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Background Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurologic syndrome that affects the elderly population in a context of concomitant medical conditions. The aim of this study was to understand the significance of comorbidities using 4 validated and specific clinical scores: Cumulative Illness Rating Scale (CIRS), American Society of Anesthesiologists (ASA) score, Comorbidity Index (CMI), and Charlson Comorbidity Index (CCI). Methods From 2015 until 2019, the Bologna PRO-Hydro multidisciplinary team selected 63 patients for shunt surgery. All comorbidity scores were collected during preoperative anesthesia evaluation. Positive shunt response was defined as an improvement in overall disability (assessed with modified Rankin Scale [mRS]), in risk of fall (assessed with Tinetti Permormance Orientated Mobility Assessment, Tinetti) and in INPH specific symptoms (assessed with INPH Grading Scale, INPHGS). Results Patients with elevated values of CIRS had worse performance in gait and balance at Tinetti scale, both before (P = 0.039) and after surgery (P = 0.005); patients with high values of CMI had inferior values of Tinetti at baseline (P = 0.027) and higher mRS after surgery (P = 0.009); ASA 2 patients had better postoperative Tinetti scores than ASA 3 patients (P = 0.027). A positive or negative shunt response was not significantly correlated with patients' preoperative comorbidity scores. Conclusions Patients with multiple comorbidities have a worse preoperative condition compared to patients with less concomitant diseases, and the proposed comorbidity scores, CIRS in particular, are useful clinical tools for the anesthesiologist. Comorbidities, though, do not impact overall postoperative outcome.

Objective The aim of this study was to assess the effects of dancing (using the Feldenkrais method) on motor and non-motor symptoms, quality of life (QoL), and objective parameters of gait at the time of intervention and at the end of the 1-year study period.Methods This was a single-arm study in which 12 subjects with Parkinson’s disease (PD) received dance intervention during a 6-month period. Objective motor scales, gait analysis, and questionnaires on non-motor symptoms were evaluated at baseline and at 3, 6, and 12 months.Results Dance intervention decreased motor scale (Unified Parkinson’s Disease Rating Scale and Tinetti scale) scores and improved gait disturbance (gait velocity and step length) without increasing levodopa equivalent dose. Furthermore, dancing decreased non-motor scale (Non-Motor Symptoms Scale and Montgomery-Asberg Depression Rating Scale) scores and improved QoL.Conclusion Our findings suggest that dance intervention can be a complementary management method for PD patients.

Introducción. Con el pasar de los años, el adulto mayor presenta varios estados de salud, donde las caídas es una de las causas más comunes de morbimortalidad ocasionada por la pérdida del equilibrio y la disminución de la movilidad, provocando el desarrollo de enfermedades discapacitantes y hasta la muerte; además que representa altos gastos socio sanitarios; que pueden ser evitados y reducidos mediante una intervención adecuada- Objetivo: Determinar los efectos de un plan de los ejercicios de equilibrio y coordinación para evitar caídas en el adulto mayor. Materiales y métodos. Estudio cuasiexperimental, de diseño longitudinal, a 23 adultos mayores ecuatorianos de entre 65 a 85 años; seleccionado a partir de criterios de inclusión y exclusión. Se realizó una revisión sistemática en bases de datos como PubMed, PEDro, Scielo, Medline, Medigraphic, y Science Direct, a partir de palabras claves, generando 50 artículos y de los cuales se obtuvieron 20 elegibles para el plan de ejercicios. El riesgo de caídas se valoró con la escala de Tinetti y la prueba Times Up and Go (TUG); mientras que el nivel de dependencia se evaluó con el índice de Barthel. Los datos obtenidos fueron tabulados y analizados a través del programa estadístico SPSS V22 de IBM, Resultados. Se observaron cambio clínicos y estadísticos significativos entre las medidas antes y después de la intervención en la escala de Tinetti (0,001) y en el índice de Barthel (0,046); mientras que en la prueba TUG no existió diferencias significativas. Conclusión. Los ejercicios de coordinación y equilibrio, son efectivos para prevenir el riesgo de caídas en este grupo de adultos mayores.

Introducción: La pérdida de equilibrio es un factor importante para sufrir una caída en adultos mayores, esto representa un problema mundial a nivel de salud; el miedo a caerse y el bajo nivel de equilibrio son obstáculos para realizar ejercicio físico; sin embargo realizar ejercicios de Frenkel son necesarios para el control motor. Objetivo: Determinar la efectividad de los ejercicios de Frenkel para mejorar el equilibrio en adultos mayores. Material y Métodos: Se realizó una investigación cuasi-experimental, con una población de 30 adultos mayores de 65 a 75 años con problemas de equilibrio que firmaron el consentimiento informado. Recibieron un protocolo de ejercicios de Frenkel durante 30 minutos; en el primer mes ejercicios en decúbito supino, en el segundo mes en sedestación y en el tercer mes en bipedestación; para la recolección de la información se realizó una evaluación antes y después de la intervención con el Test de Tinetti. El análisis estadístico de los resultados fue con el programa SPSS mediante frecuencias, porcentajes, pruebas de chi-cuadrado y Wilcoxon. Resultados: En la primera evaluación el 100% de la población tenía problemas de equilibrio, marcha, un riesgo alto de caída y riesgo de caída. Luego de la intervención mejoró el equilibrio y disminuyó significativamente el riesgo de caídas. En las pruebas de chi-cuadrado antes y después de la evaluación del equilibrio se obtuvo P=0,010; de la marcha P=0,018; se aceptan las hipótesis nulas porque es mayor a 0,05, si hay diferencia significativa. En la prueba de Wilcoxon P=0,000 lo cual comprobó que los ejercicios de Frenkel son efectivos en adultos mayores. Conclusión: Es importante realizar ejercicios de Frenkel para mejorar el equilibrio en adultos mayores ya que estos ayudan a evitar caídas.

Introducción: Es importante conocer los problemas que ocurren con el proceso natural del envejecimiento, afectando considerablemente el desempeño en acciones físicas, actividades cotidianas, así como la salud y bienestar. El problema de la alteración en la en la biomecánica postural con lleva a un riesgo de caída en adultos mayores. Objetivo: Analizar la importancia de la corrección postural en la reeducación biomecánica en adultos mayores. Material y Métodos: El diseño metodológico tiene un enfoque cuantitativo de tipo cuasi – experimental. A través de un test de Adams se evaluó la escoliosis, y la debilidad muscular en miembros inferiores con las escalas de Tinetti y Daniels, en 21 adultos mayores en una edad de 65 a 85 años, previa firma del consentimiento informado. Se realizó la intervención Fisioterapéutica por 12 semanas con visitas domiciliarias. En la intervención los ejercicios se aplicaron de manera progresiva hasta alcanzar el máximo potencial de cada adulto mayor de acuerdo a su capacidad física. Resultados: Los datos fueron procesados mediante el programa estadístico SPSS versión 25.0. Se encontró una escoliosis moderada en el 42,9%. El Test de Tinetti demuestra en marcha antes de la intervención en 66,7%, después de la intervención 71,4% considerado como bueno, Tinetti en equilibrio antes de la intervención es bueno en el 52,4%, después de la intervención 33,3% Con la escala de Daniels que mide la fuerza muscular, demostró 47,3% antes de la intervención que la fuerza muscular en miembro inferior derecho, 38,1% luego de la intervención es bueno, en miembro inferior izquierdo antes de la intervención 38,1% luego de la intervención es de 23,8%. Al realizar la prueba de comprobación de hipótesis a través de Wilcoxon y Mcnemar se demostró la necesidad de una intervención para corregir el problema en la población seleccionada para el estudio. Conclusión: La intervención de la aplicación de ejercicios terapéuticos para Escoliosis y Debilidad Muscular en Miembros Inferiores fue efectiva, con resultados satisfactorios.

This study explored the associations between the perceived walkability of neighborhood environment, walking time, and functional mobility by community-dwelling older adults in Hong Kong SAR, China. Seventy community-dwelling older adults (Mean age = 78.00 ± 7.40 years) participated in this study. Their perceived walkability of neighborhood environment was evaluated by the Chinese abbreviated version of Neighborhood Environment Walkability Survey (NEWS-A) and their walking time within a week was self-reported. The 10-Meter Walk Test and Tinetti Performance-Oriented Mobility Assessment (POMA) were used to assess the functional mobility of the participants, regarding their gait speed, balance, and gait performance, respectively. Results suggest that the perceived walkability of neighborhood environment (Aesthetics subscale) positively associated with the gait speed (rs = .35, p = .003), scores of the POMA-Balance (rs = .389, p = .001) and POMA-Gait (rs = .343, p = .004). This exploratory analysis augmented our contemporary understanding that older adults who could walk faster and with better balance and gait performance are associated with more positive perceived walkability of their neighborhood environment. It provides useful insight that could inform future high-impact investigations.

Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) progress relentlessly and lead to a need for care. Caregiving is often burdensome. Little is known about the course of caregiver burden (CB) in PSP and CBS patients. Longitudinal analysis of CB in family members caring for PSP and CBS patients. Single-center longitudinal pilot study in 68 newly diagnosed patients with probable PSP and CBS (52 Richardson’s syndrome; 1 progressive gait freezing of PSP; 15 CBS). Demographic, educational, occupational parameters, family status, motor functions (UPDRSIII, Hoehn and Yahr Score, Tinetti) and neuropsychological performance (CERAD Plus, Frontal Assessment Battery) were assessed, as well as behavioral and neuropsychiatric impairments (Frontal Behavioral Inventory, Neuropsychiatric Inventory), activities of daily living (ADL) and caregiver burden using the Caregiver Strain Index (CSI), in most patients also the Zarit Burden Interview (ZBI). Patients were followed up every 6 months for up to 2 years. Caregivers reported mild to moderate CB at baseline, which increased by 25–30% in 2 years and was significantly greater in PSP than in CBS. Risk for mental health problems increased over time, especially in female caregivers (depression). Important patient-related factors were apathy, aspontaneity, depression, irritability, disorganization, poor judgment, impairment of language, impairments in ADL, a high educational level of the patient and close family relationship. Behavioral symptoms and impaired ADL are the main patient-related factors of CB in PSP and CBS. CB can be severe and needs to be assessed repeatedly from the time of diagnosis to provide comprehensive support.

The main aim of the study was to assess the risk of falls, and physical fitness in the group of women aged 60 to 65 years of age suffering from an identified osteoporosis in comparison to a similar group of healthy women. The main question was: What is the level of physical fitness and risk of fall among women with osteoporosis compared to healthy women? The research included 262 women aged 60 to 65 of age: 135 with osteoporosis and 127 healthy ones, living in the Małopolskie and the Świętokrzyskie Provinces of Poland. To assess the level of physical fitness, the Senior Fitness Test (SFT) was used, while the Tinetti POMA (Performance Oriented Mobility Assessment) and Timed Up&Go test (TUG) were used to asses the risk of fall. Significant statistical differences in average results of physical fitness assessment were noticed as regards the following aspects: flexibility of the lower body part p

Spasticity measured by manual tests, such as modified Ashworth scale (MAS), may not sufficiently reflect mobility function in stroke survivors. This study aims to identify additional ambulatory information provided by the pendulum test. Clinical assessments including Brünnstrom recovery stage, manual muscle test, MAS, Tinetti test (TT), Timed up and go test, 10-m walk test (10-MWT), and Barthel index were applied to 40 ambulant chronic stroke patients. The pendular parameters, first swing excursion (FSE) and relaxation index (RI), were extracted by an electrogoniometer. The correlations among these variables were analyzed by the Spearman and Pearson partial correlation tests. After controlling the factor of motor recovery (Brünnstrom recovery stage), the MAS of paretic knee extensor was negatively correlated with the gait score of TT (r = − 0.355, p = 0.027), while the FSE revealed positive correlations to the balance score of TT (r = 0.378, p = 0.018). RI were associated with the comfortable speed of 10-MWT (r = 0.367, p = 0.022). These results suggest a decrease of knee extensor spasticity links to a better gait and balance in chronic stroke patients. The pendular parameters can provide additional ambulatory information, as complementary to the MAS. The pendulum test can be a potential tool for patient selection and outcome assessment after spasticity treatments in chronic stroke population.

Falls are increasing prevalent in the elderly but little data has been reported on the effect of previous life experience on balance ability. The aim of the present cross-sectional study was to determine whether participants with historically highly developed postural control (retired dancers) provided protection after activity had stopped by comparing their balance abilities with age-matched sedentary counterparts. Ten retired dancers [RD] 65 ± 7.36yrs and 10 sedentary controls[C] 66 ± 5.66yrs carried out a series of balance tests in a laboratory setting in a set order: Romberg, Functional Reach, Timed Up and Go, Berg and Tinetti. The RD group performed significantly better solely in the static balance tests (Romberg and Berg Balance) (p

Introdução: O processo de envelhecimento configura ao idoso alterações importantes no controle postural. Essas alterações de equilíbrio predispõe o indivíduo que envelhece a um maior risco de queda, sendo, por isso, cada vez mais importante a implementação e o estudo de recursos que objetivem o ganho de equilíbrio, tanto em fins preventivos quanto terapêuticos. Objetivo: Avaliar o efeito da utilização do slackline como recurso auxiliar no treino de equilíbrio em idosos. Metodologia: Trata-se de um estudo quantitativo, quase-experimental, tendo como sujeitos da pesquisa dez idosas, participantes de um grupo de envelhecimento pela Universidade Aberta à Terceira Idade. Os sujeitos foram submetidos a uma avaliação prévia, com escalas e instrumentos validados de mensuração do equilíbrio e passaram por uma intervenção para treino de equilíbrio, utilizando como recurso o slackline. Após a intervenção, que durou seis semanas, com frequência de duas vezes por semana, as idosas foram reavaliadas com os mesmos testes. Resultados: Os resultados apontaram que o treino através do slackline proporcionou um ganho significativo para equilíbrio postural na Escala de Avaliação do Equilíbrio e da Marcha de Tinetti 26,20 (p

Aim: The aim of this study is to identify optimum target levels of hemoglobin (Hgb) in older males and females according to cognitive performance, mood state, nutrition intake, balance-walking functions, muscle strength and performance in daily life activities.\ud \ud Method: A total of 1942 geriatric patients who had undergone comprehensive geriatric assessment were evaluated. The patient's demographic characteristics, comorbid diseases, number of drugs, cognitive performance, mood and nutritional states, basic and instrumental daily living activity indexes were obtained from hospital files. Hgb levels were analyzed on the same day. Receiver Operating Characteristic analysis was used to detect the optimum level of Hgb according to the best performance of geriatric assessment parameters.\ud \ud Results: 1095 participants took part of who 71.9% were female and the mean age was 76.92 ± 7.38 years (65-103 years). There was a significant negative correlation between age, number of drugs used, Geriatric Depression Scale-15, Timed Up and Go test and Hgb in both sexes while a significant positive correlation was found between Barthel and Lawton activities of daily living, Tinetti test, Mini Nutritional Assessment, Mini-Mental State Examination and Hgb (p < 0.05). The optimum Hgb levels were ≥ 13.0 for females and ≥ 13.9 in males.\ud \ud Conclusion: Findings from the present study in relation to Hgb and key geriatric evaluation parameters suggests that the optimum level of Hgb for older females and males is higher than the level of Hgb in current definitions. Data from this study suggest that the optimum value of the Hgb level is 13.0 for females and 13.9 for males.

Introdução: A esclerose lateral primária (ELP) é uma doença rara caracterizada por uma degeneração do neurônio motor superior ocorrendo geralmente na sexta década de vida com um início insidioso de uma paresia espástica simétrica, lentamente progressiva, frequentemente começando em membros superiores e inferiores. A prática de exercícios pode trazer benefícios a estes sujeitos levando a uma aprendizagem motora (AM) e melhorando o repertório motor insuficiente. Objetivo: Determinar o efeito de um protocolo de intervenção baseado na AM para melhorar a marcha e equilíbrio em jovem com ELP. Metodologia: É um estudo de caso composto por uma mulher, 29 anos, solteira, colombiana, branca, submetida à avaliação pré-teste (1 sessão), intervenção de protocolo (18 sessões) e pós teste (1 sessão). Para coleta de dados foram utilizados a Escala de Tinetti, Teste de Romberg, Timed Get Up And Go, Teste de alcance funcional, Baropodometria e Estabilometria. Resultados: A Escala de Tinetti (reação postural) mostrou melhora para balaço em um pé; na Escala de Tinetti (marcha) os resultados positivos foram encontrados em largura, simetria, continuidade e direção do passo; Testes de Romberg mostraram evolução para estabilidade sobre superfície plana com olhos fechados e sobre espuma de Fomy com olhos abertos; no teste Timed Get Up & Go o tempo de percurso foi reduzido de 13,64 segundos para 12,5 segundos. Conclusão: Após a aplicação do protocolo de intervenção baseado na AM houve avanços funcionais em marcha e equilíbrio de jovem com ELP.

Background and purpose Falls are a leading cause of morbidity, mortality, loss of independence, and significant functional decline in aging populations. Effective interventions aimed at reducing the risk of falls, and preventing associated disability and functional decline, are needed to promote the health and wellness of older adults. Recent literature has found that an Otago-based exercise program (OBEP), which incorporates strengthening, balance, and walking, may not only decrease falls and fall risk among community-dwelling older adults but may also be effective among older adults residing in assisted living facilities (ALFs). The purpose of this study is to expand upon current research by comparing the outcomes of an OBEP and traditional physical therapy (TPT) in decreasing falls and the risk of falls among older adults living in an ALF. The authors hypothesized that traditional physical therapy would reduce fall risk and the number of falls in older adults residing in ALFs more than an OBEP. Methods This study conducted a 2-group retrospective chart review of 59 older adults living in an ALF from January 2013 to October 2018 who received either TPT (n = 29) or the OBEP (n = 30). Participants were a mean of 87 years old and were classified at risk for falls by the Tinetti Performance-Oriented Mobility Assessment (POMA). Primary variables included the number of falls prior to intervention, during intervention, and 1 year following intervention, as well as pre- and posttreatment Tinetti POMA scores. Efficacy was examined using multiple linear regression analysis. Results and discussion Both groups achieved reduced falls and increased POMA scores. Group assignment did not significantly predict performance in key outcome measures, namely the number of falls (P = .199) and Tinetti POMA scores (P = .063) following treatment. Conclusions These findings indicated that both an OBEP and tpt may be effective interventions for reducing falls and fall risk in the ALF setting.

BACKGROUND: With the recent developments in science, full-immersion virtual reality devices have been developed, which may have feasibility for stroke rehabilitation. OBJECTIVE: This case report investigated the feasibility of training using a full-immersion virtual reality video game for improving motor function, balance, and gait in a young stroke survivor. METHOD: The case was a 27-year-old woman with stroke. A training using full-immersion virtual reality video game (Sony PlayStation®VR) was performed for 30 minutes per session, 3 sessions per week, for 6 weeks, with a total of 18 sessions. Before training and at each training for 6 weeks, with a total of 19 times, the motor function, balance, and gait were assessed using the Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Tinetti Balance Assessment, 10 Meter Walk Test (10MWT), Tinetti Gait Assessment, and Dynamic Gait Index (DGI). RESULTS: During the training, there were no adverse events reported. The case achieved 14 points higher than the pre-assessment with 34 points on the MAS, 16 points higher than the pre-assessment with 48 points on BBS, 6.85 sec lower than the pre-assessment, with 13.58 sec on TUG, 5 points higher than the pre-assessment with 13 points on the Tinetti Balance Assessment, 5.36 sec lower than the pre-assessment, with 8.15 sec on the 10MWT, 4 points higher than the pre-assessment with 10 points on the Tinetti Gait Assessment, and 10 points higher than the pre-assessment with 21 points on the DGI. CONCLUSION: This case report suggests that training using a full-immersion virtual reality video game may be a safe and effective method to improve motor function, balance, and gait in a young stroke survivor.

Background Parkinson's disease (PD) is characterized by non-motor symptoms (NMS) as well as by motor symptoms. Together with the impairment of cognitive functions, NMS and sleep also affect motor symptoms negatively. The aim of our study is to examine the correlation of NMS and sleep on balance in PD patients with normal cognition (PD-NC) and with mild cognitive impairment (PD-MCI). Methods A total of 69 patients were included in our study. Using the Standardized Mini-Mental State Examination, participants were divided into 2 groups, PD-NC and PD-MCI. Patients were assessed with the Unified Parkinson's Disease Rating Scale (UPDRS), the Berg Balance Scale (BBS), the Tinetti Balance Assessment Tool (TBAT), the Non-Motor Symptoms Questionnaire (NMSQ), and the Parkinson's Disease Questionnaire (PDQ-39). Results PD-MCI patients had statistically significant worse motor symptoms and more balance disorder compared to PD-NC (UPDRS: p = 0.009; BBS: p = 0.010; TBAT: p = 0.004). PD-MCI patients had greater severity of non-motor symptoms and worse sleep quality than the PD-NC group (NMSQ-total: p = 0.02; NMSQ-sleep total: p = 0.01). The evaluation has shown that with a diagnosis of MCI, NMS, and sleeping problems were correlated, and the correlation was associated with impairment of the balance function. While being more pronounced in the PD-MCI group, quality of life was affected in both groups (p < 0.05). Conclusion Our data demonstrate a negative effect on the balance function in patients with cognitive impairment suffering increased NMS and sleeping disorders. Treatment of these patients needs to concentrate on NMS and cognitive functions as much as on motor symptoms.

Objectives Idiopathic normal pressure hydrocephalus (INPH) is a neurodegenerative disorder characterized by excess cerebrospinal fluid (CSF) in the ventricles, which can be diagnosed by invasive CSF drainage test and treated by shunt placement. Here, we aim to investigate the diagnostic and prognostic power of systematic volumetric analysis based on brain structural MRI for INPH. Methods We performed a retrospective study with a cohort of 104 probable INPH patients who underwent CSF drainage tests and another cohort of 41 INPH patients who had shunt placement. High-resolution T1-weighted images of the patients were segmented using an automated pipeline into 283 structures that are grouped into different granularity levels for volumetric analysis. Volumes at multi-granularity levels were used in a recursive feature elimination model to classify CSF drainage responders and non-responders. We then used pre-surgical brain volumes to predict Tinetti and MMSE scores after shunting, based on the least absolute shrinkage and selection operator. Results The classification accuracy of differentiating the CSF drainage responders and non-responders increased as the granularity increased. The highest diagnostic accuracy was achieved at the finest segmentation with a sensitivity/specificity/precision/accuracy of 0.89/0.91/0.84/0.90 and an area under the curve of 0.94. The predicted post-surgical neurological scores showed high correlations with the ground truth, with r = 0.80 for Tinetti and r = 0.88 for MMSE. The anatomical features that played important roles in the diagnostic and prognostic tasks were also illustrated. Conclusions We demonstrated that volumetric analysis with fine segmentation could reliably differentiate CSF drainage responders from other INPH-like patients, and it could accurately predict the neurological outcomes after shunting. Key Points • We performed a fully automated segmentation of brain MRI at multiple granularity levels for systematic volumetric analysis of idiopathic normal pressure hydrocephalus (INPH) patients. • We were able to differentiate patients that responded to CSF drainage test with an accuracy of 0.90 and area under the curve of 0.94 in a cohort of 104 probable INPH patients, as well as to predict the post-shunt gait and cognitive scores with a coefficient of 0.80 for Tinetti and 0.88 for MMSE. • Feature analysis showed the inferior lateral ventricle, bilateral hippocampus, and orbital cortex are positive indicators of CSF drainage responders, whereas the posterior deep white matter and parietal subcortical white matter were negative predictors.

Background: The association between gait and cognition, and their combined impact on postural stability may underlie the increased fall risk in older adults with dementia. However, there are few interventions to improve functional mobility and reduce fall risks in people with cognitive impairment. Objectives: This study aims to investigate the feasibility and acceptability of a Safe Mobilisation Program for cognitively impaired older adults with higher level gait disorders. It also explores the potential effectiveness of the program on mobility and fall risks. Methods: Fifteen community-dwelling older adults participated in a 3-week pre-post intervention study. They were trained to take steady steps in transfers and mobilization using errorless learning and spaced retrieval teaching techniques. Results: The intervention program was feasible, all the participants completed the program and were able to mobilize safely. The program was acceptable and participants reported an increase in safety awareness, improvement in confidence while transferring and mobilising, and better quality of life. There was a trend of improvement in Falls Efficacy Scale-international (FES-I), 360° turn and Tinetti Performance Oriented Mobility Assessment (POMA), which may indicate improvement in balance and mobility. Conclusion: The Safe Mobilisation Program was feasible and acceptable in older adults with cognitive impairment and gait disorders and warrants further evaluation.

Background Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. Methods A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into 2 groups, MCR (n = 33) and MCI (n = 44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, “pure” MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. Results Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. Conclusions We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.

BACKGROUND: As the severity of dementia progresses over time, cognition and motor functions such as muscle strength, balance, and gait are disturbed, and they eventually increase the risk of fall in patients with dementia. OBJECTIVE: To determine the relationship between the fall risk and cognition, motor function, functional ability, and depression in older adults with dementia. METHODS: Seventy-four older adults diagnosed with dementia were recruited. Clinical measurements included the Fall Risk Scale by Huh (FSH), Korean version of the Mini-Mental State Examination (MMSE-K), hand grip strength (HGS), Tinetti Performance Oriented Mobility Assessment (POMA), 10-m walk test (10-MWT), Korean version of the Modified Barthel Index (MBI-K), and the Geriatric Depression Scale (GDS). RESUTLS: The MMSE-K was significantly correlated with the FSH, HGS, and the MBI-K, and FSH was significantly correlated with all of the other outcome measures. In particular, the MMSE-K, HGS, POMA, and the MBI-K were negatively correlated with fall history among the FHS sub-items. Additionally, the MMSE sub-item, attention/concentration was associated with the FSH, HGS, POMA, and the MBI-K. CONCLUSIONS: These findings suggest that falling is significantly related to impaired cognition, reduced muscle strength, impaired balance, gait, and activities of daily living abilities, and depression in older adults with dementia.

Introduction: The COVID-19 pandemic caused an increased mortality in nursing homes due to its quick spread and the age-related high lethality. Results: We observed a two-month mortality of 40%, compared to 6.4% in the previous year. This increase was seen in both COVID-19 positive (43%) and negative (24%) residents, but 8 patients among those testing negative on the swab, tested positive on serological tests. Increased mortality was associated with male gender, older age, no previous vitamin D supplementation and worse “activities of daily living (ADL)” scores, such as Barthel index, Tinetti scale and S.OS.I.A. classification. Conclusion: Our data confirms a higher geriatric mortality due to COVID-19. Negative residents also had higher mortality, which we suspect is secondary to preanalytical error and a low sensitivity of the swab test in poorly compliant subjects. Male gender, older age and low scores on ADL scales (probably due to immobility) are risk factors for COVID-19 related mortality. Finally, mortality was inversely associated with vitamin D supplementation. Design: In this observational study, we described the two-month mortality among the 157 residents (age 60-100) of a nursing home after Sars-CoV-2 spreading, reporting the factors associated with the outcome. We also compared the diagnostic tests for Sars-CoV-2.

Stroke is a significant medical condition and the significant inception of baffling longstanding inability everywhere in the world. Enduring over 24 hours or causing demise and the reason must be of a vascular starting point to affirm the stroke diagnosis. So the present study aims to the effectiveness of Dual-Task Exercise Training on Gait, Balance and walking speed among Stroke patient at Saveetha Medical College and Hospital. A quantitative approach with Pre-Experimental research with one group pre-test post-test design adopted to conduct the study among 30 antenatal mothers who were selected by non--probability purposive sampling technique. The semi-structured interview method was used to collect the demographical variables among stroke patient, and the patient’s balance and gait pattern were assessed by using the Tinetti Assessment Scale. The results of the study show that in the pre-test, the mean value is 17.7%, and the standard deviation is 3.333. And in post-test, the mean value is 19.866, and the standard deviation is 2.75. The mean difference between pre and post-test is 15.27. This study proves Effectiveness of Dual-Task Exercise Training on Gait, Balance and Walking speed among Stroke patient is effective method to prevent and to improve the Gait, Balance and Walking speed among stroke patient and also it helps the stroke patient to improve to the knowledge and to provide the better quality of life to stroke patient.

Objective:To review the effects of whole body vibration for patients with Parkinson’s disease.Design:Randomized clinical trials comparing whole body vibration with no vibration or conventional physical therapy for patients with Parkinson’s disease were searched up to July 31, 2019.Results:Seven studies with 196 patients were included for quantitative analysis. No significant difference was found between groups in motor score of unified Parkinson’s disease rating scale (UPDRS-III) (WMD [weighted mean difference] = −1.75, 95% CI, −5.40 to 1.90, I2 = 45.8%), functional reach test (SMD [standardized mean difference] = 0.21, 95% CI, −0.29 to 0.71; I2 = 0%), and other balance tests (including Berg balance test and Tinetti score) (SMD = 0.39, 95% CI, −0.01 to 0.80; I2 = 0%). No statistical difference was detected in walking velocity as well (WMD = −0.05, 95% CI, −0.17 to 0.06; I2 = 0%). In contrast, the pooled analysis from four studies on the Time Up and Go test showed favorable results for whole body vibration (WMD = −1.59, 95% CI, −2.90 to −0.28, I2 = 0%).Conclusion:Whole body vibration may not be beneficial over placebo or conventional physical therapy in overall motor function, balance, and walking velocity in patients with Parkinson’s disease. However, it might have positive effects on sit to stand transitions or turning.

Introduction and Aim: Balance synergy includes a number of postural response that enable an individual to arise and remain erect during standing and locomotion. Balance deficits causes an insufficient coordination, postural instability and impaired gait. Maintaining the independence in activities of activities of daily living is an important factor for the quality of life. Hence this study is done to promote Hemiplegic Gait in stroke patients. Materials and Methods: 150 community dwelling hemiparetic subjects from Chennai aged

Objectives To evaluate the efficacy of a proprioceptive exercise program on functional mobility, musculoskeletal endurance, dynamic and static balance, gait, and risk of falls in institutionalized older adults. Design Randomized, single-blind, controlled trial. Setting A Spanish nursing home in the autonomous community of Extremadura, Spain. Participants An initial sample was created by recruiting 148 older adult volunteers. The final sample (N=42) was randomly divided into 2 groups. Interventions Both the control and experimental group received physical therapy treatment based on a combination of adapted exercises and other physical therapy techniques (physical therapy intervention program) for a period of 12 weeks. This program consisted of 45 minutes (group intervention) plus 100 minutes (individual intervention) a week, for a total of 36 sessions (29 hours). The experimental group received a proprioceptive training program during the same intervention period, which was conducted twice weekly (24 sessions), with each session lasting 55 minutes. Main Outcome Measures Timed Up and Go (TUG), Cooper, Tinetti, 1-leg stance, and the Morse Fall Scale (MFS). Results Analysis of variance showed a time × group interaction in TUG score (F=10.41, P=.002), Cooper test (F=5.94, P=.019), Tinetti score (F=6.41, P=.015), and MFS scores (F=5.24, P=.028). Differences between groups were achieved for TUG scores (d=0.76), Tinetti scores (d=1.12), 1-leg stance test scores (d=0.77), and MFS scale scores (d=0.85). In the experimental group, within-group analyses showed pre- to post-treatment differences for TUG scores (d=0.72), Cooper test scores in meters (d=0.18), Tinetti scores (d=0.60), 1-leg stance scores (d=0.55), and MFS scores (d=0.42). Conclusions A proprioceptive exercise program demonstrated significant improvements compared with the control group in areas such as functional mobility, musculoskeletal endurance, balance, gait, and risk of falls in institutionalized older adults. This study may help to enhance our understanding of the impact of a specific protocol for a proprioceptive rehabilitation program.

Background Static postural balance performance is often impaired in people receiving haemodialysis (HD) for the treatment of stage-5 chronic kidney disease (CKD-5). However, the question as to whether lower postural balance is associated with adverse clinical outcomes such as falls has not been addressed yet. Research question We conducted a prospective cohort study to explore the association between static postural balance and falls in people receiving HD. We hypothesised that higher postural sway would be associated with increased odds of falling. Methods Seventy-five prevalent CKD-5 patients receiving HD (age: 61.8 ± 13.4 years) from three Renal Units were enrolled in this prospective cohort study. At baseline, postural balance was assessed with a force platform in eyes open (EO) and eyes closed (EC) conditions. Centre of pressure (CoP) measures of range, velocity and area were taken for the analysis. Falls experienced by study participants were prospectively recorded during 12 months of follow-up. Secondary outcomes included timed-up and go, five-repetition sit-to-stand test and the Tinetti falls efficacy scale (FES). Results In multivariable logistic regression analysis, higher CoP range in medial-lateral direction during EC was associated with increased odds of falling (OR: 1.04, 95 %CI: 1.00−1.07, p = 0.036). In ROC curve analysis, CoP velocity in EO exhibited the greatest prognostic accuracy (AUC: 0.69, 95 %CI: 0.55−0.82), however this was not statistically different from CoP measures of area and range. None of the postural balance measures exceeded the prognostic accuracy of the FES (AUC: 0.70, 95 %CI: 0.58−0.83, p = 0.005). Significance This prospective cohort study showed that higher postural sway in medial-lateral direction was associated with increased odds of falling in people receiving HD. CoP measures of range, velocity and area displayed similar prognostic value in discriminating fallers from non-fallers. The overall utility of static posturography to detect future fall-risk may be limited in a clinical setting.

A continuous monitoring of the physical strength and mobility of elderly people is important for maintaining their health and treating diseases at an early stage. However, frequent screenings by physicians are exceeding the logistic capacities. An alternate approach is the automatic and unobtrusive collection of functional measures by ambient sensors. In the current publication, we show the correlation among data of ambient motion sensors and the well-established mobility assessments Short-Physical-Performance-Battery, Tinetti and Timed Up & Go. We use the average number of motion sensor events as activity measure for correlation with the assessment scores. The evaluation on a real-world dataset shows a moderate to strong correlation with the scores of standardised geriatrics physical assessments., 15 pages, 1 figure, 16 tables

BACKGROUND: Retarded task-oriented gait, balance performance and increased fall risk are among the most debilitating problems in patients with diabetic polyneuropathy (DPN). The lower body positive pressure (LBPP) training was recently introduced in the field of rehabilitation, but evaluating the effects of the LBPP on gait, balance and fall risk in patients with DPN has not been thoroughly investigated. AIM: The aim of this study was to evaluate the effect of LBPP treadmill training program on task-oriented gait, balance performance and fall risk in patients with DPN. DESIGN: Single-blinded, randomized-controlled trial. SETTING: Rehabilitative outpatient unit. POPULATION: Sixty-two patients with DPN were randomly assigned into 5-groups; group-A (100% weight-bearing; N.=12), group-B (75% weight-bearing; N.=13), group-C (50% weight-bearing; N.=13), group-D (25% weight-bearing; N.=12) and group-E (control group; N.=12). METHODS: The intervention groups (A, B, C, D) received moderate intensity aerobic exercise training (AET) program (30-45 minutes, 50-70% heart rate reserve) on the AlterG (AlterG, Inc., Fremont, CA, USA) treadmill for 12-weeks. Task-oriented gait, balance performance and the fall risk were evaluated at baseline (evaluation-1), after 12-weeks (evaluation-2) and 12-weeks poststudy cessation (evaluation-3; follow-up) for all groups using the Tinetti balance assessment tool. RESULTS: At evaluation-2, there were significant “within-groups” increases in the balance, gait and fall risk scores. There were significant “between-groups” differences in the same evaluated variables, with the highest increases were in group-B (P

In an aging society, the incidence of sacral fragility fractures is increasing and diagnosis is often delayed. Immobilization has devastating consequences especially in elderly patients. Short-term mobilization of these patients is crucial. The aim of this study is to evaluate the early return to mobility of immobilized geriatric patients with sacral fragility fractures treated with minimally invasive lumbopelvic stabilization. Retrospective analysis of thirteen consecutive patients (13 females) which could not be mobilized with conservative treatment, and thus were treated with minimally invasive lumbopelvic stabilization. Pain intensity measurement on an 11-point Numeric Rating Scale (NRS), Tinetti Mobility Test (TMT), and Timed Up and Go Test (TUGT) were performed preoperatively and 4 weeks postoperatively. Surgical and medical complications were analyzed. Mean age at surgery was 83.92 ± 6.27 years and mean ASA score was 2.77 ± 0.42. NRS improved from a mean of 7.18 ± 0.98 preoperatively to a mean of 2.45 ± 0.93 4 weeks postoperatively (Ρ

Objectives To evaluate the effects of a home-based disability prevention program on life-space and falls efficacy among low-income older adults. Design Single-blind two-arm randomized controlled trial. Setting Participants' homes. Participants Participants were low-income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life-space (n = 194) and falls efficacy (n = 233) varied as the life-space measure was introduced 4 months after the trial began. Intervention Up to six 1-hour home visits with an occupational therapist; up to four 1-hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months. Measurements Life-space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10-item Tinetti Falls Efficacy Scale at baseline and 5 months. Results Participants were on average 75 years old, predominantly Black (86%) and female (85%-86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life-space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20-12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05-6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34-12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01-5.73), and overall life-space (adjusted OR = 2.15; 95% CI = 1.10-4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04-1.21). Conclusion Life-space and falls efficacy were improved through a multicomponent, person-directed, home-based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging.

Background Exercise interventions designed to improve physical function and reduce sedentary behaviour in haemodialysis (HD) patients might improve exercise capacity, reduce fatigue and lead to improved quality of life (QOL). The PrEscription of intraDialytic exercise to improve quAlity of Life study aimed to evaluate the effectiveness of a 6-month intradialytic exercise programme on QOL and physical function, compared with usual care for patients on HD in the UK. Methods We conducted a prospective, pragmatic multicentre randomized controlled trial in 335 HD patients and randomly (1:1) assigned them to either (i) intradialytic exercise training plus usual care maintenance HD or (ii) usual care maintenance HD. The primary outcome of the study was the change in Kidney Disease Quality of Life Short Form (KDQOL-SF 1.3) Physical Component Score between baseline and 6 months. Additional secondary outcomes included changes in peak aerobic capacity, physical fitness, habitual physical activity levels and falls (International Physical Activity Questionnaire, Duke’s Activity Status Index and Tinetti Falls Efficacy Scale), QOL and symptom burden assessments (EQ5D), arterial stiffness (pulse wave velocity), anthropometric measures, resting blood pressure, clinical chemistry, safety and harms associated with the intervention, hospitalizations and cost-effectiveness. A nested qualitative study investigated the experience and acceptability of the intervention for both participants and members of the renal health care team. Results At baseline assessment, 62.4% of the randomized cohort were male, the median age was 59.3 years and 50.4% were white. Prior cerebrovascular events and myocardial infarction were present in 8 and 12% of the cohort, respectively, 77.9% of patients had hypertension and 39.4% had diabetes. Baseline clinical characteristics and laboratory data for the randomized cohort were generally concordant with data from the UK Renal Registry. Conclusion The results from this study will address a significant knowledge gap in the prescription of exercise interventions for patients receiving maintenance HD therapy and inform the development of intradialytic exercise programmes both nationally and internationally. Trial Registration ISRCTN N83508514; registered on 17 December 2014.

The purpose of this study was to review the current evidence on the effectiveness of exercise therapy on gait function in patients with diabetic peripheral neuropathy. A comprehensive search of literature published between October 2010 and May 2020 was conducted using the following electronic databases; PubMed, AMED, CINAHL, ScienceDirect, Cochrane Library, PEDro and Google Scholar. Randomized control trials conducted to determine the effectiveness of exercise therapy on gait function in patients with diabetic neuropathy were included in this review. Non-English language published papers were excluded. This review was done in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extraction and risk of bias assessment of the studies were carried out independently by two authors. The methodological quality of the studies was evaluated using the PEDro scale and GRADE approach. The overall methodological quality of studies rated from moderate to high. Meta-analysis was not carried out due to the heterogeneity of included trials. The primary outcome measures of gait functions were the six-minute walk test, 10-meter walk test and Tinetti scale. Nine randomized controlled trials with 370 participants were analyzed. Out of them, eight studies proved its effectiveness on gait function on individuals with diabetic peripheral neuropathy. The finding of this study suggested that multi-component exercise therapy consisted of strength, ROM exercise, balance, flexibility and stretching exercises, circuit exercise training, and gait training found to enhance gait function for individuals suffering with diabetic peripheral neuropathy compared to control groups.