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We investigated the effect of aging on the ability to mentally simulate/plan a complex sequential action of the whole body, namely "rising from the floor". Forty-four non-demented elderly people (mean age: 85.2±5.5 years) and 20 young people (mean age: 26.6±4.9 years) were included in the study. They were required to put in order six images representing the main movements necessary to get up from a sitting position on the floor. We showed that older subjects had poorer performance-both in terms of proportion of success and response time-than their younger counterparts. These results are in line with previous findings showing age-related alterations in action simulation/action planning processes, and highlight the fact that elderly people have particular difficulties when the action to mentally simulate is complex., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Heart rate variability (HRV), which is considered to reflect the activity of the autonomic nervous system (ANS), has been shown to decline with age. The aim of the present study was to explore cardiac ANS in older patients showing frontal-subcortical dysfunction with "Psychomotor Disadaptation Syndrome" (PDS), through the 24-h HRV. We enrolled 14 patients with PDS (mean age: 84.5+/-6.9 years), they were compared to 13 frail control subjects (mean age: 80.6+/-6.7 years). Cardiac ANS activity was assessed by 24-h ECG recordings from three leads with a Holter digital monitor. The decrease in cardiac ANS activity observed in PDS subjects was greater than the alteration found in normally aging subjects. The abnormalities of ANS that aggravate the effects of aging can be seen as a type of physical deconditioning. Such patients could benefit from particular attention in physical training.

Objective: We hypothesised that backward disequilibrium (BD), defined by a posterior position of the centre of mass with respect to the base of support, could be caused by a backward tilt in the perception of verticality., Methods: The relationship between BD, the perception of verticality, and the history of falls in 25 subjects aged 84.5+/-7.4 years was analysed. An original ordinal scale, the BD scale (BDS), was used to quantify BD. Postural (PV) and haptic verticals (HV) were measured in sagittal plane., Results: BDS scores closely correlated with the number of falls (r = 0.81, p =10(-5)). The more the PV was tilted backward, the greater the BDS scores (r = -0.95, p<10(-6)), with a huge backward tilt of about 15 degrees in 4 subjects with severe BD. In these subjects, the tilt in perception of verticality was transmodal since a severe backward HV tilt was also found., Conclusions: This transmodality suggested high-order cognitive disruption in the construction of the subjective vertical used in postural control by subjects showing BD, which confirmed our hypothesis., Significance: This study clearly shows that perception and action with respect to gravity are closely related and brings a new insight about fall mechanisms in the elderly.

Purpose: Although there is currently no epidemiological data on backward disequilibrium, this disturbance of posture does not seem to be rare in frail elderly., Actualities and Strong Points: Backward disequilibrium is characterized by the following criteria: the location of buttocks on the anterior side of the seat while the trunk rested at the back of the armchair in the sitting position; an inadequate forward of the trunk and a backward projection of the trunk outside the base of support during sit-to-stand; and a posterior projection of the center of mass outside the base of support in the standing position. Several pathological situations either somatic (degenerative, ischemic and traumatic brain lesions), psycho-somatic (psychomotor disadaptation syndrome, extended bed confining, non-use) or psychological (depression) affections can entail backward disequilibrium. Falls, loss of autonomy and the risk of the vicious circle with its causes are the main consequences of backward disequilibrium., Prospects and Projects: Although the geriatrician is familiarized with backward disequilibrium, there is no scale to quantify it. In this paper we review causes, consequences and management of backward disequilibrium, and in order to assess it, we propose a semi-quantitative scale, based on some activities of everyday living which are sitting position, sit-to-stand, back-to-sit and standing position. So, a backward disequilibrium score could be determined.

Purpose: We describe the psychomotor disadaptation syndrome and report the last findings on its physiopathology and therapeutic. This syndrome was first described by Pr Gaudet's team in 1986 and named "psychomotor regression syndrome". This name has been recently changed into "psychomotor disadaptation syndrome"., Actualities and Strong Points: The psychomotor disadaptation syndrome is a decompensation of postural function, gait and psychomotor automatisms due to the alteration of the posture and motor programming. That alteration is linked to subcortical-frontal lesions. Clinically, the psychomotor disadaptation syndrome is characterized by postural impairments (retro-propulsion or backward disequilibrium), non-specific gait disorders, neurological signs (akinesia, reactional hypertonia, alteration of both reactive postural responses and protective reactions) and psychological troubles. Psychological troubles include fear of standing and gait in its acute feature or slowness of cognitive processing and anhedonia in its chronic feature. The psychomotor disadaptation syndrome occurs as a failure to compensate for the effects of the following three factors which entail the reduction of motor functional reserves because of their impact on frontal subcortex: 1) aging, 2) chronic illness named predisposing factors (degenerative or vascular disorders) and both 3) functional and organic acute factors. The latter factors cause a reduction of cerebral blood perfusion. The psychomotor disadaptation syndrome requires multidisciplinary management including medical, physiotherapeutic and psychological approaches., Prospects and Projects: In the next years we have to determine the frequency of psychomotor disadaptation syndrome and its physiopathology needs to be further explored.

Direct observation of postural and motor abilities appears as very important in assessment of patients showing psychomotor disadaptation syndrome (PDS). We examine feasibility and reliability of mini motor test (MMT) which has been developed in order to establish rehabilitation goals in this population. MMT is a 20-item score which assesses abilities in bed, quality of sitting position, abilities in the standing position, and quality of gait. MMT has been conducted by two different independent investigators, a physiotherapist and a physician, in four different geriatric centers. One hundred and one subjects (mean age: 84.9 +/- 6.0 years) were included in the study. The agreement between the two investigators was highly satisfying for both MMT total score and each item of MMT. Redundancy between items appeared very limited. The difference between investigators for MMT total score did not vary significantly with score of the mini-mental-state examination (MMSE). The correlation between MMT and the Katz index was found significantly negative. MMT is an easy direct-observation test which may be particularly useful in patients who present with severe postural and gait impairment. This test can be used in clinical practice by different professional actors in order to allow an interdisciplinary approach for a common rehabilitation goal in the PDS patients.

Background: This study investigated the hypothesis that postural abnormalities might increase energy expenditure during a clinical functional test in frail elderly persons., Methods: Two groups of hospitalized women (aged 73 to 100 years) were recruited. Women who showed postural and gait abnormalities as described in the psychomotor disadaptation syndrome (PDS) were compared with control participants. The authors measured energy expenditure during the timed "up and go" test. For each participant, oxygen uptake, carbon dioxide output, expiratory minute ventilation, breathing frequency, heart rate, and alveolar ventilation were recorded 10 minutes before, during, and 10 minutes after exercise. The arterial pressure of carbon dioxide was estimated from expired gases., Results: The mean oxygen uptake values were significantly higher in women with PDS than in the control group during exercise and recovery periods (4.89 +/- 1.68 vs 3.75 +/- 1.25 ml . kg(-1) . min(-1) and 4.69 +/- 1.45 vs 3.76 +/- 0.97 ml . kg(-1) . min(-1), respectively [p <.05]). Expiratory minute ventilation was always higher in women with PDS than in controls regardless of the period of the test (p <.05), and alveolar ventilation was higher in women with PDS only during the exercise period (p <.05). The estimated arterial pressure of carbon dioxide did not change significantly between the different phases of the test but was always lower (p <.05) in women with PDS compared with the control group., Conclusions: The significant increase in oxygen uptake during the exercise and recovery periods in women with PDS compared with controls suggests that postural abnormalities that characterize PDS may be associated with an increase in energy expenditure. In clinical practice, the low capacity to tolerate even moderate exercise must be considered when specific rehabilitation programs are offered to women with PDS.

Background: Depression is one of the most common risk factors for falls, but links between falls and depression are still unclear. Few studies have examined the relationship between depression and gait alteration, which may increase the risk of fall., Objective: This study aims to assess a possible relationship between depression, postural and gait abnormalities, and falls., Methods: We conducted a 1-year prospective study on patients >/=70 years who were admitted to a geriatric unit for 'spontaneous' unexplained falls. Patients were tested for depression using the 30-item Geriatric Depression Scale (GDS). Their motor performances were assessed using the Mini Motor Test (MMT), which is an easy direct-observation test, validated in France, for assessment of frail old people who present with severe postural and gait impairment. This scale is composed of 4 categories of items: (1) abilities in bed; (2) quality of the sitting position; (3) abilities in the standing position, and (4) quality of gait., Results: Sixty-nine patients were included. Depression was found in 46 patients (66.7%). The MMT score was higher in the non-depressed fallers (NDF) group (GDS 10; p < 0.05). The 2 groups were compared for each of the 4 items of the MMT: the difference between the DF and NDF groups was mainly explained by the impairment of postural abilities in the standing position., Conclusions: Our results support the idea that depression is associated with postural abnormalities in the standing position, which may predispose to falls. In clinical practice, more attention should be given to old fallers concerning diagnosis and treatment of associated depression., (Copyright 2004 S. Karger AG, Basel)

Psychomotor Disadaptation Syndrome (PDS) is characterized by backward disequilibrium in a sitting and standing position, reactional hypertonia, an alteration of postural reactions, gait modifications, and fear of falling. PDS may be the result of a loss of postural reserves, reaching a frailty threshold that does not allow subjects to maintain an adequate functional level. This clinical picture may be associated with frontal-subcortical dysfunction in which microangiopathy could play a key role. PDS may be triggered by numerous factors, such as cardiovascular and metabolic diseases, falls, and bed rest. In addition to medical and neurological evaluations, a specific rehabilitation program is one of the most important aspects of the management of patients showing PDS.

FUNDAMENTAL IMPORTANCE OF POSTURE: In the elderly subject, preservation of posture is fundamental to maintaining functional independence. In recent years, there has been much progress in our understanding of the mechanisms underlying strategies used to control equilibrium in the upright position. Physiological aging, associated with diverse disease states, dangerously alters the postural function, particularly anticipated adjustments which allow an adaptation of posture to movement. CLINICAL ASSESSMENT OF POSTURE: Several tests have been developed to assess posture in the elderly subject, particularly the time it takes to start walking. We selected certain tests which can be used in everyday practice to predict falls: the stance test, the improved Romberg test, the "timed get up and go test", measurement of walking cadence, assessment of balance reactions, sitting-standing and standing-sitting movements and capacity to get up off the floor. PATIENT CARE: Elderly patients with equilibrium disorders can benefit from specific personalized rehabilitation protocols. Different techniques have been developed for multiple afferential stimulation, reprogramming postural strategies, and correcting for deficient motor automatisms.