Anne Shumway-Cook
Publications
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A review of dual-task walking deficits in people with Parkinson's disease: motor and cognitive contributions, mechanisms, and clinical implications.
Parkinson's disease. 01/2012; 2012:918719.
Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or car... [more] Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or carrying an object. The consequences of gait impairments in PD are significant and include increased disability, increased fall risk, and reduced quality of life. However, effective therapeutic interventions for dual-task walking deficits are limited. The goals of this narrative review are to describe dual-task walking deficits in people with PD, to discuss motor and cognitive factors that may contribute to these deficits, to review potential mechanisms underlying dual-task deficits, and to discuss the effect of therapeutic interventions on dual-task walking deficits in persons with PD.
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2.08Impact points
Participation in community walking following stroke: subjective versus objective measures and the impact of personal factors.
Physical therapy. 12/2011; 91(12):1865-76.
Mobility, specifically community walking, is important, but often limited among survivors of stroke. The factors that influence the recovery of community walking are not clearly understood. The purpose of this research was to examine mobility disability following stroke, specifically: (1) the associ... [more] Mobility, specifically community walking, is important, but often limited among survivors of stroke. The factors that influence the recovery of community walking are not clearly understood. The purpose of this research was to examine mobility disability following stroke, specifically: (1) the association between subjective and objective measures of participation in community walking and (2) the association between personal factors and participation in community walking. A cross-sectional study design was used. Fifty community-dwelling survivors of stroke, aged 50 to 79 years, were enrolled in the study. Participation in community walking was measured subjectively (perceived difficulty and satisfaction) and objectively using self-report data (number of trips and walking-related activities) and step data (pedometer). The association between subjective and objective measures of participation was analyzed using Pearson correlation. The association of personal factors (age, sex, number of comorbidities, fatigue, depression, balance and fall self-efficacy, and importance of walking) with measures of participation was analyzed using multiple linear regression. Subjective and objective measures of participation were weakly associated. Self-efficacy was the only personal factor that was strongly associated with both subjective and objective measures of participation. Personal factors explained 27% to 55% of the variability in participation in community walking. Limitations included a small sample size and limited diversity among participants. Reliability of the pedometer used in this study has not been established in the stroke population. Subjective and objective measures of participation in community walking were only weakly correlated, suggesting that they measure different aspects of mobility; thus, to fully capture participation, it is critical to measure both. Personal factors were associated with subjective and objective measures of participation and are important in explaining variability in community walking following stroke.
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2.08Impact points
Understanding falls in multiple sclerosis: association of mobility status, concerns about falling, and accumulated impairments.
Physical therapy. 12/2011; 92(3):407-15.
Background Falls in people with multiple sclerosis (MS) are a serious health concern, and the percentage of people who restrict their activity because of concerns about falling (CAF) is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in ... [more] Background Falls in people with multiple sclerosis (MS) are a serious health concern, and the percentage of people who restrict their activity because of concerns about falling (CAF) is not known. Mobility function and accumulated impairments are associated with fall risk in older adults but not in people with stroke and have not been studied in people with MS. Objective The purposes of this study were: (1) to estimate the percentage of people who have MS and report falling, CAF, and activity restrictions related to CAF; (2) to examine associations of these factors with fall status; and (3) to explore associations of fall status with mobility function and number of accumulated impairments. Design A cross-sectional survey was conducted. /b> A total of 575 community-dwelling people with MS provided information about sociodemographics, falls, CAF, activity restrictions related to CAF, mobility function, and accumulated impairments. Chi-square statistics were used to explore associations among these factors. /b> In all participants, about 62% reported CAF and about 67% reported activity restrictions related to CAF. In participants who did not experience falls, 25.9% reported CAF and 27.7% reported activity restrictions related to CAF. Mobility function was associated with fall status; participants reporting moderate mobility restrictions reported the highest percentage of falls, and participants who were nonwalkers (ie, had severely limited self-mobility) reported the lowest percentage. Falls were associated with accumulated impairments; the participants who reported the highest percentage of 2 or more falls were those with 10 impairments. Limitations This cross-sectional study relied on self-reported falls, mobility, and impairment status, which were not objectively verified. /b> Both CAF and activity restrictions related to CAF were common in people with MS and were reported by people who experienced falls and those who did not. The association of fall status with mobility function did not appear to be linear. Fall risk increased with declining mobility function; however, at a certain threshold, further declines in mobility function were associated with fewer falls, possibly because of reduced fall risk exposure.
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0.08Impact points
Falls in multiple sclerosis.
PM & R : the journal of injury, function, and rehabilitation. 07/2011; 3(7):624-32; quiz 632.
To examine incidence, associated factors, and health care provider (HCP) response to falls in persons with multiple sclerosis (MS). Cross-sectional retrospective design. Community setting. Four hundred seventy-four persons with MS. Mailed survey questionnaire examined incidence, risk factors, and HC... [more] To examine incidence, associated factors, and health care provider (HCP) response to falls in persons with multiple sclerosis (MS). Cross-sectional retrospective design. Community setting. Four hundred seventy-four persons with MS. Mailed survey questionnaire examined incidence, risk factors, and HCP response to falls in persons with MS who were dwelling in the community. Univariate and multiple ordinal regression analysis identified variables associated with single and multiple falls. Falls, causes and perceived reasons for falls, and HCP response. A total of 265 participants (58.2%) reported one or more falls in the previous 6 months, and 58.5% of falls were medically injurious. Trips/slips while walking accounted for 48% of falls. Factors associated with falls included use of a cane or walker (odds ratio [OR] 2.62; 95% confidence interval [CI] 1.66-4.14), income <$25,000 (OR 1.85; 95% CI 1.13-3.04), balance problems (OR 1.28; 95% CI 1.11-1.49), and leg weakness (OR 1.26; 95% CI 1.09-1.46). Fifty-one percent of those who fell (135/265) reported speaking to an HCP about their falls; recommended strategies included safety strategies (53.2%), use of gait assistive devices (42.1%), exercise/balance training (22.2%), and home modifications (16.6%). Factors associated with falls in persons with MS are similar to those in other populations with neurologic diseases. Despite the high incidence of falls, fewer than 50% of people with MS receive information about prevention of falls from an HCP.
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A translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based fall prevention exercise and education program.
Health promotion practice. 12/2010; 12(6):832-9.
Falls in older adults are the leading cause of injury hospitalizations and fatalities in the United States; primary risk factors are muscle weakness, impaired mobility, and balance deficits. This article describes the 12-month translational research evaluation of the Stay Active and Independent for ... [more] Falls in older adults are the leading cause of injury hospitalizations and fatalities in the United States; primary risk factors are muscle weakness, impaired mobility, and balance deficits. This article describes the 12-month translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based public health, public domain fall prevention exercise and education program. Recruitment reached the target goal by 154%; 331 adults (mean age = 74.6) attended more than one class (mean classes attended = 24.8, SD = 26.6, range = 1-120) at nine community sites in one county in the 12-month period; 173 completed health and demographic forms, 132 completed program surveys, and 91 completed baseline and follow-up physical function tests. Physical function test results showed significant improvements in strength, balance, and mobility in those who were below normal limits at baseline, and in those who attended classes twice a week or more for more than 2 months. Survey results found that 93% of respondents reported improved performance of daily activities; 92% reported improved strength, balance, fitness, or flexibility; and 80% found the SAIL information guide education component helpful.
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1.56Impact points
Understanding physical factors associated with participation in community ambulation following stroke.
Disability and rehabilitation. 10/2010; 33(12):1033-42.
This study examined the association between impaired physical function and participation in community ambulation following stroke. We hypothesised that participation would be significantly less following stroke, and that physical impairments would be associated with participation. Using a case-contr... [more] This study examined the association between impaired physical function and participation in community ambulation following stroke. We hypothesised that participation would be significantly less following stroke, and that physical impairments would be associated with participation. Using a case-control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation (number of trips and walking-related activities (WRA) reported prospectively over a 12-day period). The association of physical impairments (strength, range of motion, sensation, muscle tone, vision, and activity limitations (gait speed and performance on complex walking tasks)) with level of participation was analysed using negative binomial regression and goodness of fit. Participants included 30 individuals with and 30 without stroke, average age 68 years, majority were Caucasian women. Average time since stroke was 40 months. Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction (p < 0.001). Usual gait speed, balance, muscle strength and muscle length were impaired (p < 0.001) in stroke vs. controls, and associated with number of trips and WRA (p < 0.05). However, these factors explained less than very little of the variance in participation. While individual factors were associated with level of participation, results failed to accurately predict participation in community ambulation following stroke. Other factors, such as depression, cognition and self-efficacy may be stronger determinants of participation.
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2.26Impact points
Effects of instructed focus and task difficulty on concurrent walking and cognitive task performance in healthy young adults.
Experimental brain research. Experimentelle Hirnforschung. Expérimentation cérébrale. 10/2010; 207(1-2):65-73.
Dual task paradigms can be used to examine the interactions between cognition and the control of posture and gait. Measuring and interpreting changes in dual task performance is challenging, however, because many factors can influence performance. This study examined the effects of instructed focus ... [more] Dual task paradigms can be used to examine the interactions between cognition and the control of posture and gait. Measuring and interpreting changes in dual task performance is challenging, however, because many factors can influence performance. This study examined the effects of instructed focus and walking task difficulty, and the interaction between these factors, on dual task performance in healthy young adults. Fifteen participants performed a cognitive task while walking with either a usual base or a narrow base of support. Participants were instructed to focus on either the cognitive task or walking. Trade-offs both within and between tasks were assessed using the modified attention allocation index and the performance operating characteristic. Instructed focus influenced both the cognitive task and walking. Performance on the cognitive task was faster with instructions to focus on the cognitive task, and walking was faster (and more accurate in the narrow-base condition) with instructions to focus on walking. Walking task difficulty did not affect cognitive performance but did affect walking, with faster walking in the usual-base versus narrow-base condition. There was evidence of an interaction, with greater effects of instructed focus on the cognitive task during usual versus narrow-base walking. These results support the idea that the ability to flexibly shift attention allocation and task performance in response to instructions depends on the difficulty of the postural control task. The modified attention allocation index and the performance operating characteristic were instrumental in fully characterizing trade-offs between and within tasks in order to understand dual task performance changes. A clearer understanding of the factors that affect dual task walking and the interactions between these factors has important implications for the assessment of dual task performance in both clinical and research settings.
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1.56Impact points
Assessing the effects of subthalamic nucleus stimulation on gait and mobility in people with Parkinson disease.
Disability and rehabilitation. 10/2009;
Purpose. To determine the effects of unilateral and bilateral subthalamic nucleus (STN) stimulation on gait and mobility in persons with Parkinson disease (PD). Method. We examined eight individuals with advanced PD who underwent staged stimulator implantation surgeries. Gait and mobility were asses... [more] Purpose. To determine the effects of unilateral and bilateral subthalamic nucleus (STN) stimulation on gait and mobility in persons with Parkinson disease (PD). Method. We examined eight individuals with advanced PD who underwent staged stimulator implantation surgeries. Gait and mobility were assessed in the medication-on state with a variety of clinical and laboratory measures (Unified Parkinson Disease Rating Scale items, Timed Up and Go Test, gait speed) at three time points: prior to surgery, after the first surgery (unilateral stimulation) and after the second surgery (bilateral stimulation). Results. Despite overall improvements in motor function and reduction of dyskinesia, there were no significant group effects of unilateral or bilateral stimulation on gait and mobility compared to pre-surgical function. However, there were clinically meaningful changes, both improvements and declines, at the individual level. Conclusions. Because of the consequences of gait deficits and mobility limitations for people with PD, future research should examine the effects of STN stimulation on gait in the medication-on state using sensitive and specific measures such as gait speed. Accurate assessment of gait changes is necessary to improve the evaluation of STN effects and the prediction of individuals in need of rehabilitation services to manage gait and mobility deficits.
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2.18Impact points
Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial.
Archives of physical medicine and rehabilitation. 03/2009; 90(3):381-7.
OBJECTIVE: To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment. DESIGN: A double-blind, randomized controlled trial. SETTING: University research laboratory. PARTICIPANTS: Older adults (N=23) with balance impair... [more] OBJECTIVE: To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment. DESIGN: A double-blind, randomized controlled trial. SETTING: University research laboratory. PARTICIPANTS: Older adults (N=23) with balance impairment (mean age, 74.8y). They scored 52 or less on the Berg Balance Scale (BBS) and/or walked with a self-selected gait speed of 1.1m/s or less. INTERVENTIONS: Participants were randomly assigned to 1 of 3 interventions: single-task training, dual-task training with fixed-priority instructions, and dual-task training with variable-priority instructions. Participants received 45-minute individualized training sessions, 3 times a week for 4 weeks. MAIN OUTCOME MEASURES: Gait speed under single-task and dual-task conditions was obtained at baseline, the second week, the end of training, and the twelfth week after the end of training. Other measures, including the BBS and the Activities-specific Balance Confidence (ABC) Scale, were collected at baseline and after training. RESULTS: Participants in all groups improved on the BBS (P<.001; effect size [ES]=.72), and walked significantly faster after training (P=.02; ES=.27). When a cognitive task was added, however, only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed (P<.001, ES=.57; and P<.001, ES=.46, respectively). In addition, only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up. Only the single-task training group showed a significant increase on the ABC after training (P<.001; ES=.61). CONCLUSIONS: Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect.
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2.08Impact points
Falls in the Medicare Population: Incidence, Associated Factors, and Impact on Health Care.
Physical therapy. 03/2009;
BACKGROUND AND PURPOSE:/b> Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider re... [more] BACKGROUND AND PURPOSE:/b> Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries. Participants The participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS). METHODS:/b> Categories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data. RESULTS: /b> Population estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, "fallers" consistently had larger utilization costs than "nonfallers" for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information. DISCUSSION AND CONCLUSION::/b> Falls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.
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2.58Impact points
Training-related changes in dual-task walking performance of elderly persons with balance impairment: A double-blind, randomized controlled trial.
Gait & posture. 02/2009;
The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to understand the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment. Elderly individuals with balance impairment, ... [more] The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to understand the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment. Elderly individuals with balance impairment, age 65 and older, were randomly assigned to one of three individualized training programs: single-task (ST) balance training; dual-task training with fixed-priority (FP) instruction; and dual-task training with variable-priority (VP) instruction. Balance control during gait, under practiced and novel conditions, was assessed by calculating the center of mass and ankle joint center inclination angles in the frontal plane. A smaller angle indicated better balance performance. Other outcomes included gait velocity, stride length, verbal reaction time, and rate of response. All measures were collected at baseline and the end of the 4-week training. Results indicated that all training strategies were equally effective (P>.05) at improving balance performance (smaller inclination angle) under single-task contexts. However, the VP training strategy was more effective (P=.04) in improving both balance and cognitive performance under dual-task conditions than either the ST or the FP training strategies. Improved dual-task processing skills did not transfer to a novel dual-task condition. Results support Kramer et al.'s proposal that VP training improves both single-task automatization and the development of task-coordination skills.
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3.08Impact points
Age-associated effects of a concurrent cognitive task on gait speed and stability during narrow-base walking.
The journals of gerontology. Series A, Biological sciences and medical sciences. 12/2008; 63(12):1329-34.
BACKGROUND: In older adults, changes in speed and stability during walking are associated with impaired balance and increased fall risk. Narrow-base walking requires increased frontal plane stability and can be used to assess postural control while walking. Performance of a concurrent cognitive task... [more] BACKGROUND: In older adults, changes in speed and stability during walking are associated with impaired balance and increased fall risk. Narrow-base walking requires increased frontal plane stability and can be used to assess postural control while walking. Performance of a concurrent cognitive task (dual task) may further increase the complexity of walking, potentially allowing identification of individuals with instability that is not detected under single-task conditions. The purpose of this study was to examine age-associated effects of a cognitive task on speed and frontal plane stability during narrow-base walking. METHODS: Thirty-four healthy adults participated, categorized by age: <65, 65-74, and >/=75 years. Participants walked at a comfortable pace within a narrow path under both single- and dual-task conditions. We examined spatiotemporal variables and frontal plane center of mass (CoM) parameters using a 13-segment biomechanical model. RESULTS: Increasing age (p <.001) and the performance of a concurrent cognitive task (p <.001) were both associated with decreased speed, with no interaction between these factors. Frontal plane CoM displacement and velocity increased with increasing age (both p <.001), but dual-task performance had no effect on these variables (both p >.450). CONCLUSIONS: Age-associated changes in both speed and stability are observed during narrow-base walking. Among this sample of healthy older adults, the addition of a concurrent cognitive task resulted in reduced speed, with no effect on frontal plane stability. Further research is needed to determine if dual-task, narrow-base walking is a sensitive and specific approach to identifying older adults at risk for falls.
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2.18Impact points
Managing activity difficulties at home: a survey of Medicare beneficiaries.
Archives of physical medicine and rehabilitation. 08/2008; 89(7):1256-61.
OBJECTIVE: To describe assistance from helpers and use of assistive technology and environmental modification by community-dwelling people with difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). DESIGN: Cross-sectional study using the 2004 Medicare... [more] OBJECTIVE: To describe assistance from helpers and use of assistive technology and environmental modification by community-dwelling people with difficulties in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). DESIGN: Cross-sectional study using the 2004 Medicare Current Beneficiary Survey. SETTING: Community. PARTICIPANTS: Nationally representative sample of 14,500 Medicare beneficiaries (mean age, 71.5 y; 55% female; 49% currently married; 68% living with others; 84% white). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported difficulty with ADLs and IADLs; uses of help, assistive technology, and/or environmental modification. RESULTS: Difficulties were reported most frequently for heavy housework, walking, and shopping; money management, shopping, and light housework were reported as activities most often needing a helper. Walking, bathing, and toileting were activities most often needing uses of assistive technology. Bathroom modifications were the most commonly reported environmental modification. Results from a logistic regression showed that advancing age was the primary factor associated with increasing use of helpers and assistive technology or both for difficult activities. CONCLUSIONS: Uses of helpers, assistive technology, and environmental modification are common but vary by type of ADL and/or IADL and age. Focused studies regarding uses of help and access to assistive technology and environmental modification appear needed to support community living. Public education about methods and types of accommodations appears needed and may substitute for or augment guidance from care providers.
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2.18Impact points
A longitudinal evaluation of persons with disabilities: does a longitudinal definition help define who receives necessary care?
Archives of physical medicine and rehabilitation. 07/2008; 89(6):1023-30.
OBJECTIVE: To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators. DESIGN: Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient'... [more] OBJECTIVE: To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators. DESIGN: Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient's disability status in activities of daily living (ADLs). Assessment of the health care indicators commenced after the second interview and continued throughout the survey period (an additional 1-3y). SETTING: National survey. PARTICIPANTS: Participants (N=29,074) of the Medicare Current Beneficiary Survey (1992-2001) with no, increasing, decreasing, and stable ADL disability. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The incidence of 5 avoidable outcomes, receipt of 3 preventive care measures, and adherence to 32 diagnostically based indicators assessing the quality of treatment for acute myocardial infarction [AMI], angina, breast cancer, cerebrovascular accident, transient ischemic attack, cholelithiasis, chronic obstructive pulmonary disease [COPD], congestive heart failure, depression, gastrointestinal bleeding, diabetes, and hypertension. RESULTS: For most indicators, less than 75% of eligible patients received necessary care, regardless of disability status. For 5 indicators, less than 50% of patients received appropriate treatment. In a logistic regression analysis that controlled for patient age, sex, race, and income, disability status was a significant factor in 7 quality measures (AMI, breast cancer, COPD, diabetes, angina, pneumonia, annual visits). CONCLUSIONS: Using a longitudinal definition of disability and objective health quality indicators, we found that disability status can be an important factor in determining receipt of quality health care in a broad range of diagnostic categories. However, the impact of disability status varies depending on the indicator measured. In this cohort of patients, the changing nature of a person's disability seems to have less impact than whether they ever have had any functional deficits.
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3.66Impact points
Minority disparities in disability between Medicare beneficiaries.
Journal of the American Geriatrics Society. 04/2008; 56(3):444-53.
OBJECTIVES: To examine racial and ethnic disparities in mobility limitation, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in older adults enrolled in Medicare. DESIGN: Longitudinal national survey. PARTICIPANTS: Community-dwelling respondents in the Medicare... [more] OBJECTIVES: To examine racial and ethnic disparities in mobility limitation, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in older adults enrolled in Medicare. DESIGN: Longitudinal national survey. PARTICIPANTS: Community-dwelling respondents in the Medicare Current Beneficiaries Survey from 1992 to 2004 (10,180-16,788 respondents per year). MEASUREMENTS: Disability-related outcomes included mobility limitation, difficulty in six ADLs and six IADLs. Explanatory variables included age, sex, racial or ethnic group, living situation, and income level. RESULTS: From 1992 to 2004, proportions of Medicare beneficiaries with mobility limitations were stable across racial and ethnic groups, improving slightly for ADLs and IADLs. Blacks reported more limitations in all three disability-related measures. In a longitudinal analysis, the probability of developing mobility limitation was consistently higher for blacks, followed by white Hispanics, white non-Hispanics, and Asians, after adjusting for age, sex, socioeconomic status, and living situation. For ADL and IADL difficulties, the number of reported difficulties increased with age for all ethnic and racial groups. At approximately age 75, Asians and white Hispanics reported difficulties with much higher numbers of ADLs and IADLs than the other groups. CONCLUSION: Across all ethnic and racial groups, self-reported disability has declined in the past decade, but even after adjusting for age, sex, socioeconomic status, and living situation, racial and ethnic disparities in disability outcomes persist. Race and ethnicity may influence the reporting of disability, potentially affecting measures of prevalence. Further research is needed to understand whether these differences are a result of perceptions related to disablement or true differences in disability between racial and ethnic groups.
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2.58Impact points
The effects of age on medio-lateral stability during normal and narrow base walking.
Gait & posture. 04/2008;
We examined age-related differences in frontal plane stability during performance of narrow base (NB) walking relative to usual gait. A cross-sectional analysis of participants from the Baltimore Longitudinal Study of Aging (BLSA) was performed on data from the BLSA Motion Analysis Laboratory. Parti... [more] We examined age-related differences in frontal plane stability during performance of narrow base (NB) walking relative to usual gait. A cross-sectional analysis of participants from the Baltimore Longitudinal Study of Aging (BLSA) was performed on data from the BLSA Motion Analysis Laboratory. Participants were 34 adults aged 54-92 without history of falls. We measured step error rates during NB gait and spatial-temporal parameters, frontal plane stability, and gait variability during usual and NB gait. There was a non-significant age-associated linear increase in step error rate (P=0.12) during NB gait. With increasing age, step width increased (P=0.002) and step length and stride velocity decreased (P<0.001), especially during NB gait. Age-associated increases in medio-lateral (M-L) center of mass (COM) peak velocity (P<0.001) and displacement (P=0.005) were also greater during NB compared to usual gait. With increasing age there was greater variability in stride velocity (P=0.001) and step length (P<0.001) under both conditions. Age-associated differences related to M-L COM stability suggest that the quantification of COM control during NB gait may improve identification of older persons at increased falls risk.
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2.08Impact points
Locomotor training using body-weight support on a treadmill in conjunction with ongoing physical therapy in a child with severe cerebellar ataxia.
Physical therapy. 02/2008; 88(1):88-97.
BACKGROUND AND PURPOSE: This case report describes the effects of locomotor training using body-weight support (BWS) on a treadmill and during overground walking on mobility in a child with severe cerebellar ataxia who was nonambulatory. To date, no studies have examined the efficacy of this interve... [more] BACKGROUND AND PURPOSE: This case report describes the effects of locomotor training using body-weight support (BWS) on a treadmill and during overground walking on mobility in a child with severe cerebellar ataxia who was nonambulatory. To date, no studies have examined the efficacy of this intervention in people with cerebellar ataxia. CASE DESCRIPTION: The patient was a 13-year-old girl who had a cerebellar/brainstem infarct 16 months before the intervention. Her long-term goal was to walk independently in her home with a walker. INTERVENTION: Locomotor training using a BWS system both on the treadmill and during overground walking was implemented 5 days a week for 4 weeks in a clinic. Locomotor training using BWS on a treadmill was continued 5 days a week for 4 months at home. OUTCOMES: Prior to training, she was able to take steps on her own with the help of another person, but did not take full weight on her feet or walk on a regular basis. At 6 months, she walked for household distances. Prior to training, her Pediatric Functional Independence Measure scores were 3 (moderate assistance) for all transfers, 2 (maximal assistance) for walking, and 1 (total assistance) for stairs. At 6 months, her scores were 6 (modified independence) for transfers, 5 (supervision) for walking, and 4 (minimal assistance) for stairs. Prior to training, she was unable to take independent steps during treadmill walking; at 6 months, all of her steps were unassisted. DISCUSSION AND CONCLUSION: Locomotor training using BWS on a treadmill in conjunction with overground gait training may be an effective way to improve ambulatory function in individuals with severe cerebellar ataxia, but the intensity and duration of training required for functionally significant improvements may be prolonged.
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3.08Impact points
Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: a randomized, controlled trial.
The journals of gerontology. Series A, Biological sciences and medical sciences. 01/2008; 62(12):1420-7.
OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors (balance, lower extremity strength, and mobility) in community-living older adults. METHODS: Four hundred fifty-three sedentary adults (65 years old or older) w... [more] OBJECTIVE: The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors (balance, lower extremity strength, and mobility) in community-living older adults. METHODS: Four hundred fifty-three sedentary adults (65 years old or older) were randomized to either a multifaceted intervention (3 times a week group exercise, 6 hours of fall prevention education, comprehensive falls risk assessment results sent to primary health care provider) or control group (written materials on falls prevention). Primary outcome was fall incidence rates calculated from self-reported falls reported monthly for 12 months. Secondary outcomes were tests of leg strength, balance, and mobility prior to and following the 12-month intervention. RESULTS: Twelve-month follow-up was completed on 95% of participants. Intent-to-treat analysis found that the incidence rate of falls was 25% lower among those in the intervention group compared with control group (1.33 vs 1.77 falls/person-year, rate ratio 0.75, 95% confidence interval [CI], 0.52-1.09). This difference was not statistically significant. The risk ratio for any fall was 0.96 (95% CI, 0.82-1.13). Small but significant improvements were found on the Berg Balance Test (adjusted mean difference +1.5 points, 95% CI, 0.8-2.3), the Chair Stand Test (adjusted mean difference +1.2, 95% 0.6-1.9), and the Timed Up and Go Test (adjusted mean difference -0.7, 95% CI, -1.2 to -0.2). CONCLUSIONS: A community-based multifaceted intervention was effective in improving balance, mobility, and leg strength, all known fall risk factors. Although the incidence of falls was lower, the confidence interval included the possibility of no intervention effect on falls.
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4.01Impact points
Staged unilateral versus bilateral subthalamic nucleus stimulator implantation in Parkinson disease.
Movement disorders : official journal of the Movement Disorder Society. 08/2007; 22(10):1476-81.
In 17 consecutive patients with Parkinson disease (PD), bilateral subthalamic nucleus (STN) stimulators were implanted during staged surgeries. The Unified Parkinson Disease Rating Scale (UPDRS) and the Dyskinesia Disability Scale were completed both off and on medication prior to any surgery and al... [more] In 17 consecutive patients with Parkinson disease (PD), bilateral subthalamic nucleus (STN) stimulators were implanted during staged surgeries. The Unified Parkinson Disease Rating Scale (UPDRS) and the Dyskinesia Disability Scale were completed both off and on medication prior to any surgery and also OFF and ON stimulation after each surgery. On-medication UPDRS activities of daily living (ADL) and motor examination scores changed little with unilateral or bilateral stimulation. Off-medication UPDRS motor examination scores improved to similar degrees after each staged STN electrode implantation. Most of the improvements in off-medication ADL scores, dyskinesia scores, complications of therapy, and medication dose reduction occurred after unilateral STN stimulation with smaller improvements after the second operation.
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2.18Impact points
Association of mobility limitations with health care satisfaction and use of preventive care: a survey of Medicare beneficiaries.
Archives of physical medicine and rehabilitation. 06/2007; 88(5):583-8.
OBJECTIVE: To examine the association between satisfaction with health care, the use of preventive health care, and mobility limitation. DESIGN: Cross-sectional analysis of survey data. SETTING: Community. PARTICIPANTS: A total of 12,769 people, age greater than 65, who participated in the 2001 Medi... [more] OBJECTIVE: To examine the association between satisfaction with health care, the use of preventive health care, and mobility limitation. DESIGN: Cross-sectional analysis of survey data. SETTING: Community. PARTICIPANTS: A total of 12,769 people, age greater than 65, who participated in the 2001 Medicare Current Beneficiary Survey. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-report of mobility limitation, satisfaction, and use of preventive health care (immunizations, cancer screening). Sampling weights were used in all analyses, including logistic regression for survey data, to calculate estimates for a Medicare population of 31 million. RESULTS: After controlling for sociodemographic characteristics, Medicare beneficiaries with mobility limitations were significantly more dissatisfied with their health care compared with beneficiaries without mobility limitations. Receipt of preventive care did not differ for those with and without mobility limitation on some preventive services. CONCLUSIONS: Mobility limitation is highly associated with dissatisfaction with health care among older adult beneficiaries. Although Medicare beneficiaries may receive similar rates of preventive care, those with mobility limitation may have more difficulty accessing services and be more dissatisfied with their health care in general.
Following (2)
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Rajal Cohen
Oregon Health & Science University -
Fay Horak
Oregon Health & Science University
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