recherche d’une manette de jeu s’était avérée complexe. Nous avons observé que les mouvements du fauteuil n’entravaient pas l’immersion dans l’environnement virtuel et pouvaient même l’améliorer pour certains participants. L’étape suivante sera de tester l’efficacité de ce programme chez des sujets âgés souffrant d’un syndrome post-chute en comparaison à une rééducation classique. [ABSTRACT FROM AUTHOR]