A Comparison of Straight- and Curved-Path Walking Tests Among Mobility-Limited Older Adults.
ABSTRACT BACKGROUND: Habitual gait speed (HGS) and the figure-of-8 walking test (F8WT) are measures of walking ability that have been associated with mobility outcomes and disability among older adults. Our objective was to contrast the physiologic, health, and behavioral attributes underlying performance of these two walking tests among older adults with mobility limitations. METHODS: HGS and F8WT were the primary outcomes. HGS was measured as time needed to walk a 4-m straight course at usual pace from standstill position. F8WT was measured as time to walk in a figure-of-8 pattern at self-selected usual pace from standstill position. Separate multivariable linear regression models were constructed that predicted walking performance. Independent variables included physiologic, cognitive-behavioral health attributes, and demographic information. RESULTS: Of 430 participants, 414 completed both walking tests. Participants were 67.7% female, had a mean age of 76.5±7.0 years and a mean of 4.1±2.0 chronic conditions. Mean HGS was 0.94±0.23 m/s and mean F8WT was 8.80±2.90 seconds. Within separate multivariable linear regression models (HGS: R (2) = .46, p model < .001; F8WT: R (2) = .47, p model < .001), attributes statistically significant within both models included: trunk extension endurance, ankle range of motion, leg press velocity at peak power, executive function, and sensory loss. Cognitive and physiologic attributes uniquely associated with F8WT were cognitive processing speed and self-efficacy, and reaction time and heel-to-floor time. Pain and peak leg press strength were associated with only HGS. CONCLUSIONS: Both HGS and F8WT are useful tests of walking performance. Factors uniquely associated with F8WT suggest that it may be well suited for use among older adult patients with balance problems or at risk for falls.
SourceAvailable from: Andrea Giordano[Show abstract] [Hide abstract]
ABSTRACT: Turning involves complex reorientation of the body and is accompanied by asymmetric motion of the lower limbs. We investigated the distribution of the forces under the two feet, and its relation to the trajectory features and body medio-lateral displacement during curved walking. Twenty-six healthy young participants walked under three different randomized conditions: in a straight line (LIN), in a circular clockwise path and in a circular counter-clockwise path. Both feet were instrumented with Pedar-X insoles. An accelerometer was fixed to the trunk to measure the medio-lateral inclination of the body. We analyzed walking speed, stance duration as a percent of gait cycle (%GC), the vertical component of the ground reaction force (vGRF), of both feet during the entire stance, and trunk inclination. Gait speed was faster during LIN than curved walking, but not affected by the direction of the curved trajectory. Trunk inclination was negligible during LIN, while the trunk was inclined toward the center of the path during curved trajectories. Stance duration of LIN foot and foot inside the curved trajectory (Foot-In) was longer than for foot outside the trajectory (Foot-Out). vGRF at heel strike was larger in LIN than in curved walking. At mid-stance, vGRF for both Foot-In and Foot-Out was higher than for LIN foot. At toe off, vGRF for both Foot-In and Foot-Out was lower than for LIN foot; in addition, Foot-In had lower vGRF than Foot-Out. During curved walking, a greater loading of the lateral heel occurred for Foot-Out than Foot-In and LIN foot. On the contrary, a smaller lateral loading of the heel was found for Foot-In than LIN foot. At the metatarsal heads, an opposite behaviour was seen, since lateral loading decreased for Foot-Out and increased for Foot-In. The lower gait speed during curved walking is may be shaped by the control of trunk inclination and the production of asymmetric loading of heel and metatarsal heads, hence by the different contribution of the feet in producing the body inclination towards the centre of the trajectory.Journal of NeuroEngineering and Rehabilitation 01/2015; 12(1):4. DOI:10.1186/1743-0003-12-4 · 2.62 Impact Factor
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ABSTRACT: Background: Patients with Parkinson's disease (PD) suffer from impaired gait and mobility. These changes in motor function have been associated with cognitive deficits that also commonly co-occur in PD, especially executive function (EF) and attention. Objective: We hypothesized that a cognitive remediation program would enhance gait and mobility. Methods: The 18 PD patients in this study were assessed at baseline and again at one and four weeks after completion of a 12 week long, home-based computerized cognitive training program. Subjects were asked to "play" computer games designed to improve EF and attention for 30 minutes a day, three times per week for 12 weeks, while seated. The Timed Up and Go (TUG), gait speed, and stride time variability quantified mobility. A previously validated, computerized neuropsychology battery quantified global cognitive function and its sub-domains. Results: Compared to pre-training values, global cognitive scores and time to complete the TUG significantly improved after the training. TUG components of turning speed and duration also improved. Other TUG components, gait speed, and variability did not change after training. Conclusions: These initial findings suggest that computerized cognitive training can improve cognitive function and has a beneficial carryover effect to certain aspects of mobility in patients with PD. Additional studies are required to replicate these findings and more fully assess the underlying mechanisms. Nonetheless, the present results underscore the motor-cognitive link in PD and suggest that computerized cognitive training may be applied as a therapeutic option to enhance mobility in patients with PD.12/2013; 4(1). DOI:10.3233/JPD-130321
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ABSTRACT: The prevalence of mild cognitive impairment (MCI) and mobility limitations is high among older adults. The aim of this study was to investigate the association between MCI status and both performance-based and self-report measures of mobility in community-dwelling older adults. An analysis was conducted on baseline data from the Boston Rehabilitative Impairment Study in the Elderly study, a cohort study of 430 primary care patients aged 65 or older. Neuropsychological tests identified participants with MCI and further subclassified those with impairment in memory domains (aMCI), nonmemory domains (naMCI), and multiple domains (mdMCI). Linear regression models were used to assess the association between MCI status and mobility performance in the Habitual Gait Speed, Figure of 8 Walk, Short Physical Performance Battery, and self-reported Late Life Function and Disability Instrument's Basic Lower Extremity and Advanced Lower Extremity function scales. Participants had a mean age of 76.6 years, and 42% were characterized with MCI. Participants with MCI performed significantly worse than participants without MCI (No-MCI) on all performance and self-report measures (p < .01). All MCI subtypes performed significantly worse than No-MCI on all mobility measures (p < .05) except for aMCI versus No-MCI on the Figure of 8 Walk (p = .054) and Basic Lower Extremity (p = .11). Moreover, compared with aMCI, mdMCI manifested worse performance on the Figure of 8 Walk and Short Physical Performance Battery, and naMCI manifested worse performance on Short Physical Performance Battery and Basic Lower Extremity. Among older community-dwelling primary care patients, performance on a broad range of mobility measures was worse among those with MCI, appearing poorest among those with nonmemory MCI.The Journals of Gerontology Series A Biological Sciences and Medical Sciences 05/2014; DOI:10.1093/gerona/glu063 · 4.98 Impact Factor